1
|
Nagy KI, Pribelszki E, Sira Á, Fullajtár B, Rácz T, Major T. Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943915. [PMID: 38941282 PMCID: PMC11332965 DOI: 10.12659/ajcr.943915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 04/18/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Parinaud oculoglandular syndrome is a unilateral granulomatous palpebral conjunctivitis associated with preauricular, submandibular, and cervical lymphadenopathies. Several infectious diseases can cause Parinaud oculoglandular syndrome, usually with a conjunctival entry. The most common underlying pathology is cat scratch disease, followed by the oculoglandular form of tularemia. Diagnosis is usually a serious challenge as these infections are themselves rare. On the other hand, Parinaud oculoglandular syndrome may be a rare manifestation of more common disorders (eg, tuberculosis, syphilis, mumps, herpes simplex and Epstein-Barr virus, adenovirus, Rickettsia, Sporothrix, Chlamydia infections). CASE REPORT We present the case of a 66-year-old man with granulomatous conjunctivitis and ipsilateral preauricular, submandibular, and upper cervical lymphadenopathies following a superficial corneal injury. Although the systematic amoxicillin/clavulanic acid and metronidazole antibiotic therapy started immediately at admission, the suppuration of the lymph nodes required surgical drainage. Based on his anamnesis (sheep breeding; a twig scratching his eye 2 days before the initial attendance) and symptoms, a zoonosis, namely the oculoglandular form of tularemia, was suspected, empiric ciprofloxacin therapy was administered, and the patient recovered without sequelae. The Francisella tularensis infection was eventually confirmed by microagglutination serologic assay. CONCLUSIONS If Parinaud oculoglandular syndrome is diagnosed and cat scratch fever as the most common etiology is not likely, other zoonoses, especially the oculoglandular form of tularemia, should be suspected. Serology is the most common laboratory method of diagnosing tularemia. Empiric fluoroquinolone (ciprofloxacin) or aminoglycoside (gentamicin or streptomycin) antibiotic therapy should be started immediately at the slightest suspicion of oculoglandular tularemia.
Collapse
Affiliation(s)
- Kinga Ilona Nagy
- Department of Otorhinolaryngology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| | - Erzsébet Pribelszki
- Department of Otorhinolaryngology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| | - Ágnes Sira
- Department of Radiology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| | - Borbála Fullajtár
- Department of Pathology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| | - Tamás Rácz
- Department of Otorhinolaryngology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| | - Tamás Major
- Department of Otorhinolaryngology, Heves County Markhot Ferenc Teaching Hospital and Outpatient Clinic, Eger, Hungary
| |
Collapse
|
2
|
Herrera-Rodríguez D, Jareño-Moreno S, Buch-Cardona C, Mougeot F, Luque-Larena JJ, Vidal D. Water and mosquitoes as key components of the infective cycle of Francisella tularensis in Europe: a review. Crit Rev Microbiol 2024:1-15. [PMID: 38393764 DOI: 10.1080/1040841x.2024.2319040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Francisella tularensis is the pathogen of tularemia, a zoonotic disease that have a broad range of hosts. Its epidemiology is related to aquatic environments, particularly in the subspecies holarctica. In this review, we explore the role of water and mosquitoes in the epidemiology of Francisella in Europe. F. tularensis epidemiology has been linked to natural waters, where its persistence has been associated with biofilm and amebas. In Sweden and Finland, the European countries where most human cases have been reported, mosquito bites are a main route of transmission. F. tularensis is present in other European countries, but to date positive mosquitoes have not been found. Biofilm and amebas are potential sources of Francisella for mosquito larvae, however, mosquito vector capacity has not been demonstrated experimentally, with the need to be studied using local species to uncover a potential transmission adaptation. Transstadial, for persistence through life stages, and mechanical transmission, suggesting contaminated media as a source for infection, have been studied experimentally for mosquitoes, but their natural occurrence needs to be evaluated. It is important to clear up the role of different local mosquito species in the epidemiology of F. tularensis and their importance in all areas where tularemia is present.
Collapse
Affiliation(s)
- Daniel Herrera-Rodríguez
- Departamento de Microbiología, Facultad de Medicina, Universidad de Castilla la Mancha (UCLM), Ciudad Real, España
- Instituto de Investigación en Recursos Cinegéticos (IREC - CSIC, UCLM, JCCM), Ciudad Real, España
| | - Sara Jareño-Moreno
- Facultad de Veterinaria, Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Clara Buch-Cardona
- Facultad de Biociencias, Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - François Mougeot
- Instituto de Investigación en Recursos Cinegéticos (IREC - CSIC, UCLM, JCCM), Ciudad Real, España
| | - Juan José Luque-Larena
- Departamento de Ciencias Agroforestales, E.T.S. Ingenierías Agrarias, Universidad de Valladolid (UVa), Palencia, España
- Sustainable Forest Management Research Institute (iuFOR), Universidad de Valladolid (UVa), Palencia, España
| | - Dolors Vidal
- Departamento de Microbiología, Facultad de Medicina, Universidad de Castilla la Mancha (UCLM), Ciudad Real, España
| |
Collapse
|
3
|
Izbanova U, Lukhnova L, Sadovskaya V, Zhumadilova Z, Meka-Mechenko T, Shevtsov A, Baitursyn B, Turebekov N, Tukhanova N. Characterization of tularemia foci in the Republic of Kazakhstan from 2000 to 2020. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1291690. [PMID: 38456077 PMCID: PMC10910903 DOI: 10.3389/fepid.2024.1291690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
The wide distribution of tularemia in the territory of Kazakhstan is associated with landscape and geographical characteristics. This is explained by a combination of natural factors: the presence of certain types of rodents-reservoirs and sources, ectoparasites-carriers of the causative agent of tularemia. The study of the current spatial and temporal characterization of tularemia in Kazakhstan from 2000 to 2020 will determine the epidemiological status of tularemia and improve the monitoring system in Kazakhstan. In this work we demonstrated the results of a retrospective survey of natural foci of tularemia: analysis of vector, small mammal and human data. The spatial and temporal characteristics of tularemia from 2000 to 2020 in the territory of Kazakhstan were studied in comparison with historical data, including the description of tularemia outbreaks, the clinical picture, and the source of infection, transmission factors, and geographical coordinates of outbreak registration. Sampling was carried out by trapping rodents on snap traps and collecting ticks by rodent combing and by "flagging" methods. For the last 20 years, 85 human cases of tularemia have been reported. During the period from 2000 to 2020, more than 600 strains of F. tularensis were isolated from field rodents and ticks in the natural foci of tularemia. MLVA typing of F. tularensis strains isolated from natural foci of tularemia in Kazakhstan over the past 20 years. The results of retrospective monitoring indicate that currently active foci of tularemia include the Aktobe, West Kazakhstan, Almaty, East Kazakhstan, and Pavlodar regions. Low-activity natural foci are located in the territory of the Akmola, Karaganda, North Kazakhstan, Kostanay, Atyrau, Zhambyl, and Kyzylorda regions. There are no active natural foci of tularemia in the Mangystau and Turkestan regions. The widespread occurrence of tularemia in the country is associated with landscape and geographical features that contribute to the circulation of the pathogen in the natural focus. An analysis of natural foci of tularemia showed that it is necessary to continue monitoring studies of carriers and vectors for the presence of the causative agent of the F. tularensis, in order to prevent mass cases of human disease.
Collapse
Affiliation(s)
- U. Izbanova
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - L. Lukhnova
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - V. Sadovskaya
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - Z. Zhumadilova
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - T. Meka-Mechenko
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - A. Shevtsov
- National Center for Biotechnology, Astana, Kazakhstan
| | - B. Baitursyn
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - N. Turebekov
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| | - N. Tukhanova
- M.Aikimbayev’s National Scientific Center for Especially Dangerous Infections, Almaty, Kazakhstan
| |
Collapse
|
4
|
Sharma R, Patil RD, Singh B, Chakraborty S, Chandran D, Dhama K, Gopinath D, Jairath G, Rialch A, Mal G, Singh P, Chaicumpa W, Saikumar G. Tularemia - a re-emerging disease with growing concern. Vet Q 2023; 43:1-16. [PMID: 37916743 PMCID: PMC10732219 DOI: 10.1080/01652176.2023.2277753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
Tularemia caused by Gram-negative, coccobacillus bacterium, Francisella tularensis, is a highly infectious zoonotic disease. Human cases have been reported mainly from the United States, Nordic countries like Sweden and Finland, and some European and Asian countries. Naturally, the disease occurs in several vertebrates, particularly lagomorphs. Type A (subspecies tularensis) is more virulent and causes disease mainly in North America; type B (subspecies holarctica) is widespread, while subspecies mediasiatica is present in central Asia. F. tularensis is a possible bioweapon due to its lethality, low infectious dosage, and aerosol transmission. Small mammals like rabbits, hares, and muskrats are primary sources of human infections, but true reservoir of F. tularensis is unknown. Vector-borne tularemia primarily involves ticks and mosquitoes. The bacterial subspecies involved and mode of transmission determine the clinical picture. Early signs are flu-like illnesses that may evolve into different clinical forms of tularemia that may or may not include lymphadenopathy. Ulcero-glandular and glandular forms are acquired by arthropod bite or handling of infected animals, oculo-glandular form as a result of conjunctival infection, and oro-pharyngeal form by intake of contaminated food or water. Pulmonary form appears after inhalation of bacteria. Typhoidal form may occur after infection via different routes. Human-to-human transmission has not been known. Diagnosis can be achieved by serology, bacterial culture, and molecular methods. Treatment for tularemia typically entails use of quinolones, tetracyclines, or aminoglycosides. Preventive measures are necessary to avoid infection although difficult to implement. Research is underway for the development of effective live attenuated and subunit vaccines.
Collapse
Affiliation(s)
- Rinku Sharma
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Rajendra Damu Patil
- Department of Veterinary Pathology, DGCN College of Veterinary and Animal Sciences, CSK HPKV, Palampur, Himachal Pradesh, India
| | - Birbal Singh
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, R.K. Nagar, West Tripura, India
| | | | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Devi Gopinath
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Gauri Jairath
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Ajayta Rialch
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Gorakh Mal
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Putan Singh
- Disease Investigation Laboratory, ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, Himachal Pradesh, India
| | - Wanpen Chaicumpa
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - G. Saikumar
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| |
Collapse
|
5
|
Mehl C, Mätz-Rensing K, Linde J, Struve B, Ismer G, van Hümmel C, Ulrich RG, Tomaso H. Case report: tularaemia in a white-handed gibbon ( Hylobates lar), Germany. Int J Vet Sci Med 2023; 11:121-125. [PMID: 38125824 PMCID: PMC10732199 DOI: 10.1080/23144599.2023.2264084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/05/2023] [Indexed: 12/23/2023] Open
Abstract
In 2021, a white-handed gibbon (Hylobates lar) succumbed to illness shortly after transfer from one zoo to another in Germany, due to Francisella tularensis subsp. holarctica infection. To determine the source of infection, whole genome sequencing of the gibbon-derived isolate was performed and wild pest rodents (and captive squirrels) from both zoos were screened for F. tularensis. The F. tularensis whole genome sequence obtained from the gibbon was closely related to previous subclade B.281 sequences obtained from hares from Baden-Wuerttemberg, the same region where the gibbon was first housed. However, F. tularensis DNA was detected in one Norway rat from the receiving zoo. Therefore, neither zoo can be excluded as the source of infection.
Collapse
Affiliation(s)
- Calvin Mehl
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute of Novel and Emerging Infectious Diseases (INNT), Greifswald, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel- Riems, Greifswald, Germany
| | - Kerstin Mätz-Rensing
- German Primate Center GmbH (DPZ), Leibniz Institute for Primate Research, Göttingen, Germany
| | - Jörg Linde
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute for Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| | | | | | | | - Rainer G. Ulrich
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute of Novel and Emerging Infectious Diseases (INNT), Greifswald, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel- Riems, Greifswald, Germany
| | - Herbert Tomaso
- Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Institute for Bacterial Infections and Zoonoses (IBIZ), Jena, Germany
| |
Collapse
|
6
|
Mohammed RR, Enferadi A, Sidiq KR, Sarani S, Khademi P, Jaydari A, Ahmed AK. Molecular Detection of Francisella tularensis Isolated from Ticks of Livestock in Kurdistan Region, Iraq. Vector Borne Zoonotic Dis 2023; 23:514-519. [PMID: 37582218 DOI: 10.1089/vbz.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Francisella tularensis is a Gram-negative bacterium that causes tularemia in both human and animals. Tularemia is a potential serious zoonotic disease that is transmitted by different routes, including tick bites. Materials and Methods: This study deals with investigating the prevalence of F. tularensis in the ticks of local animal farms in Kurdistan region since the farmers are normally in close contact with livestock. We used molecular methods for this purpose. A total of 412 tick and 126 blood samples were gathered from goat, sheep, and cow flocks. The existence of F. tularensis 16Sr RNA gene was examined in the samples using nested-PCR technique. Results: In the animal blood specimens, no F. tularensis was found. The incidence of F. tularensis was 1.7% (7 out of 412) in the tick samples, representing a very lower possibility of tuleremia infection. Moreover, the two subspecies of F. tularensis novicida and holarctica were identified based on the sequencing of pdpD and RD genes, respectively. The F. tularensis subsp. novicida was isolated from four species of ticks, Hyalomma anatolicum, Rhipicephalus annulatus, Rhipicephalus sanguineus, and Ornithodoros spp., whereas the F. tularensis subsp. holarctica was isolated from Haemaphysalis parva and Hyalomma dromedarii species of ticks. Conclusion: Although its prevalence is very low, the isolation of F. tularensis subsp. holarctica from the ticks of farm animals suggests possible transmission of Tularemia through tick bite in Kurdistan region of Iraq. Ref: IR-UU-AEC-3/22.
Collapse
Affiliation(s)
- Rebin Rafaat Mohammed
- Department of Pathobiology, Faculty of Veterinary Medicine, Urmia University, West Azerbaijan, Iran
| | - Ahmad Enferadi
- Department of Microbiology, Faculty of Veterinary Medicine, Urmia University, West Azerbaijan, Iran
| | - Karzan R Sidiq
- Charmo Centre for Research, Training and Consultancy, Charmo University, Chamchamal, Iraq
| | - Saeedeh Sarani
- Department of Pathobiology, Faculty of Veterinary Medicine, Zabol University, Sistan and Balochistan, Iran
| | - Peyman Khademi
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran
| | - Amin Jaydari
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran
| | - Avin Kawa Ahmed
- Sulaimani Veterinary Directorate, Chamchamal Veterinary Hospital, Sulaimani, Iraq
| |
Collapse
|
7
|
Schepens N, Verniest T, Verstreken I, Henckaerts L. Francisella tularensis subsp. holarctica bacteraemia in an immunocompetent male. Respir Med Case Rep 2023; 45:101882. [PMID: 37334032 PMCID: PMC10275714 DOI: 10.1016/j.rmcr.2023.101882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Tularemia is a rare zoonotic disease caused by the two predominant subspecies of Francisella tularensis, namely subspecies tularensis and subspecies holarctica. The latter is less virulent than the former, is endemic in Europe, and usually has a mild disease course, although respiratory involvement and bacteraemia can occur. Tularemia in Belgium is rare, but the incidence seems to be increasing. It therefore seems prudent to raise awareness among clinicians for this potentially severe disease. We report the first case of pneumonic tularemia with bacteraemia from Belgium, and want to recommend including Francisella tularensis in the differential diagnosis of pneumonia when an unfavorable evolution is seen with standard treatment.
Collapse
Affiliation(s)
- Niels Schepens
- Department of General Internal Medicine, KU Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Thessa Verniest
- Department of Pneumology, Heilig Hart Hospital, Leuven, Belgium
| | | | - Liesbet Henckaerts
- Department of General Internal Medicine, KU Leuven-University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven-University of Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Pfeil J, Heuner K, Scholz H, Strozyk T, Jacob D. Ulkus und Lymphadenitis nach Zeckenstich. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
9
|
Borgschulte HS, Jacob D, Zeeh J, Scholz HC, Heuner K. Ulceroglandular form of tularemia after squirrel bite: a case report. J Med Case Rep 2022; 16:309. [PMID: 35974355 PMCID: PMC9381146 DOI: 10.1186/s13256-022-03510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. Tularemia can lead to massively swollen lymph nodes and might even be fatal without antibiotic treatment. To our knowledge, the case described here is the first report of the disease caused by a squirrel bite in Germany. Case presentation A 59-year-old German woman with a past medical history of hypothyroidism and cutaneous lupus erythematosus presented at the emergency room at St. Katharinen Hospital with ongoing symptoms and a swollen right elbow persisting despite antibiotic therapy with cefuroxime for 7 days after she had been bitten (right hand) by a wild squirrel (Eurasian red squirrel). After another 7 days of therapy with piperacillin/tazobactam, laboratory analysis using real-time polymerase chain reaction (PCR) confirmed the suspected diagnosis of tularemia on day 14. After starting the recommended antibiotic treatment with ciprofloxacin, the patient recovered rapidly. Conclusion This is the first report of a case of tularemia caused by a squirrel bite in Germany. A naturally infected squirrel has recently been reported in Switzerland for the first time. The number of human cases of tularemia has been increasing over the last years and, therefore, tularemia should be taken into consideration as a diagnosis, especially in a patient bitten by an animal who also presents with headache, increasing pain, lymphadenitis, and fever, as well as impaired wound healing. The pathogen can easily be identified by a specific real-time PCR assay of wound swabs and/or by antibody detection, for example by enzyme-linked immunosorbent assay (ELISA), if the incident dates back longer than 2 weeks.
Collapse
Affiliation(s)
- Hannah Sophia Borgschulte
- Department of Internal Medicine 2, St. Katharinen-Hospital, Kapellenstr. 1-5, 50226, Frechen, Germany
| | - Daniela Jacob
- Division of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany
| | - Jörg Zeeh
- Department of Internal Medicine 2, St. Katharinen-Hospital, Kapellenstr. 1-5, 50226, Frechen, Germany
| | - Holger C Scholz
- Division of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany
| | - Klaus Heuner
- Division of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
| |
Collapse
|
10
|
Troha K, Božanić Urbančič N, Korva M, Avšič-Županc T, Battelino S, Vozel D. Vector-Borne Tularemia: A Re-Emerging Cause of Cervical Lymphadenopathy. Trop Med Infect Dis 2022; 7:tropicalmed7080189. [PMID: 36006281 PMCID: PMC9412492 DOI: 10.3390/tropicalmed7080189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/16/2022] Open
Abstract
Tularemia is a zoonosis caused by the highly invasive bacterium Francisella tularensis. It is transmitted to humans by direct contact with infected animals or by vectors, such as ticks, mosquitos, and flies. Even though it is well-known as a tick-borne disease, it is usually not immediately recognised after a tick bite. In Slovenia, tularemia is rare, with 1–3 cases reported annually; however, the incidence seems to be increasing. Ulceroglandular tularemia is one of its most common forms, with cervical colliquative lymphadenopathy as a frequent manifestation. The diagnosis of tularemia largely relies on epidemiological information, clinical examination, imaging, and molecular studies. Physicians should consider this disease a differential diagnosis for a neck mass, especially after a tick bite, as its management significantly differs from that of other causes. Tularemia-associated lymphadenitis is treated with antibiotics and surgical drainage of the colliquated lymph nodes. Additionally, tularemia should be noted for its potential use in bioterrorism on behalf of the causative agents’ low infectious dose, possible aerosol formation, no effective vaccine at disposal, and the ability to produce severe disease. This article reviews the recent literature on tularemia and presents a case of an adult male with tick-borne cervical ulceroglandular tularemia.
Collapse
Affiliation(s)
- Kaja Troha
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| |
Collapse
|
11
|
Xu JH, Kang L, Yuan B, Feng ZH, Li SQ, Wang J, Wang YR, Xin WW, Gao S, Li JX, Sun YS, Wang JL, Yuan Y. Development and evaluation of a rapid RPA/CRISPR-based detection of Francisella tularensis. Front Microbiol 2022; 13:901520. [PMID: 36033876 PMCID: PMC9399789 DOI: 10.3389/fmicb.2022.901520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Francisella tularensis is a dangerous pathogen that causes an extremely contagious zoonosis in humans named tularemia. Given its low-dose morbidity, the potential to be fatal, and aerosol spread, it is regarded as a severe threat to public health. The US Centers for Disease Control and Prevention (CDC) has classified it as a category A potential agent for bioterrorism and a Tier 1 Select Agent. Herein, we combined recombinase polymerase amplification (RPA) with CRISPR/Cas12a system to select the F. tularensis target gene (TUL4), creating a two-pronged rapid and ultrasensitive diagnostic method for detecting F. tularensis. The real-time RPA (RT-RPA) assay detected F. tularensis within 10 min at a sensitivity of 5 copies/reaction, F. tularensis genomic DNA of 5 fg, and F. tularensis of 2 × 102 CFU/ml; the RPA-CRISPR/Cas12a assay detects F. tularensis within 40 min at a sensitivity of 0.5 copies/reaction, F. tularensis genomic DNA of 1 fg, and F. tularensis of 2 CFU/ml. Furthermore, the evaluation of specificity showed that both assays were highly specific to F. tularensis. More importantly, in a test of prepared simulated blood and sewage samples, the RT-RPA assay results were consistent with RT-PCR assay results, and the RPA-CRISPR/Cas12a assay could detect a minute amount of F. tularensis genomic DNA (2.5 fg). There was no nonspecific detection with blood samples and sewage samples, giving the tests a high practical application value. For example, in on-site and epidemic areas, the RT-RPA was used for rapid screening and the RPA-CRISPR/Cas12a assay was used for more accurate diagnosis.
Collapse
Affiliation(s)
- Jian-Hao Xu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Lin Kang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Bing Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Zi-Han Feng
- Department of Disease Control and Prevention, The No. 96609 Hospital of Chinese People's Liberation Army, Yinchuan, China
| | - Shi-Qing Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Jing Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Ya-Ru Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
| | - Wen-Wen Xin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Shan Gao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Jia-Xin Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
| | - Yan-Song Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- *Correspondence: Yan-Song Sun
| | - Jing-Lin Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
- Jing-Lin Wang
| | - Yuan Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing, China
- Yuan Yuan
| |
Collapse
|
12
|
Schöbi N, Agyeman PKA, Duppenthaler A, Bartenstein A, Keller PM, Suter-Riniker F, Schmidt KM, Kopp MV, Aebi C. PEDIATRIC TULAREMIA– A CASE SERIES FROM A SINGLE CENTER IN SWITZERLAND. Open Forum Infect Dis 2022; 9:ofac292. [PMID: 35873298 PMCID: PMC9301579 DOI: 10.1093/ofid/ofac292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of tularemia has recently increased throughout Europe. Pediatric tularemia typically presents with ulceroglandular or glandular disease and requires antimicrobial therapy not used in the empirical management of childhood acute lymphadenitis. We describe the clinical presentation and course in a case series comprising 20 patients. Methods This is a retrospective analysis of a single-center case series of microbiologically confirmed tularemia in patients <16 years of age diagnosed between 2010 and 2021. Results Nineteen patients (95%) presented with ulceroglandular (n = 14) or glandular disease (n = 5), respectively. A characteristic entry site lesion (eschar) was present in 14 (74%). Fever was present at illness onset in 15 patients (75%) and disappeared in all patients before targeted therapy was initiated. The diagnosis was confirmed by serology in 18 patients (90%). While immunochromatography was positive as early as on day 7, a microagglutination test titer 1:≥160 was found no earlier than on day 13. Sixteen patients (80%) were initially treated with an antimicrobial agent ineffective against F. tularensis. The median delay (range) from illness onset to initiation of targeted therapy was 12 (6–40) days. Surgical incision and drainage were ultimately performed in 12 patients (60%). Conclusions Pediatric tularemia in Switzerland usually presents with early, self-limiting fever and a characteristic entry site lesion with regional lymphadenopathy draining the scalp or legs. Particularly in association with a tick exposure history, this presentation may allow early first-line therapy with an agent specifically targeting F. tularensis, potentially obviating the need for surgical therapy.
Collapse
Affiliation(s)
- Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Philipp KA Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Andrea Duppenthaler
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Andreas Bartenstein
- Department of Pediatric Surgery, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Peter M Keller
- Institute for Infectious Diseases, University of Bern , Switzerland
| | | | - Kristina M Schmidt
- Spiez Laboratory, Federal Office for Civil Protection and Swiss National Reference Center for Francisella tularensis (NANT) , Spiez , Switzerland
| | - Matthias V Kopp
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
- 17 Center North (ARCN), Member of the German Lung Research Center (DZL) , 18 University of Luebeck , Germany
| | - Christoph Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| |
Collapse
|
13
|
Detection and Genotyping of Francisella tularensis in Animal Hosts and Vectors from Six Different Natural Landscape Areas, Gansu Province, China. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6820864. [PMID: 34961822 PMCID: PMC8710147 DOI: 10.1155/2021/6820864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Objective Tularemia, also known as hare fever, is caused by the bacterium Francisella tularensis (F. tularensis) transmitted through diseased wild animals, blood sucking insects, or contaminated water or food, which is distributed worldwide. The purpose of this study was to investigate F. tularensis infection in animal hosts and vectors from six different natural landscape areas in Gansu Province and to identify the genotypes of the detected F. tularensis. Methods Rodents were captured by snap traps, and ticks were collected by dragging a cloth over the vegetation or from domestic animals. After species identification, DNA was isolated from the captured animals and detected by nested PCR assays targeting the F. tularensis fopA gene. The positive samples were further amplified to discriminate the species, and another two short-sequence tandem repeat regions (SSTR) were amplified to identify their genotypes. All positive fragments were sequenced and analyzed by ClustalX (5.0) and DNAClub software. Results A total of 407 rodents of 12 species were captured, among which six rodent species were positive for F. tularensis, with an overall prevalence of 3.93%. The geographical difference in infection rate was statistically significant. At the SSTR9 locus, there were 7 genotypes among positive rodent samples. A total of 1864 ticks were tested for evidence of tularemia by nested PCR assays, 69 of which were positive, with an average positive rate of 3.70% for F. tularensis in ticks. The positive rates were significantly different among different regions. Seven genotypes were identified at the SSTR9 locus, one of which seemed dominant in positive tick samples. All positive samples had the same genotype at the SSTR16 locus. Conclusion There is natural infection of F. tularensis among animal vectors and hosts in Gansu Province, with diverse genotypes.
Collapse
|
14
|
Host Immunity and Francisella tularensis: A Review of Tularemia in Immunocompromised Patients. Microorganisms 2021; 9:microorganisms9122539. [PMID: 34946140 PMCID: PMC8707036 DOI: 10.3390/microorganisms9122539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/31/2023] Open
Abstract
Tularemia, caused by the bacterium Francisella tularensis, is an infrequent zoonotic infection, well known in immunocompetent (but poorly described in immunocompromised) patients. Although there is no clear literature data about the specific characteristics of this disease in immunocompromised patients, clinical reports seem to describe a different presentation of tularemia in these patients. Moreover, atypical clinical presentations added to the fastidiousness of pathogen identification seem to be responsible for a delayed diagnosis, leading to a” loss of chance” for immunocompromised patients. In this article, we first provide an overview of the host immune responses to Francisella infections and discuss how immunosuppressive therapies or diseases can lead to a higher susceptibility to tularemia. Then, we describe the particular clinical patterns of tularemia in immunocompromised patients from the literature. We also provide hints of an alternative diagnostic strategy regarding these patients. In conclusion, tularemia should be considered in immunocompromised patients presenting pulmonary symptoms or unexplained fever. Molecular techniques on pathological tissues might improve diagnosis with faster results.
Collapse
|
15
|
Fingerle V, Sing A. [Diseases transmitted by ticks]. MMW Fortschr Med 2021; 163:62-73. [PMID: 33950451 DOI: 10.1007/s15006-021-9802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Volker Fingerle
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstraße 2, 85764, Oberschleißheim, Germany.
| | - Andreas Sing
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| |
Collapse
|
16
|
Matz LM, Petrosino JF. A study of innate immune kinetics reveals a role for a chloride transporter in a virulent Francisella tularensis type B strain. Microbiologyopen 2021; 10:e1170. [PMID: 33970545 PMCID: PMC8483402 DOI: 10.1002/mbo3.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Tularemia is a zoonotic disease of global proportions. Francisella tularensis subspecies tularensis (type A) and holarctica (type B) cause disease in healthy humans, with type A infections resulting in higher mortality. Repeated passage of a type B strain in the mid-20th century generated the Live Vaccine Strain (LVS). LVS remains unlicensed, does not protect against high inhalational doses of type A, and its exact mechanisms of attenuation are poorly understood. Recent data suggest that live attenuated vaccines derived from type B may cross-protect against type A. However, there is a dearth of knowledge regarding virulent type B pathogenesis and its capacity to stimulate the host's innate immune response. We therefore sought to increase our understanding of virulent type B in vitro characteristics using strain OR96-0246 as a model. Adding to our knowledge of innate immune kinetics in macrophages following infection with virulent type B, we observed robust replication of strain OR96-0246 in murine and human macrophages, reduced expression of pro-inflammatory cytokine genes from "wild type" type B-infected macrophages compared to LVS, and delayed macrophage cell death suggesting that virulent type B may suppress macrophage activation. One disruption in LVS is in the gene encoding the chloride transporter ClcA. We investigated the role of ClcA in macrophage infection and observed a replication delay in a clcA mutant. Here, we propose its role in acid tolerance. A greater understanding of LVS attenuation may reveal new mechanisms of pathogenesis and inform strategies toward the development of an improved vaccine against tularemia.
Collapse
Affiliation(s)
- Lisa M. Matz
- The Alkek Center for Metagenomics and Microbiome ResearchBaylor College of MedicineHoustonTXUSA
- The Department of Molecular Virology and MicrobiologyBaylor College of MedicineHoustonTXUSA
- Baylor College of MedicineHoustonTXUSA
| | - Joseph F. Petrosino
- The Alkek Center for Metagenomics and Microbiome ResearchBaylor College of MedicineHoustonTXUSA
- The Department of Molecular Virology and MicrobiologyBaylor College of MedicineHoustonTXUSA
- Baylor College of MedicineHoustonTXUSA
| |
Collapse
|
17
|
Linde J, Homeier-Bachmann T, Dangel A, Riehm JM, Sundell D, Öhrman C, Forsman M, Tomaso H. Genotyping of Francisella tularensis subsp. holarctica from Hares in Germany. Microorganisms 2020; 8:microorganisms8121932. [PMID: 33291395 PMCID: PMC7761992 DOI: 10.3390/microorganisms8121932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023] Open
Abstract
Francisella tularensis is the causative agent of the zoonotic disease tularemia. In Germany, most human infections are caused by contact with infected hares. The aim of this study was to characterize Francisella tularensis subsp. holarctica strains isolated from hares in Germany and to develop bioinformatics tools to analyze their genetic relatedness. In total, 257 German isolates-obtained mainly from hares (n = 233), other vertebrate animals, and ticks, but also from humans (n = 3)-were analyzed within this study. Publically available sequence data from 49 isolates were used to put our isolates into an epidemiological context and to compare isolates from natural foci and humans. Whole-genome sequences were analyzed using core-genome Multi-Locus-Sequence-Typing, canonical Single Nucleotide Polymorphism (SNP) typing and whole-genome SNP typing. An overall conformity of genotype clustering between the typing methods was found, albeit with a lower resolution for canonical single SNP typing. The subclade distribution, both on local and national levels, among strains from humans and hares was similar, suggesting circulation of the same genotypes both in animals and humans. Whilst close to identical isolates of the same subclade were found distributed over large areas, small geographical foci often harbored members of different subclades. In conclusion, although genomic high-resolution typing was shown to be robust, reproducible and allowed the identification of highly closely related strains, genetic profiling alone is not always conclusive for epidemiological linkage of F. tularensis strains.
Collapse
Affiliation(s)
- Jörg Linde
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany;
- Correspondence: ; Tel.: +49-3641-804-2320
| | - Timo Homeier-Bachmann
- Institute of Epidemiology, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany;
| | - Alexandra Dangel
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, 85764 Oberschleißheim, Germany; (A.D.); (J.M.R.)
| | - Julia M. Riehm
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, 85764 Oberschleißheim, Germany; (A.D.); (J.M.R.)
| | - David Sundell
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), SE-901 82 Umeå, Sweden; (D.S.); (C.Ö.); (M.F.)
| | - Caroline Öhrman
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), SE-901 82 Umeå, Sweden; (D.S.); (C.Ö.); (M.F.)
| | - Mats Forsman
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), SE-901 82 Umeå, Sweden; (D.S.); (C.Ö.); (M.F.)
| | - Herbert Tomaso
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany;
| |
Collapse
|