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Kossadoum RF, Baron A, Parizot M, Husain M, Poey N, Maurin M, Caspar Y, Caseris M, Bidet P, Bonacorsi S. Tularemia in Pediatric Patients: A Case Series and Review of the Literature. Pediatr Infect Dis J 2024:00006454-990000000-01024. [PMID: 39312633 DOI: 10.1097/inf.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Unfamiliar to pediatricians, tularemia can lead to delays in diagnosis and hinder appropriate treatment, as its clinical presentation often shares similarities with other more prevalent causes of lymphadenopathy diseases in children. We conducted a comprehensive literature review to offer contemporary insights into the clinical manifestations and treatment strategies for tularemia infection in children. METHODS Three cases of glandular tularemia were diagnosed in the Pediatric Robert Debré Hospital (Paris) between October 2020 and February 2022. In addition, we conducted a literature search using PubMed in December 2023 of cases of tularemia in children published in English. RESULTS The 94 cases of the literature review highlight the large age range (from 6 weeks to 17 years) and multiple sources of infection, including diverse zoonotic transmission (86.7%) and contact with contaminated water (13.3%). Fever was a consistent symptom. Ulceroglandular (46.7%), glandular (17%) and oropharyngeal forms (18.1%) predominated. The most frequently used diagnostic method was serology (60.6%). The median time to diagnosis for tularemia was 23.5 days. Hospitalization was required in 63.2% of cases, with a median duration of 4 days. Targeted treatment was based on aminoglycosides (37.6%), fluoroquinolones (30.6%) or tetracyclines (12.9%), in accordance with WHO recommendations, with a mainly favorable outcome, although several cases of meningitis were observed. CONCLUSION Pediatricians should be aware of the etiology of this febrile lymphadenopathy, notably when experiencing beta-lactam treatment failure, even in young infants, which could help reduce the extra costs associated with inappropriate antibiotic use and hospitalization.
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Affiliation(s)
- Remadji Fiona Kossadoum
- From the Equipe Opérationnelle d'Infectiologie, Service de Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Audrey Baron
- Laboratoire de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Marie Parizot
- From the Equipe Opérationnelle d'Infectiologie, Service de Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Maya Husain
- From the Equipe Opérationnelle d'Infectiologie, Service de Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Nora Poey
- From the Equipe Opérationnelle d'Infectiologie, Service de Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Max Maurin
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, CHU Grenoble Alpes - Grenoble, France
- Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Yvan Caspar
- Centre National de Référence des Francisella, Laboratoire de Bactériologie-Hygiène Hospitalière, CHU Grenoble Alpes - Grenoble, France
- Université Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France
| | - Marion Caseris
- From the Equipe Opérationnelle d'Infectiologie, Service de Pédiatrie Générale, Hôpital Robert Debré, AP-HP, Paris, France
| | - Philippe Bidet
- Laboratoire de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Cité, IAME, UMR1137, INSERM, Paris, France
| | - Stephane Bonacorsi
- Laboratoire de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Cité, IAME, UMR1137, INSERM, Paris, France
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Kara SS, Polat M, Erdeniz EH, Donmez AS. Pediatric Oropharyngeal Tularemia Cases: Challenges in Management. Vector Borne Zoonotic Dis 2024; 24:585-590. [PMID: 38651622 DOI: 10.1089/vbz.2023.0076] [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] [Indexed: 04/25/2024] Open
Abstract
Background: Tularemia is one of the most prevalent zoonoses across the world. Patients in Turkiye mostly contract the oropharyngeal form, acquired through drinking, or contact with microorganism-contaminated water. Methods: Patients with oropharyngeal tularemia aged under 18 years and diagnosed between January 01, 2017, and December 31, 2020, were evaluated retrospectively. Tularemia was diagnosed in patients with compatible histories, symptoms, clinical presentations, and laboratory test results. Results: The mean age of 38 children was 12.1 ± 3.4 years, and the female/male ratio was 0.58 (14/24). The mean duration of symptoms on admission was 33.8 ± 26.2 days. All children had enlarged lymph nodes. Malaise, fever, and loss of appetite were other frequent symptoms. Patients were treated with antibiotics for a mean of 26.2 ± 18.8 days. Gentamycin was the most frequently used antibiotic (either alone or in combination) (n = 29, 76.3%). Twenty-six (68.4%) patients underwent surgical procedures in addition to antibiotherapy. Five (13.2%) required secondary total excision. Patients with higher leukocyte counts at admission received a combination of antibiotherapy plus surgery, rather than antibiotics alone. No relapses, reretreatment requirement, or mortality were observed after 12 months of follow-up. Conclusions: Oropharyngeal tularemia in children can require longer courses of antibiotic treatment with more than one drug and more frequent surgery than previously suggested in the literature, especially if the patients are admitted late to the hospital, symptom duration is prolonged, and appropriate treatment is initiated late. Higher leukocyte counts on admission may be prognostic for longer antibiotic treatment course and suppurative complications that require surgery. Raising awareness among patients and physicians is essential.
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Affiliation(s)
- Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Aydin Adnan Menderes University, Aydin, Turkiye
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
| | - Meltem Polat
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
- Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkiye
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
- Department of Pediatric Infectious Diseases, Samsun Ondokuz Mayis University, Samsun, Turkiye
| | - Ayşe Sena Donmez
- Department of Pediatrics, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
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Maurin M, Pondérand L, Hennebique A, Pelloux I, Boisset S, Caspar Y. Tularemia treatment: experimental and clinical data. Front Microbiol 2024; 14:1348323. [PMID: 38298538 PMCID: PMC10827922 DOI: 10.3389/fmicb.2023.1348323] [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: 12/02/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Tularemia is a zoonosis caused by the Gram negative, facultative intracellular bacterium Francisella tularensis. This disease has multiple clinical presentations according to the route of infection, the virulence of the infecting bacterial strain, and the underlying medical condition of infected persons. Systemic infections (e.g., pneumonic and typhoidal form) and complications are rare but may be life threatening. Most people suffer from local infection (e.g., skin ulcer, conjunctivitis, or pharyngitis) with regional lymphadenopathy, which evolve to suppuration in about 30% of patients and a chronic course of infection. Current treatment recommendations have been established to manage acute infections in the context of a biological threat and do not consider the great variability of clinical situations. This review summarizes literature data on antibiotic efficacy against F. tularensis in vitro, in animal models, and in humans. Empirical treatment with beta-lactams, most macrolides, or anti-tuberculosis agents is usually ineffective. The aminoglycosides gentamicin and streptomycin remain the gold standard for severe infections, and the fluoroquinolones and doxycycline for infections of mild severity, although current data indicate the former are usually more effective. However, the antibiotic treatments reported in the literature are highly variable in their composition and duration depending on the clinical manifestations, the age and health status of the patient, the presence of complications, and the evolution of the disease. Many patients received several antibiotics in combination or successively. Whatever the antibiotic treatment administered, variable but high rates of treatment failures and relapses are still observed, especially in patients treated more then 2-3 weeks after disease onset. In these patients, surgical treatment is often necessary for cure, including drainage or removal of suppurative lymph nodes or other infectious foci. It is currently difficult to establish therapeutic recommendations, particularly due to lack of comparative randomized studies. However, we have attempted to summarize current knowledge through proposals for improving tularemia treatment which will have to be discussed by a group of experts. A major factor in improving the prognosis of patients with tularemia is the early administration of appropriate treatment, which requires better medical knowledge and diagnostic strategy of this disease.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Léa Pondérand
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Aurélie Hennebique
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Isabelle Pelloux
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
| | - Sandrine Boisset
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Yvan Caspar
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
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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.
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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
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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.
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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
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Tularemia: A rare cause of pediatric lymph nodes adenitis. Arch Pediatr 2021; 28:580-582. [PMID: 34511278 DOI: 10.1016/j.arcped.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/29/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
Adenopathy in pediatrics can have many different causes: infectious, tumoral, and inflammatory. We report the case of an 8-year-old patient with a febrile popliteal ulceration associated with an inflammatory satellite inguinal lymph node adenitis. Serological tests and polymerase chain reaction analyses confirmed the diagnosis of ulceroglandular tularemia. An appropriate antimicrobial therapy led to a full recovery. This case reminds us to consider tularemia as a potential emergent disease in children presenting with subacute to chronic lymphadenopathy and thereby to choose the correct diagnostic tool and appropriate antimicrobial therapy.
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Darmon-Curti A, Darmon F, Edouard S, Hennebique A, Guimard T, Martin-Blondel G, Klopfenstein T, Talarmin JP, Raoult D, Maurin M, Fournier PE. Tularemia: A Case Series of Patients Diagnosed at the National Reference Center for Rickettsioses From 2008 to 2017. Open Forum Infect Dis 2020; 7:ofaa440. [PMID: 33209946 PMCID: PMC7651688 DOI: 10.1093/ofid/ofaa440] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We describe the epidemiological, clinical, and prognostic aspects of 177 tularemia cases diagnosed at the National Reference Center for rickettsioses, coxiellosis, and bartonelloses between 2008 and 2017. METHODS All patients with a microbiological diagnosis of tularemia made in the laboratory were included. Clinical and epidemiological data were collected retrospectively from clinicians in charge of patients using a standardized questionnaire. Diagnostic methods used were indirect immunofluorescence serology, real-time polymerase chain reaction (PCR), and universal PCR targeting the 16S ribosomal ribonucleic acid gene. RESULTS The series included 54 females and 123 males (sex ratio, 2.28; mean age, 47.38 years). Eighty-nine (50.2%) were confirmed as having tularemia on the basis of a positive Francisella tularensis PCR or seroconversion, and 88 (49.8%) were considered as probable due to a single positive serum. The regions of France that were most affected included Pays de la Loire (22% of cases), Nouvelle Aquitaine (18.6% of cases), and Grand Est (12.4% of cases). Patients became infected mainly through contact with rodents or game (38 cases, 21.4%), through tick-bites (23 cases, 12.9%), or during outdoor leisure activities (37 cases, 20.9%). Glandular and ulceroglandular forms were the most frequent (109 cases, 61.5%). Two aortitis, an infectious endocarditis, a myocarditis, an osteoarticular infection, and a splenic hematoma were also diagnosed. Tularemia was discovered incidentally in 54.8% of cases. Seventy-eight patients were hospitalized, and no deaths were reported. CONCLUSIONS Our data suggest that in an endemic area and/or in certain epidemiological contexts, tularemia should be sought to allow an optimized antibiotic therapy and a faster recovery.
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Affiliation(s)
- Anne Darmon-Curti
- Aix Marseille University, Institut de Recherche pour le Developpement (IRD), MEPHI, Institut Hospitalo Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - François Darmon
- Laboratoire d'Informatique Gaspard-Monge (LIGM), Unité Mixte de Recherche (UMR) 8049, Ecole des Ponts ParisTech, UPE, Marne-la-Vallée, France
| | - Sophie Edouard
- Aix Marseille University, Institut de Recherche pour le Developpement (IRD), MEPHI, Institut Hospitalo Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Aurélie Hennebique
- Centre National de Référence des Francisella, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France
| | - Thomas Guimard
- Infectious Diseases and Emergency Department, Centre Hospitalier de La Roche sur Yon, La Roche-sur-Yon, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, Toulouse, France
- UMR INSERM/CNRS 1043, Centre de Physiopathologie Toulouse Purpan, Toulouse, France
| | | | - Jean-Philippe Talarmin
- Internal Medicine and Infectious Diseases Department, Centre Hospitalier de Cornouaille, Quimper, France
| | - Didier Raoult
- Aix Marseille University, Institut de Recherche pour le Developpement (IRD), MEPHI, Institut Hospitalo Universitaire (IHU)-Méditerranée Infection, Marseille, France
- Centre National de Référence des Rickettsia, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
| | - Max Maurin
- Centre National de Référence des Francisella, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, TIMC-IMAG, Grenoble, France
| | - Pierre-Edouard Fournier
- Centre National de Référence des Rickettsia, Coxiella et Bartonella, IHU-Méditerranée Infection, Marseille, France
- Aix Marseille University, IRD, Service de Santé des Armées, VITROME, IHU-Méditerranée Infection, Marseille, France
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Maurin M. Francisella tularensis, Tularemia and Serological Diagnosis. Front Cell Infect Microbiol 2020; 10:512090. [PMID: 33194778 PMCID: PMC7649319 DOI: 10.3389/fcimb.2020.512090] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Tularemia is a zoonotic disease caused by the bacterium Francisella tularensis. The predominant sources, routes of infection, and clinical manifestations of human infections greatly vary according to the geographic area considered. Moreover, clinical suspicion of tularemia is often tricky because of the lack of specificity of the clinical manifestations. Because F. tularensis isolation is tedious and detection of its DNA usually requires removal of infected tissues, serological techniques are most often used for diagnostic confirmation. However, these techniques are varied and poorly standardized. The microagglutination test (MAT), the indirect immunofluorescence assay (IFA), and ELISA tests are currently the most frequently used techniques. These home-made and commercial tests are mainly used for tularemia diagnosis but also seroprevalence studies. ELISA tests detect specific antibodies within two weeks of disease evaluation, compared to 2-3 weeks for MAT and IFA. However, more false-positive results are usually reported with ELISA. The long-term persistence of anti-F. tularensis antibodies in patients with past tularemia infection hampers the diagnostic specificity of all these tests. Also, cross-reacting antibodies have been described (especially with Brucella and Yersinia species), although usually at a low level. The immunoblotting technique can highlight these serological cross-reactions. Tularemia remains an underdiagnosed disease in most endemic areas, and the clinical presentations of this disease are evolving. It is necessary to improve further speed and accuracy of tularemia diagnosis, as well as the standardization of diagnostic procedures.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité Informatique-Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, Centre National de la Recherche Scientifique (CNRS), Grenoble, France
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Nemmour A, Bakri A, Fischer CA, Brand Y. Paediatric oropharyngeal tularaemia requiring surgical intervention. BMJ Case Rep 2019; 12:e229754. [PMID: 31494583 PMCID: PMC6731923 DOI: 10.1136/bcr-2019-229754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/04/2022] Open
Abstract
Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.
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Affiliation(s)
- Amina Nemmour
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Adzreil Bakri
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
| | - Claude A Fischer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- University Basel, Basel, Switzerland
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Karlı A, Şensoy G, Paksu Ş, Korkmaz MF, Ertuğrul Ö, Karlı R. Treatment-failure tularemia in children. KOREAN JOURNAL OF PEDIATRICS 2018; 61:49-52. [PMID: 29563944 PMCID: PMC5854842 DOI: 10.3345/kjp.2018.61.2.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/10/2017] [Accepted: 12/15/2017] [Indexed: 01/14/2023]
Abstract
Purpose Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10–14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.
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Affiliation(s)
- Arzu Karlı
- Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Gülnar Şensoy
- Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Şule Paksu
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | | | - Ömer Ertuğrul
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Rıfat Karlı
- Department of Otorhinolaryngology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Baggett MV, Gonzalez RG, Bhattacharyya RP, Mahowald MA. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 4-2016. A 58-Year-Old Woman with a Skin Ulcer, Fever, and Lymphadenopathy. N Engl J Med 2016; 374:573-81. [PMID: 26863359 DOI: 10.1056/nejmcpc1508550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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