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Background Tularemia is an important reemerging disease with a multimodal transmission pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden. Methods Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011 and 2021 were collected through review of electronic medical records and participant questionnaires; 415 of 784 accepted participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or polymerase chain reaction). A multivariable logistic regression model was used to investigate variables associated with retreatment. Results Median age of participants was 54 years (interquartile range [IQR], 41.5–65) and 49.2% were female. Although ulceroglandular tularemia was the predominant form (n = 215, 65.7%), there were several cases of pulmonary tularemia (n = 40; 12.2%). Inflammatory markers were largely nonspecific, with monocytosis frequently observed (n = 36/75; 48%). Tularemia was often misdiagnosed on presentation (n = 158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics and 102 (31.2%) retreated. Persistent lymphadenopathy was infrequent (n = 22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with retreatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR, 3.25–20.75] vs 7 [IQR, 4–11.25] days; adjusted P =.076), and doxycycline-based treatment regimen (vs ciprofloxacin; adjusted P =.084), although this was not significant after correction for multiple comparisons. Conclusions We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis, and timely commencement of treatment for an appropriate duration. [ABSTRACT FROM AUTHOR]

Background Fluoroquinolones lack approval for treatment of tularemia but have been used extensively for milder illness. Here, we evaluated fluoroquinolones for severe illness. Methods In an observational study, we identified case-patients with respiratory tularemia from July to November 2010 in Jämtland County, Sweden. We defined severe tularemia by hospitalization for >24 hours and severe bacteremic tularemia by Francisella tularensis subsp. holarctica growth in blood or pleural fluid. Clinical data and drug dosing were retrieved from electronic medical records. Chest images were reexamined. We used Kaplan–Meier curves to evaluate time to defervescence and hospital discharge. Results Among 67 case-patients (median age, 66 years; 81% males) 30-day mortality was 1.5% (1 of 67). Among 33 hospitalized persons (median age, 71 years; 82% males), 23 had nonbacteremic and 10 had bacteremic severe tularemia. Subpleural round consolidations, mediastinal lymphadenopathy, and unilateral pleural fluid were common on chest computed tomography. Among 29 hospitalized persons with complete outcome data, ciprofloxacin/levofloxacin (n = 12), ciprofloxacin/levofloxacin combinations with doxycycline and/or gentamicin (n = 11), or doxycycline as the single drug (n = 6) was used for treatment. One disease relapse occurred with doxycycline treatment. Treatment responses were rapid, with median fever duration 41.0 hours in nonbacteremic and 115.0 hours in bacteremic tularemia. Increased age-adjusted Charlson comorbidity index predicted severe bacteremic tularemia (odds ratio, 2.7 per score-point; 95% confidence interval, 1.35–5.41). A 78-year-old male with comorbidities and delayed ciprofloxacin/gentamicin treatment died. Conclusions Fluoroquinolone treatment is effective for severe tularemia. Subpleural round consolidations and mediastinal lymphadenopathy were typical findings on computed tomography among case-patients in this study. [ABSTRACT FROM AUTHOR]

Background Francisella tularensis , the causative agent of tularemia, is endemic throughout the Northern Hemisphere and requires as few as 10 organisms to cause disease, making this potential bioterrorism agent one of the most infectious bacterial pathogens known. Aminoglycosides, tetracyclines, and, more recently, fluoroquinolones are used for treatment of tularemia; however, data on the relative effectiveness of these and other antimicrobial classes are limited. Methods Nine databases, including Medline, Global Health, and Embase, were systematically searched for articles containing terms related to tularemia. Articles with case-level data on tularemia diagnosis, antimicrobial treatment, and patient outcome were included. Patient demographics, clinical findings, antimicrobial administration, and outcome (eg, intubation, fatality) were abstracted using a standardized form. Results Of the 8878 publications identified and screened, 410 articles describing 870 cases from 1993 to 2023 met inclusion criteria. Cases were reported from 35 countries; more than half were from the United States, Turkey, or Spain. The most common clinical forms were ulceroglandular, oropharyngeal, glandular, and pneumonic disease. Among patients treated with aminoglycosides (n = 452 [52%]), fluoroquinolones (n = 339 [39%]), or tetracyclines (n = 419 [48%]), the fatality rate was 0.7%, 0.9%, and 1.2%, respectively. Patients with pneumonic disease who received ciprofloxacin had no fatalities and the lowest rates of thoracentesis/pleural effusion drainage and intubation compared to those who received aminoglycosides and tetracyclines. Conclusions Aminoglycosides, fluoroquinolones, and tetracyclines are effective antimicrobials for treatment of tularemia, regardless of clinical manifestation. For pneumonic disease specifically, ciprofloxacin may have slight advantages compared to other antimicrobials. [ABSTRACT FROM AUTHOR]

Background Neuroinvasive infection with Francisella tularensis , the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. Methods We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. Results One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. Conclusions Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment. [ABSTRACT FROM AUTHOR]

Background Tularemia, a potentially fatal zoonosis caused by Francisella tularensis , has been reported from nearly all US states. Information on relative effectiveness of various antimicrobials for treatment of tularemia is limited, particularly for newer classes such as fluoroquinolones. Methods Data on clinical manifestations, antimicrobial treatment, and illness outcome of patients with tularemia are provided voluntarily through case report forms to the US Centers for Disease Control and Prevention by state and local health departments. We summarized available demographic and clinical information submitted during 2006–2021 and evaluated survival according to antimicrobial treatment. We grouped administered antimicrobials into those considered effective for treatment of tularemia (aminoglycosides, fluoroquinolones, and tetracyclines) and those with limited efficacy. Logistic regression models with a bias-reduced estimation method were used to evaluate associations between antimicrobial treatment and survival. Results Case report forms were available for 1163 US patients with tularemia. Francisella tularensis was cultured from a clinical specimen (eg, blood, pleural fluid) in approximately half of patients (592; 50.9%). Nearly three-quarters (853; 73.3%) of patients were treated with a high-efficacy antimicrobial. A total of 27 patients (2.3%) died. After controlling for positive culture as a proxy for illness severity, use of aminoglycosides, fluoroquinolones, and tetracyclines was independently associated with increased odds of survival. Conclusions Most US patients with tularemia received high-efficacy antimicrobials; their use was associated with improved odds of survival regardless of antimicrobial class. Our findings provide supportive evidence that fluoroquinolones are an effective option for treatment of tularemia. [ABSTRACT FROM AUTHOR]

Background Tularemia is caused by the gram-negative bacterium Francisella tularensis. Although rare, tularemia during pregnancy has been associated with pregnancy complications; data on efficacy of recommended antimicrobials for treatment are limited. We performed a systematic literature review to characterize clinical manifestations of tularemia during pregnancy and examine maternal, fetal, and neonatal outcomes with and without antimicrobial treatment. Methods We searched 9 databases, including Medline, Embase, Global Health, and PubMed Central, using terms related to tularemia and pregnancy. Articles reporting cases of tularemia with ≥1 maternal or fetal outcome were included. Results Of 5891 articles identified, 30 articles describing 52 cases of tularemia in pregnant patients met inclusion criteria. Cases were reported from 9 countries, and oropharyngeal and ulceroglandular tularemia were the most common presenting forms. A plurality (46%) of infections occurred in the second trimester. Six complications were observed: lymph node aspiration, lymph node excision, maternal bleeding, spontaneous abortion, intrauterine fetal demise, and preterm birth. No deaths among mothers were reported. Of 28 patients who received antimicrobial treatment, 1 pregnancy loss and 1 fetal death were reported. Among 24 untreated patients, 1 pregnancy loss and 3 fetal deaths were reported, including one where F. tularensis was detected in placental and fetal tissues. Conclusions Pregnancy loss and other complications have been reported among cases of tularemia during pregnancy. However, risk of adverse outcomes may be lower when antimicrobials known to be effective are used. Without treatment, transplacental transmission appears possible. These data underscore the importance of prompt recognition and treatment of tularemia during pregnancy. [ABSTRACT FROM AUTHOR]

Tularemia is a disease caused by Francisella tularensis , a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis , veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis , we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia. [ABSTRACT FROM AUTHOR]

Tularemia is caused by the highly infectious bacterium Francisella tularensis , which is recognized as a Tier 1 bioterrorism agent. Tularemia has a range of recognized clinical manifestations, but fewer than 20 bone or joint infections from 6 countries have been reported in the literature to date. This series includes 13 cases of F. tularensis septic arthritis or osteomyelitis in the United States during 2004–2023 and describes exposures, clinical presentation, diagnosis, and outcomes for this rare but severe form of tularemia. Clinicians should consider F. tularensis in patients with compatible exposures or a history of joint replacement or immunosuppression. [ABSTRACT FROM AUTHOR]

Background The incidence of pneumonic tularemia is very low; therefore, it is not feasible to conduct clinical efficacy testing of tularemia medical countermeasures (MCMs) in humans. The US Food and Drug Administration's Animal Model Qualification Program under the Drug Development Tools Program is a regulatory pathway for animal models used in MCM efficacy testing and approval under the Animal Rule. The National Institute of Allergy and Infectious Diseases and Biomedical Advanced Research and Development Authority worked together to qualify the cynomolgus macaque model of pneumonic tularemia. Methods Using the model parameters and end points defined in the qualified model, efficacy of the antibiotics doxycycline and ciprofloxacin was evaluated in separate studies. Antibiotic administration, aimed to model approved human dosing, was initiated at time points of 24 hours or 48 hours after onset of fever as an indicator of disease. Results Upon aerosol exposure (target dose of 1000 colony-forming units) to Francisella tularensis SchuS4, 80% of vehicle-treated macaques succumbed or were euthanized. Ciprofloxacin treatment led to 10 of 10 animals surviving irrespective of treatment time. Doxycycline administered at 48 hours post-fever led to 10 of 10 animals surviving, while 9/10 animals survived in the group treated with doxycycline 24 hours after fever. Selected surviving animals in both the placebo and doxycycline 48-hour group showed residual live bacteria in peripheral tissues, while there were no bacteria in tissues from ciprofloxacin-treated macaques. Conclusions Both doxycycline and ciprofloxacin were efficacious in treatment of pneumonic tularemia, although clearance of bacteria may be different between the 2 drugs. [ABSTRACT FROM AUTHOR]

The article focuses on the historical and ongoing threat posed by Francisella tularensis, a highly infectious pathogen causing tularemia. Topics discussed include the pathogen's infectious nature, its potential as a bioweapon, the changing epidemiology of tularemia, and the importance of preparedness, communication, and clear guidelines for responding to outbreaks.

Francisella tularensis is the causative agent of tularemia. We tested the susceptibility of 278 F. tularensis isolates from the United States received during 2009–2018 to 8 antimicrobial drugs (ciprofloxacin, levofloxacin, doxycycline, tetracycline, gentamicin, streptomycin, chloramphenicol, and erythromycin). All isolates were susceptible to all tested drugs. [ABSTRACT FROM AUTHOR]

A correction is presented to the article correcting an error in the proof publication of the Plymoth et al. study, where the second author was mistakenly listed as Robert Lundquist instead of Robert Lundqvist.

Whole-genome sequences of Francisella tularensis isolated from 10 patients involved in a respiratory tularemia outbreak were compared with 110 global archived isolates. Surprisingly, outbreak and archived isolates were often extremely similar despite sometimes great separation in time and/or space.Background. The bacterium Francisella tularensis is recognized for its virulence, infectivity, genetic homogeneity, and potential as a bioterrorism agent. Outbreaks of respiratory tularemia, caused by inhalation of this bacterium, are poorly understood. Such outbreaks are exceedingly rare, and F. tularensis is seldom recovered from clinical specimens.Methods. A localized outbreak of tularemia in Sweden was investigated. Sixty-seven humans contracted laboratory-verified respiratory tularemia. F. tularensis subspecies holarctica was isolated from the blood or pleural fluid of 10 individuals from July to September 2010. Using whole-genome sequencing and analysis of single-nucleotide polymorphisms (SNPs), outbreak isolates were compared with 110 archived global isolates.Results. There were 757 SNPs among the genomes of the 10 outbreak isolates and the 25 most closely related archival isolates (all from Sweden/Finland). Whole genomes of outbreak isolates were >99.9% similar at the nucleotide level and clustered into 3 distinct genetic clades. Unexpectedly, high-sequence similarity grouped some outbreak and archival isolates that originated from patients from different geographic regions and up to 10 years apart. Outbreak and archival genomes frequently differed by only 1–3 of 1 585 229 examined nucleotides.Conclusions. The outbreak was caused by diverse clones of F. tularensis that occurred concomitantly, were widespread, and apparently persisted in the environment. Multiple independent acquisitions of F. tularensis from the environment over a short time period suggest that natural outbreaks of respiratory tularemia are triggered by environmental cues. The findings additionally caution against interpreting genome sequence identity for this pathogen as proof of a direct epidemiological link. [ABSTRACT FROM AUTHOR]

Physicians must be vigilant in suspecting tularemia. Diagnostic sensitivity can be increased by collecting a pertinent exposure history and performing judicious laboratory testing. Further research should determine efficacy of fluoroquinolones for tularemia, preferably through a formal clinical trial.Background. Clinical recognition of tularemia is essential for prompt initiation of appropriate antibiotic treatment. Although fluoroquinolones have desirable attributes as a treatment option, limited data on efficacy in the US setting exist.Methods. To define the epidemiology of tularemia in Missouri, and to evaluate practices and outcomes of tularemia management in general, we conducted a detailed retrospective review and analysis of clinical records for patients reported to the state from 2000 to 2007.Results. We reviewed records of 121 of 190 patients (64%) reported with tularemia; 79 (65%) were males; the median age was 37 years. Most patients presented with ulceroglandular (37%) and glandular (25%) forms of tularemia, followed by pneumonic (12%), typhoidal (10%), oculoglandular (3%), and oropharyngeal (2%) forms. Most cases (69%) were attributed to tick bites. Median incubation period was 3 days (range, 1–9 days), and patients sought care after a median of 3 days of illness (range, 0–44 days). Systemic disease occurred more commonly in older patients. Patients were prescribed tetracyclines (49%), aminoglycosides (47%), and fluoroquinolones (41%). Nine of 10 patients treated with ciprofloxacin for ≥10 days recovered uneventfully, without accompanying aminoglycosides or tetracyclines.Conclusions. Tularemia is frequently initially misdiagnosed. A thorough exposure history, particularly for tick bites, and awareness of clinical features may prompt clinicians to consider tularemia and facilitate appropriate testing. Promising success with oral fluoroquinolones could provide an acceptable alternative to intravenous aminoglycosides or long courses of tetracyclines where clinically appropriate. [ABSTRACT FROM AUTHOR]

Background. Tularemia is an endemic but rare disease in France. We describe the epidemiologic, clinical, diagnostic, treatment, and prognostic aspects of the disease in 101 consecutive patients investigated during a 5-year period (2006-2010). Methods. All tularemia cases confirmed at the French Reference Center for Tularemia (FRCT) were included. Data were collected both at the Institut de Veille Sanitaire (mandatory notification) and FRCT. Diagnostic methods included serological tests (microagglutination and indirect immunofluorescence assay), Francisella tularensis cultures, real-time polymerase chain reaction (RT-PCR) tests, and molecular identification of the F. tularensis subspecies involved. Results. The patient cohort consisted of 55 men and 46 women (sex ratio, 1.2; average age, 51.7 years), including 93 sporadic cases that occurred throughout France. Contaminations occurred predominantly through contact with or ingestion of lagomorphs (31.7%), tick bites (10.9%), or contaminated environments (7.9%). The glandular and ulceroglandular forms predominated (57.5% of cases), but 18.8%of patients experienced a systemic disease and 29.7% were hospitalized. Specific diagnosis was mainly based on serology, but 38.6% of patients had positive RT-PCR tests and 20.8% had a positive culture. F. tularensis subspecies holarctica was identified in 25 patients. All patients except 1 recovered from infection, but 38.6% experienced relapses despite appropriate antibiotic therapy. Conclusions. The epidemiological and clinical aspects of tularemia in France are varied, suggesting different modes of contamination. The high rates of systemic diseases and hospitalization indicate that the more serious cases are more likely to be diagnosed and notified. RT-PCR tests may help to improve diagnosis and reporting of the disease. [ABSTRACT FROM AUTHOR]

Background. In the United States, tularemia is caused by Francisella tularensis subsps. tularensis (type A) and holarctica (type B). Molecular subtyping has further divided type A into 2 subpopulations, A1 and A2. Significant mortality differences were previously identified between human infections caused by A1 (14%), A2 (0%) and type B (7%). To verify these findings and to further define differences among genotypes, we performed a large-scale molecular epidemiologic analysis of F. tularensis isolates from humans and animals. Methods. Pulsed-field gel electrophoresis with PmeI was performed on 302 type A and 61 type B isolates. Pulsed-field gel electrophoresis pattern and epidemiologic analyses were performed. Logistic regression was used to assess factors associated with human mortality. Results. Pulsed-field gel electrophoresis typing identified 4 distinct type A genotypes, A1a, A1b, A2a, and A2b, as well as type B. Genotypic and geographic divisions observed among isolates from humans were mirrored among isolates from animals, specifically among animal species that are linked to human infection and to enzootic maintenance of tularemia. Significant differences between human infections caused by different genotypes were identified with respect to patient age, site of organism recovery, and mortality. Human infections due to A1b resulted in significantly higher mortality (24%) than those caused by A1a (4%), A2 (0%), and type B (7%). Conclusions. Three type A genotypes, A1a, A1b, and A2, were shown to be epidemiologically important. Our analysis suggests that A1b strains may be significantly more virulent in humans than A1a, A2, or type B strains. These findings have important implications for disease progression, disease prevention, and basic research programs. [ABSTRACT FROM AUTHOR]

Tularemia is an endemic zoonotic infection caused by Francisella tularensis, which primarily causes infection in humans who have handled contaminated animal tissue or have been bitten by infected arthropods. Because of its ease of dispersion and transmission and its high degree of infectivity, F. tularensis is also considered to be a bioterrorism agent. Consequently, there is renewed interest in the development of safe, effective measures, such as vaccines, to prevent the morbidity and mortality associated with aerosol exposure to F. tularensis. Current efforts, however, are hampered by the lack of an animal model that faithfully reproduces human infection. Employing a model of ‘induced human infection’ with aerosol administration of F. tularensis, Dr. Theodore E. Woodward and colleagues pioneered the clinical studies of tularemia vaccines that form the basis for current tularemia vaccine research. [ABSTRACT FROM AUTHOR]

Introduction. Live vaccine strain (LVS) Francisella tularensis is a live, attenuated investigational tularemia vaccine that has been used by the US Army for decades to protect laboratory workers. Postvaccination bacterial kinetic characteristics of LVS at the inoculation site and in the blood are unknown and, therefore, were assessed in a prospective study. LVS vaccination of laboratory workers provided the opportunity to compare culture with polymerase chain reaction (PCR) for the detection of F. tularensis in human clinical samples. Methods. Blood and skin swab samples were prospectively collected from volunteers who received the LVS tularemia vaccine at baseline (negative controls) and at 5 specified time points (days 1, 2, 7 or 8, 14 or 15, and 35 after vaccination). Bacterial culture and PCR of whole blood samples (17 volunteers) and inoculation site swabs (41 volunteers) were performed. Results. The culture and PCR results of all blood samples were negative. Results of real-time PCR from the inoculation site samples were positive for 41 (100%) of 41 volunteers on day 1, for 40 (97.6%) of 41 volunteers on day 2, for 24 (58.5%) of 41 on day 7 or 8, for 6 (16.7%) of 36 on day 14 or 15, and for 0 (0%) of 9 on day 35. Positive results of bacterial cultures of the inoculation site samples occurred significantly less frequently, compared with PCR testing, with 4 (9.8%) of 41 volunteers having positive results on day 1 ( P < .001) and 4 (9.8%) of 41 on day 2 (P < .001); all results from subsequent days were negative. Conclusions. F. tularensis LVS genomic DNA was detected in the majority of samples from the inoculation site up to 1 week after LVS vaccination, with real-time PCR being more sensitive than culture. Our data suggest that bacteremia does not occur after LVS vaccination in normal, healthy human volunteers. [ABSTRACT FROM AUTHOR]

Focuses on a study which reviewed clinical and laboratory features that may be helpful in detecting a tickborne infection. Information on lyme disease; Gastrointestinal manifestations of Ehrlichiosis; Histopathologic findings in tularemia.

This study describes the clinical characteristics of tularemia in Spain's first epidemic outbreak and the therapeutic response and compares the efficacy of 3 antibiotics (streptomycin, ciprofloxacin, and doxycycline). For 142 cases of tularemia, the therapeutic failure rate was 22.5%; ciprofloxacin was the antibiotic with the lowest percentage of therapeutic failures and with the fewest side effects. [ABSTRACT FROM AUTHOR]

Comments on issues related to medicine. Case of acalculous cholecystitis associated with Plasmodium falciparum malaria; Treatment of tularemia with Ciprofloxacin; Use of a procedure in the diagnosis of culture-negative spontaneous bacterial peritonitis.

The section presents several studies of interest in clinical infectious diseases. An analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutation is offered, with the examination of nasopharyngeal samples collected in Great Britain between March and June 2020. A controlled trial was conducted to determine the primary treatment of patients with aspergillosis using either posaconazole or voriconazole.

The original reports of human infection with Francisella tularensis noted vesicular skin rash as a manifestation. We present 2 cases of tularemia initially diagnosed as herpes simplex or varicella zoster infection. Clinicians must recognize the cutaneous manifestations of tularemia and be able to distinguish these from lesions seen with herpes viruses. [ABSTRACT FROM AUTHOR]

Presents a case study of tularemia in acutely ill immunocompromised patients. Review of related literature; Vital signs of the patients; Physical and laboratory examinations results; Treatment.

The article presents case study of two man, one 64-year-old who had received a heart transplant in 2013 presented in Tours, France, in May 2016 with a 2-week history of fever and night sweats. And other 51-year-old diabetic man presented in Tours with ketoacidosis and septic shock 7 years after he had undergone liver transplantation for which he was still receiving immunosuppressive therapy.

The article reports on the presumptive positive Francisella tularensis blood culture associated with dog exposure. It cites on the 73 year old woman who had a pulmonary sarcoidosis and died from respiratory failure but had a laboratory test confirming she had an F. tularensis, a tier 1 select agent. The article also discusses on the human tularemia cases are reported in the United States in which humans are infected through arthropod bites.

nitial serological test results were positive for Francisella tularensis antibodies, at a titer of 1:640, 4 weeks after the onset of symptoms. F. tularensis is a fastidious gram-negative coccobacillus that grows best on supplemented media, such as cysteine-glucose blood agar it does not grow on routine sheep blood agar but may be recovered on chocolate agar, which may lead to a misidentification as Haemophilus species, as in this case. Tularemia typically presents with a cutaneous ulcer and local lymphadenopathy, ulceroglandular tularemia.

Discusses the case of an aged man with tularemia presenting with gait ataxia. Agglutination testing of a blood specimen obtained at sixth day of admission being positive for antibody to Francisella tularensis (FT); Blood cultures obtained at admission being positive for FT; Importance of considering infectious, parainfectious and postinfectious processes when evaluating patients with cerebellar ataxia.

The article reports that pet hamsters are a potential source of tularemia, the U.S. health officials remind healthcare professionals in the January 7, edition of the "Morbidity and Mortality Weekly Report." Researchers from the Centers for Disease Control and Prevention describe the case of a 3-year-old boy from Colorado who was recently diagnosed with tularemia after being bitten by a pet hamster. Tissue culture yielded a suspected Francisella tularensis isolate, which was subsequently confirmed as such by real-time polymerase chain reaction and other tests.

The article reports that in 2004, three Boston University (BU) researchers developed tularemia after being exposed in a laboratory to Francisella tularensis. The first exposures happened in spring 2004, with 2 researchers becoming ill in late May 2004. The researchers complained of having flu like symptoms, and one researcher was hospitalized overnight. The third infected researcher became ill in September 2004 and required hospitalization for several days. The scientists at BU believed that they were working with a strain that had been altered specifically for vaccine research so as not to cause illness.