A case of Francisella tularensis meningitis in a 64-year-old man treated with quinolones

Ducatez, Norman; Melboucy, S; Bentayeb, H.; Dayen, C.; Suguenot, R.; Lecuyer, E.; Douadi, Youssef

doi:10.1016/j.idnow.2021.06.306

Cited by 4 publications

(7 citation statements)

References 11 publications

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“…After patient recovery, the case was analyzed in a joint meeting of hospital infectious diseases medical staff and laboratory. F tularensis is not a common causative bacteria for meningitis and as expected incidence of meningitis caused by F. tularensis is low (Lovell et al 1986, Ho nger et al 2009, Contentin et al 2011, Venkatesan et al 2019, Ducatez et al 2022), the treatment was not initially directed towards F. tularensis but rather, the antibiotic resistance was measured against general panel of gram negative rods. The resistance of our unidenti ed bacteria to beta-lactamases and ertapenem, left relatively little choices for antimicrobial medication and for this cipro oxacin was successfully administered.…”

Section: Discussionmentioning

confidence: 99%

Positive Francisella tularensis meningitis outcome despite the delay of identification: a case report

Mäki-Koivisto,

Korkala,

Simola

et al. 2023

Preprint

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Francisella tularensis is a gram negative bacteria, that may cause a zoonotic disease, tularemia. We describe here a patient case, where previously healthy young woman in Northern Finland contacted primary/occupational health care as she had fever and headache. Due to the symptoms and lack of further diagnostic tools in the primary health care, the patient was transferred to University Hospital (UH). There she received empirically ampicillin and cetriaxone. In the UH the cerebrospinal fluid sample (CSF) was drawn and subsequently scarce growth of small gram negative bacteria was observed. Maldi-tof did not provide identification, but the bacteria was found to be sensitive to ciprofloxacin with disk diffusion method and subsequently the treatment was redirected to ciprofloxacin. During the time patient was infected, there were several positive tularemia samples found in the area. Therefore, in house tularemia nucleic acid method (PCR) was used on the growing bacteria. Additionally, 16S rDNA sequencing was performed and these methods identified the bacteria as F. tularensis spp. holarctica. Fortunately, the patient recovered completely with ciprofloxacin and was discharged without any further complications or permanent side effects. Our case underlines the need to fully understand the limits of specific diagnostic methods such as Maldi-tof used in clinical laboratory settings.

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Section: Discussionmentioning

confidence: 99%

Positive Francisella tularensis meningitis outcome despite the delay of identification: a case report

Mäki-Koivisto,

Korkala,

Simola

et al. 2023

Preprint

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“…Meningitis caused by F. tularensis is rare, but cases have been reported [ 7 , 9 , 12 , 16 , 24 ]. In our case F. tularensis was identified as the causative microbe by an in house PCR method and 16s rDNA sequencing.…”

Section: Discussionmentioning

confidence: 99%

“…Francisella tularensis is an aerobic Gram-negative intracellular coccobacilli and the causative agent of a rare zoonotic disease, tularemia, in humans [ 3 ]. Only a few cases of tularemia meningitis have been reported [ 7 , 9 , 12 , 16 , 24 ], but patient outcome may be fatal. According to Hofinger et al [ 12 ] 7/16 cases were lethal during 1931 to 2009 in the USA, where F. tularensis spp .…”

Section: Introductionmentioning

confidence: 99%

Positive Francisella tularensis meningitis outcome despite delayed identification: a case report

Mäki-Koivisto,

Korkala,

Simola

et al. 2023

Ann Clin Microbiol Antimicrob

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Francisella tularensis is a Gram-negative bacteria, that may cause a zoonotic disease, tularemia. Here, we describe a patient case, where a previously healthy young woman in Northern Finland contacted health care because of fever and headache. Due to the symptoms and lack of further diagnostic tools in primary health care, she was transferred to University Hospital (UH) where ampicillin and ceftriaxone was given empirically. A cerebrospinal fluid sample (CSF) was drawn showing small Gram-negative rods that grew on chocolate agar after 2 days of incubation. Matrix-assisted laser-desorption-ionization time of-flight (Maldi-tof) did not provide identification, but the bacteria was interpreted as sensitive to ciprofloxacin and the treatment was changed to ciprofloxacin. During the time the patient was infected, there were several positive tularemia samples found in the area. Therefore, an in house tularemia nucleic acid method (PCR) was used on the bacterial culture. Additionally, 16S rDNA sequencing was performed and these methods identified the bacteria as F. tularensis. Fortunately, the patient recovered completely with ciprofloxacin and was discharged without any complications. Our case underlines the need to understand the limits of specific diagnostic methods, such as Maldi-tof, used in clinical laboratory settings. It also highlights the need of both clinicians and laboratory staff to be aware of the many clinical presentations of tularemia when working in an endemic area.

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“…Streptomycin, gentamicin, doxycycline, ciprofloxacin and chloramphenicol have been most frequently used for treating tularemia meningitis patients ( Lovell et al, 1986 ; Hofinger et al, 2009 ; Contentin et al, 2011 ; Venkatesan et al, 2020 ; Ducatez et al, 2022 ). These antibiotics were often administered in combination or successively for a total duration of 2 to 8 weeks ( Lovell et al, 1986 ; Hofinger et al, 2009 ; Contentin et al, 2011 ; Venkatesan et al, 2020 ; Ducatez et al, 2022 ). A 68-year-old man with tularemia meningitis was cured after receiving thiamphenicol for 6 days, then gentamicin for 18 days, then ciprofloxacin for 4 weeks ( Contentin et al, 2011 ).…”

Section: Tularemia Treatment In Humansmentioning

confidence: 99%

“…In contrast, a 64-year-old man was cured after only 2 weeks of ciprofloxacin. Although tularemia meningitis treatment is not standardized, most cases occurring over the past two decades have recovered without sequelae while receiving variable antibiotic treatments ( Gangat, 2007 ; Hofinger et al, 2009 ; Contentin et al, 2011 ; Venkatesan et al, 2020 ; Ducatez et al, 2022 ). The use of phenicols for tularemia meningitis seems no longer justified due to the risk of fatal aplastic anemia.…”

Section: Tularemia Treatment In Humansmentioning

confidence: 99%

Tularemia treatment: experimental and clinical data

Maurin,

Pondérand,

Hennebique

et al. 2024

Front. Microbiol.

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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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A case of Francisella tularensis meningitis in a 64-year-old man treated with quinolones

Cited by 4 publications

References 11 publications

Positive Francisella tularensis meningitis outcome despite the delay of identification: a case report

Positive Francisella tularensis meningitis outcome despite the delay of identification: a case report

Positive Francisella tularensis meningitis outcome despite delayed identification: a case report

Tularemia treatment: experimental and clinical data

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