A Shunt Infection Caused by <i>Francisella tularensis</i>

Abstract

We report the first case of a child with a shunt infection caused by Francisella tularensis, the causative agent of tularemia. This patient is also unique in that the disease was limited to the central nervous system.

Histologic and molecular diagnosis of tularemia: a potential bioterrorism agent endemic to North America

“…In addition, pathologists should be aware that tularemia can cause atypical lesions such as suppurative leptomeningitis or ulcers anywhere in the gastrointestinal tract. Although rarely reported in the literature, 3,23,36 gastrointestinal and neurologic symptoms may dominate the presentation of FT infection, and pulmonary findings may be absent, particularly early in the course of disease. Laboratory diagnosis of tularemia has historically been challenging.…”

New Approaches to Diagnosis and Therapy of Tularemia

“…In the last decade F. tularensis has been unexpectedly isolated in a number of subjects compromised by underlying conditions unrelated to tularemia. Two patients were compromised by deficiency in neutrophil leucocytes, 14,15 and others were compromised by transplantation‐associated immunosuppressive therapy, 16,17 stomach cancer, 18 HIV disease, 19 or insertion of prosthetic medical device 20,21 . Although living in areas endemic for tularemia, the history of these cases did not suggest exposure to F. tularensis .…”

Increase in Human Cases of Tularemia — Colorado, Nebraska, South Dakota, and Wyoming, January–September 2015

“…tularensis has been isolated occasionally from patients hospitalized because of febrile disease of unknown origin. A majority of these patients were compromised by neutrophil deficiency (Maranan et al, 1997;Sarria et al, 2003), transplantation-associated immunosuppressive therapy (Naughton et al, 1999;Khory et al, 2005), stomach cancer (Han, Ho & Safdar, 2004), HIV disease (Gries & Fairchok, 1996) or the presence of a prosthetic medical device (Pittman, Williams & Friedman, 1996;Cooper et al, 1999). Although these subjects lived in areas where F. tularensis is endemic, illness was not preceded by obvious exposure events and the route of transmission of F. tularensis remained unknown.…”