Severe infections due to Francisella tularensis ssp. holarctica in solid organ transplant recipient: report of two cases and review of literature

Bahuaud, Olivier; Brun, Cécile; Chalopin, Thomas; Lacasse, Marion; Marec, Julien Le; Pantaleon, Clémence; Nicolas, Charlotte; Barbier, Louise; Bernard, Louis; Lemaignen, Adrien

doi:10.1186/s12879-019-3863-0

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…Because the owner was known to be an individual at high risk for disease due to immunocompromise, rapid contact was made to ensure prophylaxis and also to assure the owner that the dog was not a risk for infection. Tularemia has been reported in individuals with solid organ transplants on immunosuppressant medications, and many have had a good outcome with appropriate treatment [ 16 ]. However, cases often are challenging to diagnose given lack of recognition of the rare zoonotic diseases and the need for molecular diagnostics in some cases [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tularemia has been reported in individuals with solid organ transplants on immunosuppressant medications, and many have had a good outcome with appropriate treatment [ 16 ]. However, cases often are challenging to diagnose given lack of recognition of the rare zoonotic diseases and the need for molecular diagnostics in some cases [ 16 ]. In this case, owner risk for infection was low; however, education on the risk for zoonotic and environmental diseases in general was instituted to ensure future health.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Zoonotic Risk following Diagnosis of Canine Tularemia in a Veterinary Medical Teaching Hospital

Johnson

Epstein

Dear

et al. 2022

IJERPH

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Tularemia is a rare zoonotic disease found worldwide. The agent responsible for disease, Francisella tularensis, is one of the most highly infectious pathogens known, one that is capable of causing life-threatening illness with inhalation of <50 organisms. High infectivity explains concerns of its use in bioterrorism. This case describes a 4-year-old male neutered Australian shepherd presented for evaluation of hyporexia and fever. Physical examination revealed marked enlargement of the right superficial cervical lymph node. Tularemia lymphadenitis was diagnosed by lymph node aspiration cytology and culture. Public health officials were advised of the isolation of this zoonotic pathogen, and contact tracing was instituted. Seven individuals associated with the aspiration event were screened for tularemia and treated with prophylactic ciprofloxacin. All were negative, and none became sick. The dog was treated with doxycycline for 3 weeks, and clinical signs and physical examination abnormalities were resolved fully. The owner, a solid organ transplant recipient, was also screened for disease and received prophylactic doxycycline due to a history of shared exposure. The owner remained well throughout the course of his dog’s disease and has heightened awareness of potential zoonoses. This case highlights the importance of animals as a sentinel for human health threats and for coordination of human and veterinary care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of Zoonotic Risk following Diagnosis of Canine Tularemia in a Veterinary Medical Teaching Hospital

Johnson

Epstein

Dear

et al. 2022

IJERPH

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“…Tularemia has occasionally been reported in patients with an immunosuppressive disease or treatment ( Limaye and Hooper, 1999 ; Naughton et al, 1999 ; Sarria et al, 2003 ; Khoury et al, 2005 ; Mittalhenkle and Norman, 2006 ; Faucon et al, 2011 ; Ozkok et al, 2012 ; Weile et al, 2013 ; Calin et al, 2017 ; Bahuaud et al, 2019 ; Table 11 ). The above cases occurred in the USA, France, Germany, and Turkey, in patients of 24–69 years (mean age, 49.8 years), with a male predominance (8 of 9 cases for which gender was specified).…”

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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“…Moreover, due to the fastidiousness of culture recovery of Francisella tularensis, diagnosis often relies on serological techniques for which results are obtained 10 to 15 days after sampling [6]. Thanks to the development of molecular techniques, quick and positive results are obtained with PCR-based methods [7][8][9]. However, the sensitivity of PCR in blood is low due to the presence of amplification inhibitors, and these techniques are most reliable on tissue, sputum, or exudate samples [7,10].…”

Section: Introductionmentioning

confidence: 99%

Host Immunity and Francisella tularensis: A Review of Tularemia in Immunocompromised Patients

2021

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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.

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Severe infections due to Francisella tularensis ssp. holarctica in solid organ transplant recipient: report of two cases and review of literature

Cited by 12 publications

References 13 publications

Assessment of Zoonotic Risk following Diagnosis of Canine Tularemia in a Veterinary Medical Teaching Hospital

Assessment of Zoonotic Risk following Diagnosis of Canine Tularemia in a Veterinary Medical Teaching Hospital

Tularemia treatment: experimental and clinical data

Host Immunity and Francisella tularensis: A Review of Tularemia in Immunocompromised Patients

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