Tularemia: current diagnosis and treatment options

Abstract

Tularemia is an infection caused by Francisella tularensis with a worldwide distribution and diverse clinical manifestations. Limitations in both culture and serologic testing have led to substantial research into new diagnostic techniques and their clinical application, with PCR testing as the best example. This review focuses on the utility of culture, PCR and serologic testing for tularemia. In addition, we also review the evidence to support different therapeutic options for tularemia, highlighting both the most effective supporting evidence for therapeutic recommendations as well as gaps in current knowledge. We conclude the article with suggestions regarding potential areas for future research.

Francisella tularensisas a potential agent of bioterrorism?

“…Tularemia treatment & prophylaxis F. tularensis is naturally resistant to many antibiotic classes in vitro, including b-lactams, and macrolides for type B biovar II strains [6,7]. Because F. tularensis is a facultative intracellular bacterium, only antibiotics with appropriate intracellular pharmacokinetic and pharmacodynamic properties are active [8].…”

“…doxycycline) and the fluoroquinolones (ciprofloxacin, levofloxacin) are first-line drugs for treatment of tularemia patients [6,7]. No acquired resistance to these drugs has been reported so far in clinical situations, but resistant mutants have been easily selected in vitro [9][10][11].…”

“…The use of a fluoroquinolone or a tetracycline is advocated for tularemia cases of mild-to-moderate severity [6,7]. It is commonly considered that treatment failure and/or relapses occur in 5-10% and 10-15% of patients treated with fluoroquinolone or tetracycline, respectively.…”

“…The macrolides are considered unreliable. Streptomycin remains the reference drug for treatment of severe diseases [6,7]. When unavailable, gentamicin is now used instead, but with higher relapse rates.…”

“…Infection is usually more severe and poorly responsive to treatment in immunocompromised patients and/or when antibiotic therapy has been delayed. Patients with suppurated lymphadenopathies often require surgical excision of the suppurated lymph nodes [6,7]. The pneumonic and typhoidal forms may be life-threatening diseases, but usually do not induce sequelae in surviving patients.…”