Ulceroglandular form of tularemia after squirrel bite: a case report

Abstract

Background The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. Tularemia can lead to massively swollen lymph nodes and might even be fatal without antibiotic treatment. To our knowledge, the case described here is the first report of the disease caused by a squirrel bite in Germany. Case presentation A 59-year-old German woman with a past medical history of hypothyroidism and cutaneous lupus erythematosus presented at the emergency room at St. Katharinen Hospital with ongoing symptoms and a swollen right elbow persisting despite antibiotic therapy with cefuroxime for 7 days after she had been bitten (right hand) by a wild squirrel (Eurasian red squirrel). After another 7 days of therapy with piperacillin/tazobactam, laboratory analysis using real-time polymerase chain reaction (PCR) confirmed the suspected diagnosis of tularemia on day 14. After starting the recommended antibiotic treatment with ciprofloxacin, the patient recovered rapidly. Conclusion This is the first report of a case of tularemia caused by a squirrel bite in Germany. A naturally infected squirrel has recently been reported in Switzerland for the first time. The number of human cases of tularemia has been increasing over the last years and, therefore, tularemia should be taken into consideration as a diagnosis, especially in a patient bitten by an animal who also presents with headache, increasing pain, lymphadenitis, and fever, as well as impaired wound healing. The pathogen can easily be identified by a specific real-time PCR assay of wound swabs and/or by antibody detection, for example by enzyme-linked immunosorbent assay (ELISA), if the incident dates back longer than 2 weeks.

Squirrel bite—a rare cause of necrotizing soft tissue infection: Case report

“…Again, two cases of a pyrexial illness associated with vesiculo-papular skin eruptions occurring after the bite of the ground squirrel were reported in Nigeria. 16 Other diseases which have been reported in association with squirrel bites include radial artery pseudoaneurysm, 17 tularemia, 18 anaphylactic shock, 19 rabies, 20 and lymphocutaneous sporotrichosis. 21 Prompt initiation of broad-spectrum empiric antibiotic therapy after taking a sample for culture, is one of the key principles in the management of necrotizing soft tissue infection.…”

“…Again, two cases of a pyrexial illness associated with vesiculo‐papular skin eruptions occurring after the bite of the ground squirrel were reported in Nigeria. 16 Other diseases which have been reported in association with squirrel bites include radial artery pseudoaneurysm, 17 tularemia, 18 anaphylactic shock, 19 rabies, 20 and lymphocutaneous sporotrichosis. 21 …”

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

“…F. tularensis is aerobic Gram-negative intracellular coccobacilli and the causative agent of rare zoonotic disease, tularemia, in humans (Borgschulte et al 2022). Only few cases of tularemia meningitis have been reported (Lovell et al 1986 F. tularensis causes infections on animals, mainly in hares, squirrels, mice, and other rodents (Akimana and Kwaik 2011).…”

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

“…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.…”