Water-borne oculoglandular tularemia: Two complicated cases and a review of the literature

Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome

“…Following an incubation period of 3-5 days, the disease manifests with acute flu-like symptoms (fever, chills, fatigue, myalgia, and headaches) [9]. In the oculoglandular form, the route of transmission is highly variable (eg, directly by hands contaminated at flaying of infected animals, indirectly by periocular arthropod bites, or swimming or bath in contaminated water) [12][13][14]. Lakos et al report an OGT acquired after crushing a tick removed from a dog [15].…”

“…In addition, adequate antibiotic therapy given in the early phase of the disease can blunt the serologic response, resulting in a false-negative test result [8]. According to a recent review article, serology was the most frequently applied diagnostic test of OGT [13]. As an alternative or a supplement to serology, polymerase chain reaction (PCR) specific to the 16S rRNA or the tul4 and fopA bacterial genes is suggested.…”

“…F. tularensis, although extremely resistant to environmental stress, is very fastidious if cultured, needing special growth conditions (cysteine-enriched media and long culture time) [5]. In addition, because it is highly contagious, its culture is a potential hazard to laboratory personnel, necessitating Biosafety Level 2 precautions [13].…”

“…The first-line treatment of tularemia is streptomycin or gentamicin, especially in generalized cases, while in milder cases quinolones and doxycycline may be the best choices [24]. In North America, where type A causes severe disease, streptomycin is preferred, while in Europe, where exclusively type B disease has been detected so far, most authors recommend ciprofloxacin either in intravenous (2×400 mg) or oral (2×500 mg) routes of administration [13,19]. The duration of ciprofloxacin therapy depends on symptoms, but a minimum of 10-14 days is suggested [8].…”

“…To prevent possible complications, adequate antibiotic therapy should be started immediately at the slightest suspicion of tularemia [15]. Beta-lactams are not indicated, although several authors mention their empiric administration between the onset of the disease and the suspicion of tularemia [8,[12][13][14][15]25].…”