ro13-9904 and Tularemia

Tularemia, a re-emerging, potential life threatening infectious disease, can present itself with nonspecific clinical symptoms including fever, chills and malaise. Taking a detailed history of exposure and a highly raised index of clinical suspicion are necessary to take the appropriate diagnostic and therapeutic steps in this setting. Here, a case report of typhoid tularaemia is presented.. A 53-year old male forester and farmer with protracted fever, abdominal pain, diarrhoea and loss of weight, who experienced productive cough and a pulmonary infiltrate later in the course of disease, was admitted for further investigation. Tularaemia was suspected only owing to history and confirmed by serologic testing more than three weeks after the beginning of the symptoms. The initial antibiotic therapy with ceftriaxone/doxycycline was switched to ciprofloxacin, resulting in the resolution of fever and symptoms.. Tularaemia has to be considered as a differential diagnosis in febrile patients, even more in cases with protracted fever. Since tularaemia is expanding geographically, involving more animal hosts and causing larger outbreaks, clinicians have to be aware of this potentially fatal disease.

Topics: Abdominal Pain; Anti-Bacterial Agents; Body Weight; Ceftriaxone; Ciprofloxacin; Cough; Diagnosis, Differential; Diarrhea; Doxycycline; Farmers; Fever; Francisella tularensis; Humans; Male; Middle Aged; Serologic Tests; Tularemia

Tularemia is a rare zoonosis. The most common way is ingestion of contaminated meat or water, but the infection may also be acquired by insect bite. The clinical picture of the disease may be nonspecific. Due to polymorphisms of clinical picture, specific treatment is often delayed. In the last 50 years, in Poland, the most infections were acquired by handling hares. In our article, we present the case of a patient who was infected with Francisella tularensis due to arthropod bite. In the presented case, the diagnosis was difficult, because of the nonspecific clinical picture. Information of the epidemiology and the clinical picture changes of tularemia may have great clinical significance. Tularemia requires the special attention of physicians. All patients with lymphadenopathy and arthropod bite history should be screened for tularemia in the outpatient department and, if necessary, treated in hospital.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Arthropod Vectors; Bites and Stings; Ceftriaxone; Fever; Francisella tularensis; Humans; Lymphatic Diseases; Male; Poland; Rifampin; Streptomycin; Treatment Outcome; Tularemia; Zoonoses

Topics: Aged; Anti-Bacterial Agents; Bacteriological Techniques; Blood; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Francisella tularensis; Gentamicins; Humans; Immunocompromised Host; Kidney Transplantation; Male; Pneumococcal Infections; Tularemia

Topics: Adolescent; Ceftriaxone; Conjunctivitis; Doxycycline; Drug Therapy, Combination; Fever; Follow-Up Studies; Francisella tularensis; Humans; Insect Bites and Stings; Lymphadenitis; Male; Tularemia

Tularemia, an infection caused by the coccobacillus Francisella tularensis, can be a difficult disease process to diagnose and treat. The difficulty in treating this disease is related to the pathophysiology of the infection and the toxicity of the antimicrobial agents presently recommended for treatment. Recent in vitro data have suggested that antimicrobial drugs other than standard agents (streptomycin, gentamicin, chloramphenicol, or tetracycline) may be effective. We present eight cases of documented failure of outpatient use of ceftriaxone in the treatment of tularemia. Our data suggest that while ceftriaxone may have excellent MICs in vitro, these MICs do not necessarily correlate with successful in vivo outcomes.

Topics: Adolescent; Ambulatory Care; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Female; Francisella tularensis; Humans; Infant; Microbial Sensitivity Tests; Streptomycin; Tularemia