A Case Report of Oculoglandular Tularemia—Chasing Zebras Among Potential Diagnoses

Kreutzmann, Tobias; Schönfeld, Annika; Zange, Sabine; Lethaus, Bernd

doi:10.1016/j.joms.2020.08.018

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Soft tissue infections in tularemia patients are rare and mainly include cellulitis and subcutaneous abscesses ( Junkins and Snyder, 2011 ; Şenel et al, 2015 ; Arslan et al, 2016 ; Whitsell and Becker, 2020 ; Kreutzmann et al, 2021 ). They may occur through direct inoculation or hematogenous spread of F. tularensis to the skin or extension of a lymph node suppuration to the adjacent tissue.…”

Section: Tularemia Treatment In Humansmentioning

confidence: 99%

“…He was cured after suppurated lymph node excision and treatment with streptomycin (10 days) and tetracycline (8 weeks). A 60-year-old man with OG tularemia and orbital cellulitis did not improve under sulbactam-ampicillin treatment ( Kreutzmann et al, 2021 ). He was cured after excision of suppurated cervical lymph nodes and treatment with ciprofloxacin relayed by doxycycline because of side effects.…”

Section: Tularemia Treatment In Humansmentioning

confidence: 99%

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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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Section: Tularemia Treatment In Humansmentioning

confidence: 99%

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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“…Histopathological examination by itself is not specific for OGT, but it may be helpful in differential diagnosis (eg, tuberculosis, cat scratch disease, Rosai-Dorfman disease) [21]. Conventional aerobic cultures from conjunctival swabs are not routinely recommended in the diagnosis of OGT because of the low isolation rate (5%) [12].…”

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confidence: 99%

Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome

Nagy,

Pribelszki,

Sira

et al. 2024

Am J Case Rep

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Objective:Rare disease Background:Parinaud oculoglandular syndrome is a unilateral granulomatous palpebral conjunctivitis associated with preauricular, submandibular, and cervical lymphadenopathies. Several infectious diseases can cause Parinaud oculoglandular syndrome, usually with a conjunctival entry. The most common underlying pathology is cat scratch disease, followed by the oculoglandular form of tularemia. Diagnosis is usually a serious challenge as these infections are themselves rare. On the other hand, Parinaud oculoglandular syndrome may be a rare manifestation of more common disorders (eg, tuberculosis, syphilis, mumps, herpes simplex and Epstein-Barr virus, adenovirus, Rickettsia, Sporothrix, Chlamydia infections). Case Report:We present the case of a 66-year-old man with granulomatous conjunctivitis and ipsilateral preauricular, submandibular, and upper cervical lymphadenopathies following a superficial corneal injury. Although the systematic amoxicillin/clavulanic acid and metronidazole antibiotic therapy started immediately at admission, the suppuration of the lymph nodes required surgical drainage. Based on his anamnesis (sheep breeding; a twig scratching his eye 2 days before the initial attendance) and symptoms, a zoonosis, namely the oculoglandular form of tularemia, was suspected, empiric ciprofloxacin therapy was administered, and the patient recovered without sequelae. The Francisella tularensis infection was eventually confirmed by microagglutination serologic assay. Conclusions:If Parinaud oculoglandular syndrome is diagnosed and cat scratch fever as the most common etiology is not likely, other zoonoses, especially the oculoglandular form of tularemia, should be suspected. Serology is the most common laboratory method of diagnosing tularemia. Empiric fluoroquinolone (ciprofloxacin) or aminoglycoside (gentamicin or streptomycin) antibiotic therapy should be started immediately at the slightest suspicion of oculoglandular tularemia.

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

Copur

Sürme²

2023

Travel Medicine and Infectious Disease

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A Case Report of Oculoglandular Tularemia—Chasing Zebras Among Potential Diagnoses

Cited by 3 publications

References 6 publications

Tularemia treatment: experimental and clinical data

Tularemia treatment: experimental and clinical data

Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome

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

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