2016
DOI: 10.3389/fmed.2016.00009
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Keep an Ear Out for Francisella tularensis: Otomastoiditis Cases after Canyoneering

Abstract: We report here three unusual cases of otomastoiditis due to Francisella tularensis, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we… Show more

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Cited by 12 publications
(11 citation statements)
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“…Otomastoiditis caused by F. tularensis subsp. holarctica were reported in three patients (two from France, one from Germany) after canyoning in the same river in France, between 2009 and 2014 [68]. Otitis likely occurred after exposure to F. tularensis contaminated water, although the source was not specifically identified [68].…”
Section: Tularemia Of Aquatic Sourcesmentioning
confidence: 99%
“…Otomastoiditis caused by F. tularensis subsp. holarctica were reported in three patients (two from France, one from Germany) after canyoning in the same river in France, between 2009 and 2014 [68]. Otitis likely occurred after exposure to F. tularensis contaminated water, although the source was not specifically identified [68].…”
Section: Tularemia Of Aquatic Sourcesmentioning
confidence: 99%
“…In France, for three human cases linked to water exposure in the same river between 2009 and 2014, water samples were analyzed but Francisella sp. Was not identified (Guerpillon et al, 2016). Therefore, further investigations need to be conducted on the persistence of F. tularensis in water, especially in France.…”
Section: Geographic Distributionmentioning
confidence: 99%
“…In addition, the onset of an oro-pharyngeal tularemia can occur as late as 3 weeks after a relevant exposure. The pathologic mechanisms of a protracted course of tularemia are still unclear but an immune reaction to persistent antigens or pathogens appears a plausible explanation (Straube and Hess, 1986 ; Hanke et al, 2009 ; Lübbert et al, 2009 ; Capka et al, 2010 ; Dlugaiczyk et al, 2010 ; Fritzsch and Splettstoesser, 2010 ; Hauri et al, 2010 ; Potz-Biedermann et al, 2011 ; Bulut et al, 2013 ; Weile et al, 2013 ; Kohlmann et al, 2014 ; Guerpillon et al, 2016 ). The infection route often remains unclear and can be suggested only by a detailed anamnestic investigation.…”
Section: Diagnoses and Clinical Aspects Of Tularemiamentioning
confidence: 99%