Pleuropulmonale Tularämie bei einem 63-jährigen Jäger in Deutschland

Abstract

Due to its low prevalence in Germany and multiple possible clinical manifestations, the diagnosis of tularemia can be difficult. Hence, it is decisive to include tularemia in the differential diagnosis, especially if anamnestic or epidemiological evidence exists.

Tularemia in Germany—A Re-emerging Zoonosis

“…Between 2002 and 2016, 10 case clusters were reported. Except for two with a connection to situations in other countries and one large outbreak caused by grape must (unintentional contamination), the remaining eight clusters consisted of 2–10 cases and were associated with contact to wild animals, five of them in the context of hunting activities (Straube and Hess, 1986 ; Hofstetter et al, 2006 ; Schätzle and Schwenk, 2008 ; Hauri et al, 2010 ; Schubert et al, 2011 ; Kohlmann et al, 2014 ; Boone et al, 2015 ; Borde et al, 2017 ).…”

“…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.…”