Tularaemia – a diagnostic challenge

Abstract

Introduction.Tularaemia is an infrequently occurring disease in Poland. It has therefore rarely been taken into account in the differential diagnosis of skin lesions, lymphadenitis, or soft tissue abscesses. This fact, accompanied by non-specific initial presentation, may lead to a delay in diagnosis and a more severe course of the disease. Objective. The aim of the study is to present the current state of knowledge on tularaemia and convince medical professionals to take it into consideration in the diagnosis of skin lesions, lymphadenitis, and tissue abscesses. Review methods. A literature review using PubMed and other online resources, using terms including 'tularaemia', 'lymphadenitis', etc., was undertaken. Papers were reviewed for relevance and scientific merit. Abbreviated description of the state of knowledge. Tularaemia, also known as 'rabbit fever', is a zoonotic infection caused by Francisella tularensis, an aerobic, facultative intracellular, gram-negative bacteria. In Europe, it is mainly spread via tick bites and contact with wild animals such as lagomorphs and rodents. Clinical presentation may differ depending on the transmission route; the ulceroglandular and glandular forms of disease predominate. An early diagnosis and implementation of appropriate antibiotic therapy are the cornerstones of successful treatment and make it possible to avoid a surgical incision and drainage of suppurative complications. Summary. Raised awareness and knowledge on tularaemia among health care professionals are required for timely diagnosis and treatment. Arrival from endemic areas, contact with wild animals, tick bites, and exclusion of more common etiologies of presenting signs should prompt consideration of tularaemia. More research is needed for a better understanding of the burden of the disease and its impact on public health in Poland.

Tularemia: The Resurgence of a Diagnostic Challenge and Clinical Dilemma in the United States

“…The oculoglandular form is predominated by preauricular lymphadenopathy and conjunctivitis, while the oropharyngeal form presents with pharyngitis, stomatitis, and cervical lymphadenopathy [ 5 ]. The systemic forms of tularemia (pneumonic, typhoidal) are spread by the most virulent strain of this disease, with reported mortality rates of up to 60% [ 2 , 9 ]. Fortunately, pneumonic tularemia is rarely seen in clinical practice, however, the typhoidal form is present in 10-15% of cases [ 6 , 9 ].…”

“…The systemic forms of tularemia (pneumonic, typhoidal) are spread by the most virulent strain of this disease, with reported mortality rates of up to 60% [ 2 , 9 ]. Fortunately, pneumonic tularemia is rarely seen in clinical practice, however, the typhoidal form is present in 10-15% of cases [ 6 , 9 ].…”

“…Antibodies may not be present early in the disease course, but repeated testing several weeks after the onset of initial symptoms will likely demonstrate seroconversion which can act as a confirmatory test [ 10 ]. Should seroconversion not occur, clinicians should suspect other etiologies which may present with similar symptomatology such as cat-scratch disease, plague, influenza, brucellosis, and infectious mononucleosis [ 6 , 9 ].…”

Ulceroglandular form of tularemia after squirrel bite: a case report

“…The respiratory form of tularemia after inhalation of the pathogen may cause cough, chest pain, dyspnea, and pneumonia [ 6 ]. For diagnosis, serological methods, antigen detection, or molecular methods are used [ 38 ]. Specific real-time PCR assays and bacterial growth on suitable agar plates (for example, chocolate, Neisseria selective medium plus) allow the pathogen to be identified in clinical material, such as wound swabs or blood cultures [ 38 ].…”

“…For diagnosis, serological methods, antigen detection, or molecular methods are used [ 38 ]. Specific real-time PCR assays and bacterial growth on suitable agar plates (for example, chocolate, Neisseria selective medium plus) allow the pathogen to be identified in clinical material, such as wound swabs or blood cultures [ 38 ]. If an isolate is available, mass-assisted laser desorption/ionization time-of-flight spectrometry can be used for identification of F. tularensis .…”