Typhoidal Tularemia in a Human Immunodeficiency Virus-Infected Adolescent

Francisella tularensis Bacteremia

“…However, in our case, as in all the other cases reported in northern Europe, there was no evidence of underlying disease. In 16 of the 20 published case reports, F. tularensis bacteremia was associated, as in our case, with underlying pneumonia (7,11,13,17,19,20,23,24,25,28,29). Among the other reported cases, two were characteristic of typhoidal tularemia (11,14) and another was an oropharyngeal form (13).…”

“…In 16 of the 20 published case reports, F. tularensis bacteremia was associated, as in our case, with underlying pneumonia (7,11,13,17,19,20,23,24,25,28,29). Among the other reported cases, two were characteristic of typhoidal tularemia (11,14) and another was an oropharyngeal form (13). In 10 cases, a history of previous exposure to ticks or wild animals was found (10,11,13,17,20,(22)(23)(24)(25).…”

“…F. tularensis can also cause lung infections after inhalation of infectious aerosols or systemic illness, such as typhoidal tularemia. Only 20 documented cases of bacteremia caused by F. tularensis have been reported worldwide, mainly in the United States (16 cases) (7,10,11,14,17,19,20,(22)(23)(24)(25)28) and more rarely in northern Europe (2 cases in Norway and 2 cases in Sweden) (13,29). The blood isolates obtained in the United States belong mainly to biovar A and rarely to biovar B, while all the isolates obtained in northern Europe belong to biovar B.…”

“…Among the other reported cases, two were characteristic of typhoidal tularemia (11,14) and another was an oropharyngeal form (13). In 10 cases, a history of previous exposure to ticks or wild animals was found (10,11,13,17,20,(22)(23)(24)(25). In four of the reported cases, neither decreased host defense factors nor a previous history of direct or indirect animal contact was noted (19,25,29).…”

“…In our case, the blood culture was positive after 6 days of incubation. However, in other cases, an incubation period of 12 or even 21 days was necessary before positive blood cultures could be obtained (11,20). A final blind subculture has also been recommended for cases for which there is a high index of suspicion (5,26).…”