Abstract
Background
Tularaemia is a zoonotic disease caused by Francisella tularensis, a highly virulent bacterium that affects humans and small wild animals. It is transmitted through direct contact with infected animals or indirectly through contaminated soil, water or arthropod bites (e.g. ticks). Primary thoracic manifestations of tularaemia are infrequent and, therefore, a diagnostic challenge for clinicians.
Methods
We report six tularaemia cases with exclusively thoracic involvement diagnosed in a clinic for pulmonary diseases in Bavaria between 10/2020 and 02/2022.
Results
All patients lived or were active in rural areas, four reported a recent tick bite. All patients presented with thoracic lymphadenopathy and pulmonary tumours or consolidations; all underwent bronchoscopy with EBUS-TBNA of lymph nodes, three lung biopsies as well. Five patients showed inflammatory changes in the endobronchial mucosa. The main histological findings were necrotic epithelioid granulomas with remarkable granulocyte infiltration. All cases were identified by positive serology, five by PCR (here identification of F.t. ssp. Holarctica) from biopsy as well. As first-line therapy, oral ciprofloxacin was given (5/6); in 2/6 cases, a combination of quinolone–rifampicin was given.
Conclusions
Pulmonary tularaemia may occur after tick bites and without extrathoracic manifestations. In patients who present with thoracic lymphadenopathy and pulmonary consolidations and who are exposed to increased outdoor activities, tularaemia should be included in the diagnostic pathway. Histologically, the presence of neutrophil–granulocyte infiltrations might help to distinguish tularaemia from other granulomatous infections, e.g. tuberculosis. The combination of quinolone–rifampicin rather than i.v. gentamicin reduced length of hospital stay in two patients.
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Data Availability
No datasets were generated or analysed during the current study.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by M. Vacca, M. Heiß-Neumann, B. Wilhelms and S. Zange. The first draft of the manuscript was written by M.Vacca and B. Wilhelms. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Vacca, M., Wilhelms, B., Zange, S. et al. Thoracic manifestations of tularaemia: a case series. Infection (2024). https://doi.org/10.1007/s15010-024-02204-1
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DOI: https://doi.org/10.1007/s15010-024-02204-1