pp 1–13 | Cite as

Tularemia: an experience of 13 cases including a rare myocarditis in a referral center in Eastern Switzerland (Central Europe) and a review of the literature

  • Manuel Frischknecht
  • Angelina Meier
  • Bernhard Mani
  • Lucas Joerg
  • Olaf Chan-Hi Kim
  • Katia Boggian
  • Carol StrahmEmail author



Tularemia, a zoonotic disease caused by Francisella tularensis, can cause a broad spectrum of disease in humans including six major clinical presentations: the ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal and pneumonic form. The epidemiology and ecology and thus transmission of tularemia are complex, depending on conditions unique to specific locations.

Case series and methods

Thirteen cases with different forms of the disease and one very rare case of a myocarditis are reported, discussed, and reviewed within the scope of current literature.


Tularemia is a rare, but emerging disease in Central Europe with glandular and ulceroglandular disease as its predominant forms. Transmission is mainly caused by contact with lagomorphs, rodents and tick bites. However, domestic cats may play an important role in transmission too. Myocarditis is probably a worldwide, but very rare manifestation of tularemia.


Tularemia Francisella tularensis Myocarditis Oculoglandular tularemia Glandular tularemia Pulmonary tularemia 



General practitioner


Emergency room


C-reactive protein


White blood cells


Aspartate aminotransferase


Alanine aminotransferase


Lactate dehydrogenase


Creatine kinase


Units per milliliter


Units per liter


Giga per liter


Milligram per liter


Nanogram per liter


Polymerase chain reaction




Computed tomography


Magnetic resonance imaging


Positron emissions tomography




Enzyme-linked immunosorbent assay


Twice a day


Nonsteroidal anti-inflammatory drugs




Deoxyribonucleic acid


Ribonucleic acid



In particular, we would like to thank Nancy Landes and Carol Idone for the language editing.

Compliance with ethical standards

Conflict of interest

We received no financial support for this work. We state that there is no conflict of interest.

Informed consent

Written informed consent for publication of the cases and images was obtained from all the patients.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St. GallenSt. GallenSwitzerland
  2. 2.Division of General Internal MedicineCantonal Hospital St. GallenSt. GallenSwitzerland
  3. 3.Center of Laboratory Medicine (ZLM)St. GallenSwitzerland
  4. 4.Division of CardiologyCantonal Hospital St. GallenSt. GallenSwitzerland
  5. 5.Division of Radiology and Nuclear MedicineCantonal Hospital St. GallenSt. GallenSwitzerland

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