Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis (F.t.), a highly virulent bacterium for humans and small wild animals. F.t. is transmitted to humans mainly through contact with infected animals or arthropod bites (especially ticks). Its clinical features are flu-like, non-specific and often accompanied by lymphadenopathy.
We report five tularemia cases diagnosed in a clinic for pulmonary diseases in Bavaria (Germany) between 09/2020 and 11/2021. All patients lived or were active in rural areas and presented mild symptoms. The most common clinical features were fever, malaise and weight loss; three patients reported a tick bite before the symptom onset. Radiologically all showed thoracic lymphadenopathy, two additional multiple pulmonary nodules, two a central pulmonary consolidation. All patients underwent biopsy of affected lymphnodes using EBUS-TBNA, two also a lung biopsy. The main histological findings were necrotic epitheloid granulomas with remarkable granulocyte infiltration. After exclusion of malignancies, mycobacterial infections or sarcoidosis tularemia was included into our diagnostic workup. All of the cases were identified by positive serum IgG and IgM against F.t. LPS and PCR assay (here identification of F.t. ssp. holarctica) from biopsy. As first line therapy oral Ciprofloxacin was given. In cases of a failing response or in more severe cases a combination of Ciprofloxacin and Rifampicin showed a successful remission.
Due to its low incidence and unspecific clinical presentation the diagnosis of tularemia is often delayed and incidental. It should therefore be included as a differential diagnosis in patients with activities in rural areas and lymphadenopathy with typical histological patterns.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 2759.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
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