Abstract
Tularemia is an emerging zoonotic disease mainly of the Northern Hemisphere caused by the Gram-negative coccobacillus Francisella tularensis. It is affecting a wide range of animals and causes human disease after insect and tick bites, skin contact, ingestion and inhalation. A 66-year-old man presented to our clinic with cavitary pneumonia and distinct pleural effusion. After failure of empiric antibiotic therapy, thoracoscopic assisted decortication and partial excision of the middle lobe were conducted. Conventional culture methods and broad-range bacterial PCR including RipSeqMixed analysis were performed from the excised biopsies. Culture results remained negative but broad-range PCR targeting the first half of the 16S rRNA gene revealed F. tularensis DNA. This result was confirmed by F. tularensis-specific PCR and by serology. The source of infection could not be explored. To conclude, we report the rare clinical picture of a community-acquired pneumonia followed by pleural effusion and empyema due to F. tularensis. Broad range bacterial PCR proved to be a powerful diagnostic tool to detect the etiologic organism.
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References
Petersen JM, Schriefer ME. Francisella. In: Jorgensen JH, Carroll KC, Funke G, Pfaller MA, Landry MF, Richter SS, Warnock DW, editors. Manual of clinical microbiology. Washington: ASM Press; 2015. p. 851–62.
Hinić V, Aittakorpi A, Suter S, Turan S, Schultheiss E, Frei R, et al. Evaluation of the novel microarray-based prove-it bone and joint assay for direct detection of pathogens from normally sterile body sites in comparison with culture and broad-range bacterial PCR. J Microbiol Methods. 2014;107:38–40.
Eliasson H, Back E. Tularaemia in an emergent area in Sweden: an analysis of 234 cases in five years. Scand J Infect Dis. 2007;39:880–9.
Walters KA, Olsufka R, Kuestner RE, Cho JH, Li H, Zornetzer GA, et al. Francisella tularensis subsp. tularensis induces a unique pulmonary inflammatory response: role of bacterial gene expression in temporal regulation of host defense responses. PLoS One. 2013;8:e62412.
Swiss Federal Office of Public Health, http://www.bag.admin.ch/k_m_meldesystem/00733/00804/index.html?lang=de.
Weber IB, Turabelidze G, Patrick S, Griffith KS, Kugeler KJ, Mead PS. Clinical recognition and management of tularemia in Missouri: a retrospective records review of 121 cases. Clin Infect Dis. 2012;55:1283–90.
Matyas BT, Nieder HS, Telford SR. Pneumonic tularemia on Martha’s Vineyard: clinical, epidemiologic, and ecological characteristics. Ann New York Acad Sci. 2007;1105:351–77.
Belhassen-Garcia M, Velasco-Tirado V, Alvela-Suarez L, Fraile-Alonso Mdel C, Carpio-Perez A, Pardo-Lledias J. Cavitary pneumonia and skin lesions. Resp Care. 2012;57:457–9.
Johansson A, Berglund L, Eriksson U, Goransson I, Wollin R, Forsman M, et al. Comparative analysis of PCR versus culture for diagnosis of ulceroglandular tularemia. J Clin Microbiol. 2000;38:22–6.
Goldenberger D, Schneider M, Frei R, Lardinois D, Furrer K. Aetiology of thoracic empyema in adults: Increased pathogen detection using nucleic acid–based assays in pleural fluid and corresponding pleural biopsies. 25th European Congress of Clinical Microbiology and Infectious Diseases. 25–28 April 2015, Copenhagen, Denmark, P0379.
Splettstoesser WD, Piechotowski I, Buckendahl A, Frangoulidis D, Kaysser P, Kratzer W, et al. Tularemia in Germany: the tip of the iceberg? Epidem Infection. 2009;137:736–43.
Enderlin G, Morales L, Jacobs RF, Cross JT. Streptomycin and alternative agents for the treatment of tularemia: review of the literature. Clin Infect Dis. 1994;19:42–7.
Acknowledgments
The authors would like to thank PD Dr. Guido Bloemberg from Institute of Medical Microbiology at the University of Zürich for performing the F. tularensis-specific PCR and PD Dr. Paola Pilo, Institute of Infectious Diseases and Pathobiology, University of Berne for helpful scientific support. In addition, we acknowledge Dr. Thomas J. Armstrong to review the manuscript for correct use of English.
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Bloch-Infanger, C., Furrer, K., Wiese, M. et al. An unexpected cause for cavitary pneumonia and empyema. Infection 44, 539–541 (2016). https://doi.org/10.1007/s15010-015-0861-z
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DOI: https://doi.org/10.1007/s15010-015-0861-z