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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

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Abstract

Background

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.

Conclusion

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.

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Abbreviations

GP:

General practitioner

ER:

Emergency room

CRP:

C-reactive protein

WBC:

White blood cells

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

LDH:

Lactate dehydrogenase

CK:

Creatine kinase

U/ml:

Units per milliliter

U/l:

Units per liter

G/l:

Giga per liter

mg/l:

Milligram per liter

ng/l:

Nanogram per liter

PCR:

Polymerase chain reaction

ECG:

Electrocardiogram

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PET:

Positron emissions tomography

I.V.:

Intravenous

ELISA:

Enzyme-linked immunosorbent assay

Bid:

Twice a day

NSAID:

Nonsteroidal anti-inflammatory drugs

Ssp.:

Subspecies

DNA:

Deoxyribonucleic acid

RNA:

Ribonucleic acid

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Manuel Frischknecht, Katia Boggian & Carol Strahm

  2. Division of General Internal Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Angelina Meier

  3. Center of Laboratory Medicine (ZLM), Frohbergstrasse 3, 9001, St. Gallen, Switzerland

    Bernhard Mani

  4. Division of Cardiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Lucas Joerg

  5. Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Olaf Chan-Hi Kim

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  1. Manuel Frischknecht
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  2. Angelina Meier
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  3. Bernhard Mani
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Correspondence to Carol Strahm.

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

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

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Frischknecht, M., Meier, A., Mani, B. et al. 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. Infection 47, 683–695 (2019). https://doi.org/10.1007/s15010-019-01269-7

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