TY  - JOUR
A1  - Wetzstein, Nils
A1  - Kärcher, Iris
A1  - Küpper-Tetzel, Klaus P.
A1  - Kann, Gerrit
A1  - Hogardt, Michael
A1  - Jozsa, Katalin
A1  - Jacob, Daniela
A1  - Grunow, Roland
A1  - Just-Nübling, Gudrun
A1  - Wolf, Timo
T1  - Clinical characteristics in a sentinel case as well as in a cluster of tularemia patients associated with grape harvest
T2  - International journal of infectious diseases
N2  - Background: Tularemia is caused by Francisella tularensis and can occasionally establish foodborne transmission.
Methods: Patients were identified by active case detection through contact with the treating physicians and consent for publication was obtained. Clinical data were accumulated through a review of the patient charts. Serology, culture, and PCR methods were performed for confirmation of the diagnosis.
Case cluster: A 46-year-old patient was hospitalised in the University Hospital Frankfurt (a tertiary care hospital) for pharyngitis and cervical lymphadenitis with abscess. A diagnosis of tularemia was made serologically, but treatment with ciprofloxacin initially failed. F. tularensis was detected in pus from the lymph node using a specific real-time PCR. The use of RD1 PCR led to the identification of the subspecies holarctica. Antibiotic therapy with high-dose ciprofloxacin and gentamicin was administered and was subsequently changed to ciprofloxacin and rifampicin. During a must-tasting, five other individuals became infected with tularemia by ingestion of contaminated must. All patients required treatment durations of more than 14 days.
Conclusions: Mechanically harvested agricultural products, such as wine must, can be a source of infection, probably due to contamination with animal carcasses. The clinical course of tularemia can be complicated and prolonged and requires differentiated antibiotic treatment.
KW  - Tularemia
KW  - Zoonosis
KW  - Francisella tularensis
KW  - Francisella tularensis subspecies holarctica
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50269
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-502692
SN  - 1878-3511
SN  - 1201-9712
N1  - © 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
VL  - 84
SP  - 116
EP  - 120
PB  - Elsevier
CY  - Amsterdam [u. a.]
ER  -