Clinical characteristics in a sentinel case as well as in a cluster of tularemia patients associated with grape harvest

  • 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.
Metadaten
Author:Nils Wetzstein, Iris Kärcher, Klaus P. Küpper-Tetzel, Gerrit Kann, Michael HogardtORCiDGND, Katalin Jozsa, Daniela Jacob, Roland Grunow, Gudrun Just-Nübling, Timo WolfORCiDGND
URN:urn:nbn:de:hebis:30:3-502692
DOI:https://doi.org/10.1016/j.ijid.2019.04.031
ISSN:1878-3511
ISSN:1201-9712
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/31071480
Parent Title (English):International journal of infectious diseases
Publisher:Elsevier
Place of publication:Amsterdam [u. a.]
Contributor(s):Eskild Petersen
Document Type:Article
Language:English
Year of Completion:2019
Date of first Publication:2019/05/06
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2019/06/13
Tag:Francisella tularensis; Francisella tularensis subspecies holarctica; Tularemia; Zoonosis
Volume:84
Page Number:5
First Page:116
Last Page:120
Note:
© 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/).
HeBIS-PPN:450770699
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Open-Access-Publikationsfonds:Medizin
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0