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.
Author:Nils Wetzstein, Iris Kärcher, Klaus P. Küpper-Tetzel, Gerrit Kann, Michael HogardtORCiDGND, Katalin Jozsa, Daniela Jacob, Roland Grunow, Gudrun Just-Nübling, Timo WolfORCiDGND
Pubmed Id:
Parent Title (English):International journal of infectious diseases
Place of publication:Amsterdam [u. a.]
Contributor(s):Eskild Petersen
Document Type:Article
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
Page Number:5
First Page:116
Last Page:120
© 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 (
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0