Keep an Ear Out for Francisella tularensis: Otomastoiditis Cases after Canyoneering

Abstract

We report here three unusual cases of otomastoiditis due to Francisella tularensis, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we believe that F. tularensis should be considered as a possible etiology in case of otitis media, failure of the conventional antibiotic treatment, and suspicious exposure of the bacteria.

Keywords: France; Francisella tularensis; canyoneering; otitis media; otomastoiditis.

Figure 1

Mastoid CT scan of patient 3. (A) High-resolution axial section focus of the right temporal bone. Acute otitis media with tympanomastoid homogenous opacity inflammatory filling of the whole tympanic cavity () and mastoid cells (*). (B) Swelling related to the right tonsillitis (*).

Figure 2

Post treatment imaging. (A) Gadolinium-enhanced axial T1 weighted fat-suppressed MRI. Minimal persistence of gadolinium enhancement in the right mastoid. (B) PET CT fused image. Good aeration and minimal persistence of 18 FDG uptake in the right mastoid. No other associated bone or tissue anomaly.