The clinical spectrum of tularemia-Two cases

Mathilde Ørbæk; Anne-Mette Lebech; Marie Helleberg

doi:10.1016/j.idcr.2020.e00890

The clinical spectrum of tularemia-Two cases

IDCases. 2020 Jun 27:21:e00890. doi: 10.1016/j.idcr.2020.e00890. eCollection 2020.

Authors

Mathilde Ørbæk¹, Anne-Mette Lebech^{1

2}, Marie Helleberg¹

Affiliations

¹ Department of Infectious Diseases, The National University Hospital, Rigshospitalet, Denmark.
² Institute of Clinical Medicine, University of Copenhagen, Denmark.

Abstract

We report two cases of tularemia with different clinical manifestations, both suspected of tick-borne transmission and with near-complete remission of all symptoms within 3 months after antimicrobial treatment. The first patient presented with a classical ulceroglandular manifestation; general malaise, an ulcer and lymphadenopathy, occurring two weeks after a tick bite. Diagnosis was established by polymerase chain reaction of a skin biopsy from the ulcer. The second patient presented with a rare systemic manifestation including bacteremia and myocarditis resulting in severe clinical heart failure, pulmonary edema and secondary kidney failure. Previous tick bites were elucidated after the bacteremia was discovered. The cases underscore the heterogeneity of manifestations, the diagnostic approach and the importance of thorough medical history including recent exposures especially in cases with infection of unknown origin.

Keywords: Clinical manifestations; Francisella tularensis; Tick-borne infections; Treatment.

Publication types

Case Reports