Neuroinvasive Francisella tularensis Infection: Report of 2 Cases and Review of the Literature.

Autor:	Cash-Goldwasser S; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA., Beeson A; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA., Marzec N; Colorado Department of Public Health and Environment, Denver, Colorado, USA., Ho DY; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA., Hogan CA; Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA.; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Budvytiene I; Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA., Banaei N; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.; Clinical Microbiology Laboratory, Stanford University Medical Center, Stanford, California, USA.; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Born DE; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Gephart MH; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA., Patel J; Parkview Medical Center, Pueblo, Colorado, USA., Dietrich EA; Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA., Nelson CA; Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Jan 31; Vol. 78 (Suppl 1), pp. S55-S63.
DOI:	10.1093/cid/ciad719
Abstrakt:	Background: Neuroinvasive infection with Francisella tularensis, the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. Methods: We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. Results: One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. Conclusions: Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment. Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
Databáze:	MEDLINE
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