Abstract
BackgroundTularemia is a rare zoonotic infection caused by bacterium Francisella tularensis. It has been well described in immunocompetent patients but poorly described in immunocompromised patients notably in solid organ transplant recipients.Case presentationsWe report here two cases of tularemia in solid organ transplant recipients including first case after heart transplant. We also carried out an exhaustive review of literature describing characteristics of this infection in solid organ transplant recipients.
Highlights
Tularemia is a rare zoonotic infection caused by bacterium Francisella tularensis
Tularemia should be considered in case of pulmonary symptoms in solid organ transplant recipient with persistent fever
We report here two new cases of Tularemia in solid organ transplant (SOT) recipients and present a review of literature
Summary
We performed an exhaustive review of the literature using PubMed and Google scholar with the following research algorithm: (“Francisella tularensis” OR “holarctica” OR “tularemia”) AND (“solid organ transplantation” OR “ciclosporin” OR “tacrolimus” OR “transplantation”). Serology later confirmed blood cultures were positive but standard techniques initially failed to identify F. tularensis, requiring molecular identification method Both the patients received empiric antibiotic therapy for pneumonia that failed to improve their condition but a secondarily adapted antibiotic therapy containing ciprofloxacin proved to be effective. In our two cases and one from literature [12], laboratory technicians were exposed to aerosolized pathogens while performing the different tests required to obtain a diagnosis They all received a prophylactic treatment with Doxycycline or Ciprofloxacin and no complication was reported. This study highlights a frequent pulmonary presentation in such situation and suggests that it should be considered in case of pneumonia in a SOT recipient with a history of potential exposure to aerosolized pathogens.
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