Temporal differences of onset between primary skin lesions and regional lymph node lesions for tularemia in Japan: a clinicopathologic and immunohistochemical study of 19 skin cases and 54 lymph node cases

Shigeyuki Asano,Tetsutaro Sata,Masaru Kojima,Yasushi Akaike,Hiromi Fujita,Haruki Wakasa,Kazuki Yamazaki,Yuko Sato,Takayuki Kanno,Kikuo Mori

doi:10.1007/s00428-012-1246-7

Abstract

For tularemia, a zoonosis caused by the gram-negative coccobacillus Francisella tularensis, research of the relation between skin lesions and lymph node lesions has not been reported in the literature. This report describes skin lesions and lymph node lesions and their mutual relation over time for tularemia in Japan. Around the second day after infection (DAI), a subcutaneous abscess was observed (abscess form). Hand and finger skin ulcers formed during the second to the fourth week. Subcutaneous and dermal granulomas were observed with adjacent monocytoid B lymphocytes (MBLs) (abscess–granulomatous form). From the sixth week, large granulomas with central homogeneous lesions emerged diffusely (granulomatous form). On 2–14 DAI, F. tularensis antigen in skin lesions was detected in abscesses. During 7–12 DAI, abscesses with adjacent MBLs appeared without epithelioid granuloma (abscess form) in regional lymph nodes. During the second to fifth week, granulomas appeared with necrosis (abscess–granulomatous form). After the sixth week, large granulomas with a central homogeneous lesion (granulomatous form) appeared. F. tularensis antigen in lymph node lesions was observed in the abscess on 7–92 DAI. Apparently, F. tularensis penetrates the finger skin immediately after contact with infected hares. Subsequently, the primary lesion gradually transfers from skin to regional lymph nodes. The regional lymph node lesions induced by skin lesion are designated as dermatopathic lymphadenopathy. This study revealed temporal differences of onset among the skin and lymph node lesions.

Highlights

This study revealed temporal differences of onset among the skin and lymph node lesions
Tularemia is a zoonosis caused by the gram-negative coccobacillus Francisella tularensis, the etiologic agent of the disease [1,2,3,4,5]
Clinical features of the skin lesions (19 cases) and lymph node lesions (54 cases) are presented in Tables 2 and 3 and almost all patients had visited the doctor for common coldlike symptoms such as a sudden high fever (38–40°C) with chill, headache, back pain, cough, and sore throat

Summary

Introduction

Tularemia is a zoonosis caused by the gram-negative coccobacillus Francisella tularensis, the etiologic agent of the disease [1,2,3,4,5]. Soken Honma, a physician in Mito, Ibaraki Prefecture, Japan, described tularemia as “hare meat poisoning” (1837) [3] in the oldest report of the disease. In California, USA, McCoy (1911) [6] reported a plague-like disease affecting squirrels. F. tularensis was named after Francis and the town in which the bacterium was isolated: Tulare, California, USA (1921) [6]. Japanese armed forces (1932–1945) and the U.S Army (1950–1960) undertook studies to develop tularemia bacteria for use as a biological weapon [1, 8, 9]

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Results

Conclusion