Abstract
We describe a case of human tularemia caused by Francisella tularensis subsp. holarctica in a stem cell transplant recipient with chronic graft-versus-host disease who was receiving levofloxacin prophylaxis. The infection was characterized by pneumonia with septic complications. The patient was successfully treated with doxycycline.
Highlights
Tularemia is a zoonotic infection caused by the gramnegative bacterium Francisella tularensis
F. tularensis was suspected on the basis of biochemical identification, and the isolate was sent to the reference laboratory for tularemia for confirmation (Bundeswehr Institute of Microbiology, Munich, Germany)
The strain was susceptible for levofloxacin, according to Clinical and Laboratory Standards Institute standards, the MIC of 0.25 mg/L was at least twice as high when compared with 69 other F. tularensis subsp. holarctica strains (0.031, n = 11; 0.062, n = 54; 0.125, n = 4) (7)
Summary
Tularemia is a zoonotic infection caused by the gramnegative bacterium Francisella tularensis. Patients infected with F. tularensis have abrupt onset of fever, chills, headache, and malaise after an incubation period of 2–21 days. Antimicrobial drug therapy should be administered to patients with this suspected or confirmed diagnosis, even though spontaneous resolution may occur in 50%–95% of Author affiliations: Heart and Diabetes Centre North Rhine– Westphalia, Bad Oeynhausen, Germany
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