Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany
Francisella tularensis, the causative agent of tularemia, poses a challenge for diagnosis and treatment due to its diverse clinical presentations and low incidence. Hence, the awareness among clinicians is comparatively low. This study reports the clinical characteristics, diagnostic approaches, and...
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Elsevier
2025-07-01
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| Series: | Ticks and Tick-Borne Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1877959X25000561 |
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| author | Sophie E. Müller Sophie Schneitler Sabine Zange Maximilian Linxweiler Arne Simon Lorenz Thurner Sören L. Becker |
| author_facet | Sophie E. Müller Sophie Schneitler Sabine Zange Maximilian Linxweiler Arne Simon Lorenz Thurner Sören L. Becker |
| author_sort | Sophie E. Müller |
| collection | DOAJ |
| description | Francisella tularensis, the causative agent of tularemia, poses a challenge for diagnosis and treatment due to its diverse clinical presentations and low incidence. Hence, the awareness among clinicians is comparatively low. This study reports the clinical characteristics, diagnostic approaches, and treatment outcomes of tularemia cases at one tertiary center in Germany over a 12-yearperiod.This retrospective monocentric case series considered all tularemia cases diagnosed at Saarland University Medical Center in Homburg, Germany between January 2013 and December 2024. Cases were identified from electronic medical records, and the certainty of tularemia was graded as definite, probable and possible infection, based on results of serology, polymerase chain reaction (PCR) assays, or blood cultures. Clinical data were extracted from patient records and supplemented by follow-up information from the clinicians.We identified 14 tularemia cases, including 6 definite as well as 3 probable and 5 possible cases. The clinical presentation was highly variable, with the (ulcero-)glandular form being the most common entity (10/14). Invasive diagnostics or surgery were required in eleven out of 14 patients. Initial misdiagnosis was common, leading to delayed diagnosis and multiple courses of ineffective antibiotics. Definite treatment included fluoroquinolones or doxycycline, and led to resolution of symptoms in most patients.The varied clinical manifestations of tularemia, from classic (ulcero-)glandular forms to severe and atypical presentations illustrate its diagnostic and clinical complexity. Enhanced awareness and early consideration are crucial, especially in endemic areas or patients with anamnestic environmental exposures. |
| format | Article |
| id | doaj-art-5211fe6784de41b0aede4524334b11da |
| institution | Kabale University |
| issn | 1877-9603 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| series | Ticks and Tick-Borne Diseases |
| spelling | doaj-art-5211fe6784de41b0aede4524334b11da2025-08-20T03:55:49ZengElsevierTicks and Tick-Borne Diseases1877-96032025-07-0116410249210.1016/j.ttbdis.2025.102492Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from GermanySophie E. Müller0Sophie Schneitler1Sabine Zange2Maximilian Linxweiler3Arne Simon4Lorenz Thurner5Sören L. Becker6Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Corresponding author.Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, GermanyBundeswehr Institute of Microbiology, Munich, GermanyDepartment of Otorhinolaryngology, Head and Neck Surgery, Saarland University, Homburg, GermanyDepartment of Pediatric Hematology and Oncology, Saarland University, Homburg, GermanyDepartment of Hematology, Oncology, Clinical Immunology and Rheumatology, Saarland University, Homburg, GermanyInstitute of Medical Microbiology and Hygiene, Saarland University, Homburg, GermanyFrancisella tularensis, the causative agent of tularemia, poses a challenge for diagnosis and treatment due to its diverse clinical presentations and low incidence. Hence, the awareness among clinicians is comparatively low. This study reports the clinical characteristics, diagnostic approaches, and treatment outcomes of tularemia cases at one tertiary center in Germany over a 12-yearperiod.This retrospective monocentric case series considered all tularemia cases diagnosed at Saarland University Medical Center in Homburg, Germany between January 2013 and December 2024. Cases were identified from electronic medical records, and the certainty of tularemia was graded as definite, probable and possible infection, based on results of serology, polymerase chain reaction (PCR) assays, or blood cultures. Clinical data were extracted from patient records and supplemented by follow-up information from the clinicians.We identified 14 tularemia cases, including 6 definite as well as 3 probable and 5 possible cases. The clinical presentation was highly variable, with the (ulcero-)glandular form being the most common entity (10/14). Invasive diagnostics or surgery were required in eleven out of 14 patients. Initial misdiagnosis was common, leading to delayed diagnosis and multiple courses of ineffective antibiotics. Definite treatment included fluoroquinolones or doxycycline, and led to resolution of symptoms in most patients.The varied clinical manifestations of tularemia, from classic (ulcero-)glandular forms to severe and atypical presentations illustrate its diagnostic and clinical complexity. Enhanced awareness and early consideration are crucial, especially in endemic areas or patients with anamnestic environmental exposures.http://www.sciencedirect.com/science/article/pii/S1877959X25000561Francisella tularensisTularemiaDiagnosisSerologyPCRBlood culture |
| spellingShingle | Sophie E. Müller Sophie Schneitler Sabine Zange Maximilian Linxweiler Arne Simon Lorenz Thurner Sören L. Becker Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany Ticks and Tick-Borne Diseases Francisella tularensis Tularemia Diagnosis Serology PCR Blood culture |
| title | Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany |
| title_full | Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany |
| title_fullStr | Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany |
| title_full_unstemmed | Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany |
| title_short | Clinical characteristics of and diagnostic approaches to human Francisella tularensis infection: a retrospective, monocentric case study from Germany |
| title_sort | clinical characteristics of and diagnostic approaches to human francisella tularensis infection a retrospective monocentric case study from germany |
| topic | Francisella tularensis Tularemia Diagnosis Serology PCR Blood culture |
| url | http://www.sciencedirect.com/science/article/pii/S1877959X25000561 |
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