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Targeting tularemia: clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden
Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Department of Infectious Diseases, Westmead Hospital, Sydney, New South Wales, Australia.ORCID iD: 0000-0002-2036-0383
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Sunderby Research Unit, Umeå University, Umeå, Sweden.ORCID iD: 0000-0003-4059-3368
Department of Communicable Disease Control, County Council of Norrbotten , Luleå , Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.ORCID iD: 0000-0002-0768-8405
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2024 (English)In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Tularemia is an important re-emerging disease with a multimodal transmission-pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden.

Methods: Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011-2021 were collected through review of electronic medical records and participant questionnaires; with 415 out of 784 accepting participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or PCR). A multivariable logistic regression model was used to investigate variables associated with re-treatment.

Results: Median age of participants was 54 years (IQR 41.5-65) and 49.2% were female. While ulceroglandular tularemia was the predominant form (n=215, 65.7%), there were several cases of pulmonary tularemia (n=40; 12.2%). Inflammatory markers were largely non-specific, with monocytosis frequently observed (n=36/75; 48%). Tularemia was often misdiagnosed upon presentation (n=158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics, and 102 (31.2%) re-treated. Persistent lymphadenopathy was infrequent (n=22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with re-treatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR 3.25-20.75] vs. 7 [IQR 4-11.25] days; adjusted p=0.076), and doxycycline-based treatment regimen (vs. ciprofloxacin; adjusted p=0.084), although not significant after correction for multiple comparisons.

Conclusion: We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis and timely commencement of treatment for an appropriate duration.

Place, publisher, year, edition, pages
Oxford University Press, 2024.
Keywords [en]
Francisella tularensis, doxycycline, ciprofloxacin, treatment, outcome
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:umu:diva-222845DOI: 10.1093/cid/ciae098ISI: 001188651700001PubMedID: 38393822OAI: oai:DiVA.org:umu-222845DiVA, id: diva2:1847889
Funder
Norrbotten County Council, NLL-933177Umeå University, ALF Universitets-STNorrbotten County Council, ALF Universitets-STRegion Västerbotten, RV-966950Region Västerbotten, RV-939171
Note

Available from: 2024-03-31 Created: 2024-03-31 Last updated: 2024-04-02

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Plymoth, MartinLundqvist, RobertGustafsson, Tomas N.

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