Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
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
Show others and affiliations
2024 (English)In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 78, no 5, p. 1222-1231Article in journal (Refereed) Published
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. Vol. 78, no 5, p. 1222-1231
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: 38393822Scopus ID: 2-s2.0-85193440311OAI: 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

Errata: Correction to: Targeting Tularemia: Clinical, Laboratory, and Treatment Outcomes From an 11-year Retrospective Observational Cohort in Northern Sweden, Clinical Infectious Diseases, 2024;, ciae175, https://doi.org/10.1093/cid/ciae175

Available from: 2024-03-31 Created: 2024-03-31 Last updated: 2024-05-27Bibliographically approved

Open Access in DiVA

fulltext(989 kB)34 downloads
File information
File name FULLTEXT03.pdfFile size 989 kBChecksum SHA-512
613cb891a1e9f43c86ed896a09256e25a17c6ed7454ee7dc38ecccd30948b5913f5b7a8b40e7bb0bf11f4265e0b4f7ae2680fc5dda08887995d184912c554aae
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Plymoth, MartinLundqvist, RobertSjöstedt, AndersGustafsson, Tomas N.

Search in DiVA

By author/editor
Plymoth, MartinLundqvist, RobertSjöstedt, AndersGustafsson, Tomas N.
By organisation
Department of Clinical MicrobiologyDepartment of Public Health and Clinical Medicine
In the same journal
Clinical Infectious Diseases
Infectious Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 323 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 1020 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf