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Targeting tularemia: clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi. Department of Infectious Diseases, Westmead Hospital, Sydney, New South Wales, Australia.ORCID-id: 0000-0002-2036-0383
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. 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 universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.ORCID-id: 0000-0002-0768-8405
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2024 (Engelska)Ingår i: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 78, nr 5, s. 1222-1231Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2024. Vol. 78, nr 5, s. 1222-1231
Nyckelord [en]
Francisella tularensis, doxycycline, ciprofloxacin, treatment, outcome
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
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
Forskningsfinansiär
Region Norrbotten, NLL-933177Umeå universitet, ALF Universitets-STRegion Norrbotten, ALF Universitets-STRegion Västerbotten, RV-966950Region Västerbotten, RV-939171
Anmärkning

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

Tillgänglig från: 2024-03-31 Skapad: 2024-03-31 Senast uppdaterad: 2024-05-27Bibliografiskt granskad

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Plymoth, MartinLundqvist, RobertSjöstedt, AndersGustafsson, Tomas N.

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