Neck glandular type of tularemia in an 18-year old women

2019 ◽  
Vol 8 (2) ◽  
pp. 1-5
Author(s):  
Joanna Tomaszewska ◽  
Ewa Jaworowska ◽  
Jolanta Niścigorska-Olsen
Keyword(s):  
Francisella Tularensis ◽  
Young Women ◽  
Contaminated Soil ◽  
Molecular Test ◽  
Gram Negative ◽  
Clinical Forms ◽  
Mucous Membranes ◽  
Empiric Antibiotic ◽  
Endemic Areas ◽  
Insect Bites

Tularemia is a rare zoonosis disease caused by Gram-negative, aerobic bacilli – Francisella tularensis. In Poland endemic areas of tularemia are in the northern and eastern regions of the country. The most frequent contamination route is percutaneous, by mucous membranes, inhalation or ingestion. There have been no reports of human to human transmission. The main reservoir of tularemia are animals: rabbits, hares, mice and squirrels, which are infected by an insect bites (ticks, mosquito, fly) or contact with contaminated soil or water. Tularemia has many clinical forms: ulceroglandular, glandular, oculoglandular, oropharyngeal (streptococcal), pulmonary (primary), gastrointestinal (visceral), pseudo typhoid (septic). Clinical and radiological presentation of tularemia is nonspecific. Serological and molecular test are hardly available. Treatment is based on not empiric antibiotic (streptomycin, gentamicin). The aim of the study is to present the case of neck glandular type of tularemia in a young women and encountered diagnostic and therapeutic problems.

scholarly journals Francisella tularensisBacteremia: A Case Report from Sudan

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Salma E. R. Mohamed ◽  
Aymun I. Mubarak ◽  
Lamia O. Alfarooq
Keyword(s):  
Lymph Nodes ◽  
Francisella Tularensis ◽  
Shortness Of Breath ◽  
Negative Bacterium ◽  
Blood Cell Count ◽  
Southern Sudan ◽  
Gram Negative ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Highly Virulent

Francisella tularensisis a highly virulent intracellular gram-negative bacterium. The organism is usually isolated from wild and domestic animals and invertebrate. Man gets infection by direct contact with those animals or their products but the most common mode of transmission is via arthropod vectors. The disease is endemic in North America, parts of Europe, and Asia but has never been reported in Africa. A 29-year old male living in a rural area of Southern Sudan has been maintained on continuous ambulatory peritoneal dialysis for two years. He presented to our center in May 2010 complaining of fever, dry cough, shortness of breath, and abdominal discomfort for four days. He was very ill, pale, and dehydrated. There were enlarged tender submandibular lymph nodes, but no mouth ulcers or other palpable lymph nodes. Peritonitis was excluded by effluent white blood cell count and culture. Empiric antibiotic treatment with ceftriaxon, and ciprofloxacin was started. Gram-negative coccobacilli were isolated by blood culture. The organism was identified asFrancisella tularensis. We started him on a ten-day course of gentamicin after which he improved. This is, to the best of our knowledge, the first reported case of bacteremia caused byFrancisella tularensisin Sudan.

scholarly journals 1554. Epidemiology of Adult Bacterial Hand Infections at Two Urban Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S777-S778
Author(s):  
Arsheena Yassin ◽  
Christine Stavropoulos ◽  
Krystina L Woods ◽  
Jiashan Xu ◽  
Justin Carale ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
Antibiotic Regimen ◽  
Gram Positive ◽  
Gram Negative ◽  
Streptococcus Species ◽  
Urban Hospitals ◽  
Haemophilus Parainfluenzae ◽  
Empiric Antibiotic ◽  
Gram Negative Organisms

Abstract Background Hand infections represent a major source of morbidity, which can result in hand stiffness and amputation. Early appropriate empiric antibiotic regimen may reduce the associated morbidity, hence the importance to examine local epidemiology. The aim of this study was to define the current epidemiology of adult hand infections at two urban hospitals in New York City. Methods We performed a double center, retrospective study of adult patients hospitalized from March 2018 to May 2020. Patients with positive cultures associated with the hand infections were included. Retrospectively, 100 patients were reviewed. Data on baseline demographic, clinical, surgical, microbiology, and treatment parameters were collected. Results Of the 100 patients, 76% were male, with median age of 47.5 years (35, 58.25) and average C-reactive protein (CRP) of 50.66 mg/L (± 64.64) on admission (see Table 1). Previous hospitalization within 1 year (38%), previous surgical procedures (39%) and recent IV medication use (26%) were common. 130 bacterial isolates were identified (see Table 2). The most frequent organisms were Gram-positive, with Methicillin susceptible Staphylococcus aureus (MSSA, 25.38%), Streptococcus species (20.08%), and Methicillin resistant Staphylococcus aureus (MRSA, 15.38%) being the most common. Gram-negative organisms were infrequent, with Haemophilus parainfluenzae (3.85%), Enterobacter cloacae (3.85) and Pseudomonas aeruginosa (3.08%) being the most prevalent. Of the 100 patients, 27% had polymicrobial infections, associated with trauma (6%), illicit IV use (6%) and unknown (7%) etiologies. Table 1: Baseline demographics and co-morbid conditions Table 2: Types and numbers of organisms in relation to etiologies Conclusion Within our population, the most common organisms associated with hand infections were Gram-positive, with Staphylococcus aureus and Streptococcus species being the most prevalent. Gram-negative pathogens were infrequently isolated. The results within this study can provide guidance to clinicians on assessing the appropriate empiric antibiotic regimen in patients with hand infections, and can serve as a basis for further studies identifying risk factors associated with isolation of organisms associated with hand infections. Disclosures All Authors: No reported disclosures

An AraC/XylS Family Transcriptional Regulator Modulates the Oxidative Stress Response of Francisella tularensis

2021 ◽  
Author(s):  
Dina Marghani ◽  
Zhuo Ma ◽  
Anthony J. Centone ◽  
Weihua Huang ◽  
Meenakshi Malik ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Stress Response ◽  
Francisella Tularensis ◽  
Human Disease ◽  
Transcriptional Regulator ◽  
Intracellular Survival ◽  
Gram Negative ◽  
Expression Of Genes ◽  
Transcription Regulators

Francisella tularensis is a Gram-negative bacterium that causes a fatal human disease known as tularemia. The Centers for Disease Control have classified F. tularensis as Category A Tier-1 Select Agent. The virulence mechanisms of Francisella are not entirely understood. Francisella possesses very few transcription regulators, and most of these regulate the expression of genes involved in intracellular survival and virulence. The F. tularensis genome sequence analysis reveals an AraC ( FTL_ 0689) transcriptional regulator homologous to the AraC/XylS family of transcriptional regulators. In Gram-negative bacteria, AraC activates genes required for L-arabinose utilization and catabolism. The role of the FTL_ 0689 regulator in F. tularensis is not known. In this study, we characterized the role of FTL_ 0689 in gene regulation of F. tularensis and investigated its contribution to intracellular survival and virulence. The results demonstrate that FTL_0689 in Francisella is not required for L-arabinose utilization. Instead, FTL_ 0689 specifically regulates the expression of the oxidative and global stress response, virulence, metabolism, and other key pathways genes required by Francisella when exposed to oxidative stress. The FTL_0689 mutant is attenuated for intramacrophage growth and virulence in mice. Based on the deletion mutant phenotype, FTL_0689 was termed osrR ( o xidative s tress r esponse r egulator). Altogether, this study elucidates the role of the osrR transcriptional regulator in tularemia pathogenesis. IMPORTANCE: The virulence mechanisms of category A select agent Francisella tularensis , the causative agent of a fatal human disease known as tularemia, remain largely undefined. The present study investigated the role of a transcriptional regulator and its overall contribution to the oxidative stress resistance of F. tularensis . The results provide an insight into a novel gene regulatory mechanism, especially when Francisella is exposed to oxidative stress conditions. Understanding such Francisella - specific regulatory mechanisms will identify potential targets for developing effective therapies and vaccines to prevent tularemia.

Francisella tularensis infection

2020 ◽  
pp. 1091-1094
Author(s):  
Petra C.F. Oyston
Keyword(s):  
North America ◽  
Supportive Care ◽  
Francisella Tularensis ◽  
Clinical Presentation ◽  
Small Rodents ◽  
Gram Negative ◽  
Arthropod Vector ◽  
Positive Identification ◽  
Rich Media ◽  
Life Threatening

Fransicella tularensis is a small Gram-negative coccobacillus that circulates in small rodents, rabbits, and hares, most frequently in Scandinavia, northern North America, Japan, and Russia. Clinical presentation depends on the route of infection. Most commonly this follows the bite of an infected arthropod vector, resulting in ulceroglandular tularaemia. The most acute and life-threatening disease, respiratory or pneumonic tularaemia, arises following inhalation of infectious aerosols or dusts. The organism is highly fastidious, requiring rich media for isolation and specialized reagents for positive identification; most cases are diagnosed serologically. Treatment is with supportive care and antibiotics (usually ciprofloxacin, doxycycline, or gentamicin). There is no vaccine.

Tularemia

2016 ◽  
Author(s):  
Alida Gertz
Keyword(s):  
Health Care ◽  
Antibiotic Resistance ◽  
Oral Administration ◽  
Supportive Care ◽  
Health Care System ◽  
Francisella Tularensis ◽  
Small Mammals ◽  
Clinical Symptoms ◽  
Gram Negative ◽  
Route Of Transmission

Tularemia, caused by the gram-negative coccobacillus Francisella tularensis, is an extremely infectious bacterial zoonosis. Symptoms depend on site of exposure; they can be nonspecific and may include fever, lymphadenopathy, ulcer or papule, and nausea/vomiting. Natural transmission occurs via small mammals, such as rabbits, or arthropod bites. IV or IM antibiotics are preferred over oral forms. Supportive care is also critical; some patients may require respiratory support. If used as a biological weapon, aerosolized F. tularensis would be the most likely route of transmission. Clinical symptoms would include those of pneumonic tularemia. In the event of a bioterrorist attack, oral administration antibiotics can be used, as the health care system may not be able to accommodate intravenous or intramuscular treatment. Antibiotic resistance should also be considered if patients deteriorate despite use of recommended antibiotics.

scholarly journals Epidemiology of Inappropriate Empiric Antibiotic Therapy for Bacteremia Based on Discordant In vitro Susceptibilities: Risk factors and Taxon-level Variation in Burden and Outcome in 156 US hospitals, 2000–2014

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S13-S14
Author(s):  
Sameer S Kadri ◽  
Yi Ling Lai ◽  
Emily Ricotta ◽  
Jeffrey Strich ◽  
Ahmed Babiker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Therapy ◽  
Empiric Antibiotic Therapy ◽  
In Vitro Susceptibility ◽  
Gram Negative ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Empiric Antibiotic

Abstract Background Discordance between in vitro susceptibility and empiric antibiotic therapy is inextricably linked to antibiotic resistance and decreased survival in bloodstream infections (BSI). However, its prevalence, patient- and hospital-level risk factors, and impact on outcome in a large cohort and across different pathogens remain unclear. Methods We examined in vitro susceptibility interpretations for bacterial BSI and corresponding antibiotic therapy among inpatient encounters across 156 hospitals from 2000 to 2014 in the Cerner Healthfacts database. Discordance was defined as nonsusceptibility to initial therapy administered from 2 days before pathogen isolation to 1 day before final susceptibility reporting. Discordance prevalence was compared across taxa; risk factors and its association with in-hospital mortality were evaluated by logistic regression. Adjusted odds ratios (aOR) were estimated for pathogen-, patient- and facility-level factors. Results Of 33,161 unique encounters with BSIs, 4,219 (13%) at 123 hospitals met criteria for discordant antibiotic therapy, ranging from 3% for pneumococci to 55% for E. faecium. Discordance was higher in recent years (2010–2014 vs. 2005–2009) and was associated with older age, lower baseline SOFA score, urinary (vs. abdominal) source and hospital-onset BSI, as well as ≥500-bed, Midwestern, non-teaching, and rural hospitals. Discordant antibiotic therapy increased the risk of death [aOR = 1.3 [95% CI 1.1–1.4]). Among Gram-negative taxa, discordant therapy increased risk of mortality associated with Enterobacteriaceae (aOR = 1.3 [1.0–1.6]) and non-fermenters (aOR = 1.7 [1.1–2.5]). Among Gram-positive taxa, risk of mortality from discordant therapy was significantly higher for S. aureus (aOR = 1.3 [1.1–1.6]) but unchanged for streptococcal or enterococcal BSIs. Conclusion The prevalence of discordant antibiotic therapy displayed extensive taxon-level variability and was associated with patient and institutional factors. Discordance detrimentally impacted survival in Gram-negative and S. aureus BSIs. Understanding reasons behind observed differences in discordance risk and their impact on outcomes could inform stewardship efforts and guidelines for empiric therapy in sepsis. Disclosures All authors: No reported disclosures.

scholarly journals Tularemia of the Head and Neck: A Possible Sign of Bioterrorism

2003 ◽  
Vol 82 (4) ◽  
pp. 263-265 ◽  
Author(s):  
Howard D. Stupak ◽  
Michael C. Scheuller ◽  
David N. Schindler ◽  
David E. Ellison
Keyword(s):  
Head And Neck ◽  
Francisella Tularensis ◽  
Neck Mass ◽  
Biological Weapon ◽  
Diagnosis And Treatment ◽  
Biological Weapons ◽  
Biological Warfare ◽  
Gram Negative ◽  
Diagnosis And Management ◽  
Other World

Recent bioterror attacks and other world events have focused the medical community's attention on agents that might be used in biological warfare. One of these potential biological weapons is Francisella tularensis, a gram-negative coccobacillus that is one of the most infectious bacteria known. F tularensis can cause severe, even fatal, systemic tularemia. Under normal circumstances, F tularensis is transmitted by infected ticks, insects, and other animals. As a weapon of terrorism, the bacterium would likely be disseminated as an aerosol and contracted by inhalation. Because many cases of tularemia are characterized by head and neck symptoms, otolaryngologists should be familiar with the diagnosis and management of this disease. In this article, we describe a case of zoonotic tularemia that manifested as a neck mass, and we review the pathophysiology, diagnosis, and treatment of tularemia. We also summarize what is known about its potential as a biological weapon.

The unusual case of neck lymphadenopathy - oculoglandular form of tularemia

2018 ◽  
Vol 7 (2) ◽  
pp. 1-5
Author(s):  
Katarzyna Baranowska-Kempisty ◽  
Jolanta Kluz-Zawadzka ◽  
Sylwia Warzybok-Bajda ◽  
Krzysztof Szuber
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Francisella Tularensis ◽  
Unusual Case ◽  
Drug Research ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Elisa Test ◽  
Gram Negative ◽  
The Right

Tularemia is anthropozoonosis caused by Bacteria Francisella tularensis a gram negative, non-motile aerobic bacillus.[5][8] The bacteria is transmitted mostly by rabbits, hares, rodents and arthropods. The pathogen penetrates into an organism via damaged skin, conjunctiva or mucosa- either through inhalation or ingestion. The clinical manifestations depend on the route of acquisition. Six forms of the disease can be distinguished: ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory, typhoidal, and intestinal. [11] We present a case report of the rarest oculoglandular form of tularemia. The patient was admitted to the hospital with right pre-auricular swelling, right sided neck lymphadenopathy, conjunctivitis and a nodule of the right eyelid. After excluding more common differential diagnoses, an ELISA test was performed and Francisella tularensis antibodies were identified. Patient administered proper antibiotic therapy. Tularemia is a rarely occurring disease in Poland and is nearly never taken into consideration by otolaryngologists when diagnosing patients with neck lymphadenopathy. In clinical practice, otorhinolaryngologists should always consider this infectious zoonosis, especially the oculoglandular and oropharyngeal forms, as delayed diagnosis and treatment may causes serious health consequences in patients. In the future new drug research should be conducted because of the adverse effect of widely used medications specially for children and pregnant woman.

scholarly journals SECRETORY IMMUNOGLOBULIN A LEVEL IN SALIVA OF CHRONIC KIDNEY DISEASE PATIENTS ON DIALYSIS

2014 ◽  
pp. 14-18
Author(s):  
A. V. Klimchuk
Keyword(s):  
Immunoglobulin A ◽  
Bacterial Toxins ◽  
Gram Negative Bacteria ◽  
Secretory Immunoglobulin A ◽  
Dialysis Patients ◽  
Gram Negative ◽  
Markers Of Inflammation ◽  
Endotoxin Translocation ◽  
Mucous Membranes ◽  
Secretory Immunoglobulin

Dialysis patients have elevated levels of markers of inflammation. Endotoxin of gram negative bacteria is one of the most potent inducers of inflammation. Endotoxin translocation from the gut into the blood can triggerproinflammatory response. Secretory immunoglobulin A (sIgA) in the mucous membranes can neutralize bacterial toxins and prevent their translocation, if the immune response is adequate.

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