Epidemiological Review of Francisella Tularensis: A Case Study in the Complications of Dual Diagnoses

Identification of Most Relevant Features for Classification of Francisella tularensis using Machine Learning

Background:

Francisella tularensis is a stealth pathogen fatal for animals and humans. Ease of its propagation, coupled with high capacity for ailment and death makes it a potential candidate for biological weapon.

Objective:

Work related to the pathogen’s classification and factors affecting its prolonged existence in soil is limited to statistical measures. Machine learning other than conventional analysis methods may be applied to better predict epidemiological modeling for this soil-borne pathogen.

Methods:

Feature-ranking algorithms namely; relief, correlation and oneR are used for soil attribute ranking. Moreover, classification algorithms; SVM, random forest, naive bayes, logistic regression and MLP are used for classification of the soil attribute dataset for Francisella tularensis positive and negative soils.

Results:

Feature-ranking methods concluded that clay, nitrogen, organic matter, soluble salts, zinc, silt and nickel are the most significant attributes while potassium, phosphorous, iron, calcium, copper, chromium and sand are the least contributing risk factors for the persistence of the pathogen. However, clay is the most significant and potassium is the least contributing attribute. Data analysis suggests that feature-ranking using relief produced classification accuracy of 84.35% for multilayer perceptron; 82.99% for linear regression; 80.27% for SVM and random forest; and 78.23% for naive bayes, which is better than other ranking methods. MLP outperforms other classifiers by generating an accuracy of 84.35%, 82.99% and 81.63% for feature-ranking using relief, correlation and oneR algorithms, respectively.

Conclusion:

These models can significantly improve accuracy and can minimize the risk of incorrect classification. They further help in controlling epidemics and thereby minimizing the socio-economic impact on the society.

Seroepidemiology, Spatial Distribution, and Risk Factors of Francisella tularensis in Jordan

There is a paucity of data on Francisella tularensis in the Middle East and North Africa. This is the first countrywide study to determine the seroprevalence, spatial distribution, and risk factors for F. tularensis in Jordan. A total of 828 Jordanians were serologically tested for F. tularensis by ELISA. These individuals filled out a self-administered questionnaire to collect demographic and risk factor information. Bivariate and multivariate logistic regressions were performed to determine which variables are associated with seropositivity. The overall seroprevalence of F. tularensis was 7.7% (95% CI: 6.10-9.75). The bivariate analyses showed that age, region of residence, small ruminant ownership, and practicing horticulture were significantly associated with seropositivity, and these variables were controlled for in the multivariate analysis. The multivariate analysis showed an increased odds of seropositivity among individuals living in northern desert, middle, and northern highland areas, compared with individuals living in the drier southern area, as 7.27 (95% CI: 2.49-21.19), 3.79 (95% CI: 1.53-9.39), and 3.52 (95% CI: 1.45-388.55), respectively. Individuals owning a small ruminant had 1.86 (95% CI: 1.02-3.40) greater odds for seropositivity than individuals who do not own a small ruminant. Individuals practicing horticulture had 2.10 (95% CI: 1.20-3.66) greater odds for seropositivity than individuals who do not practice horticulture. This is the first study to address the seroprevalence of F. tularensis in Jordan and the Middle East. Further research is needed to identify clinical cases of tularemia in Jordan and to determine the circulating F. tularensis subspecies.

First case report of post-operative infection due to Francisella tularensis after cardiac surgery

BACKGROUND

Francisella tularensis is a rare zoonotic bacterium that spreads sporadically by various routes, including infected arthropod bites, ingestion of contaminated water and inhalation of contaminated dust. However, its occurrence in postoperative chest infection has never been reported. Pathogen isolation, serology and molecular detection methods are commonly used for the diagnosis of tularaemia.

CASE PRESENTATION

We present the first case report of the isolation of F. tularensis from a patient with a chest infection (a boy in his teens) following cardiac surgery for closure of a ventral septal defect. It was isolated on blood and chocolate agar on the third day after the subculture of drain fluid collected in a blood culture bottle incubated in Bact T/Alert 3-D (bioMerieux, France). The organism was identified as F. tularensis by Vitek GN ID Cards (Vitek 2 Compact, bioMerieux, France). The patient made a smooth recovery with antibiotic therapy.

CONCLUSION

F. tularensis can cause post-operative infection, especially in patients with a rural background.

Multiplex Detection of Three Select Agents Directly from Blood by Use of the GeneXpert System

Francisella tularensis, Bacillus anthracis, and Yersinia pestis are tier 1 select agents with the potential to rapidly cause severe disease. Rapid detection of these bacteria from patient samples at the point of care could contribute to improved clinical outcomes in the event of a bioterrorism attack. A multiplex nested PCR assay for detection of F. tularensis, B. anthracis, and Y. pestis directly from patient blood samples was developed using the GeneXpert system. The multiplex GeneXpert cartridge-based assay includes all necessary sample processing and amplification reagents. Blood samples spiked with different numbers of CFU were used to measure the analytical limit of detection (LOD) and dynamic range. Sensitivity was determined by testing spiked blood samples and negative-control blood in a blind manner. Specificity was determined by testing against nontarget pathogens and blood samples from clinical patients. The assay LOD was 8.5 CFU/ml for F. tularensis, 10 CFU/ml for B. anthracis, and 4.5 CFU/ml for Y. pestis The sensitivity was 100% at the LOD for all three select agent bacteria in spiked patient blood samples. The assay specificity was 100% when it was tested against both nontarget pathogens and clinical patient blood samples. The total assay time was approximately 100 min. This automated assay, which is suitable for use at the point of care, identifies three select agents directly in blood without the need for enrichment with a high sensitivity within 100 min. This assay may enable rapid detection and treatment of patients infected with the target organisms in the event of a bioterrorism attack.

Nodular Lymphangitis (Sporotrichoid Lymphocutaneous Infections). Clues to Differential Diagnosis

Nodular lymphangitis, also known as sporotrichoid lymphocutaneous infections, is characterized by suppurative inflammatory nodules along the lymphatic vessels. This manifestation is classic of sporotrichosis, however, other infections such as nocardiosis, atypical mycobacteriosis, leishmaniasis, among others, can also express this clinical pattern. Sporotrichosis, which often occurs in gardeners, remains the most recognized cause of nodular lymphangitis. The histopathological studies, as well as the culture are diagnostic standards of lesions that do not respond to empirical treatment. In this article, we will review the main causes of nodular lymphangitis or lymphocutaneous sporotrichoid infections.