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Kara SS, Polat M, Erdeniz EH, Donmez AS. Pediatric Oropharyngeal Tularemia Cases: Challenges in Management. Vector Borne Zoonotic Dis 2024; 24:585-590. [PMID: 38651622 DOI: 10.1089/vbz.2023.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Background: Tularemia is one of the most prevalent zoonoses across the world. Patients in Turkiye mostly contract the oropharyngeal form, acquired through drinking, or contact with microorganism-contaminated water. Methods: Patients with oropharyngeal tularemia aged under 18 years and diagnosed between January 01, 2017, and December 31, 2020, were evaluated retrospectively. Tularemia was diagnosed in patients with compatible histories, symptoms, clinical presentations, and laboratory test results. Results: The mean age of 38 children was 12.1 ± 3.4 years, and the female/male ratio was 0.58 (14/24). The mean duration of symptoms on admission was 33.8 ± 26.2 days. All children had enlarged lymph nodes. Malaise, fever, and loss of appetite were other frequent symptoms. Patients were treated with antibiotics for a mean of 26.2 ± 18.8 days. Gentamycin was the most frequently used antibiotic (either alone or in combination) (n = 29, 76.3%). Twenty-six (68.4%) patients underwent surgical procedures in addition to antibiotherapy. Five (13.2%) required secondary total excision. Patients with higher leukocyte counts at admission received a combination of antibiotherapy plus surgery, rather than antibiotics alone. No relapses, reretreatment requirement, or mortality were observed after 12 months of follow-up. Conclusions: Oropharyngeal tularemia in children can require longer courses of antibiotic treatment with more than one drug and more frequent surgery than previously suggested in the literature, especially if the patients are admitted late to the hospital, symptom duration is prolonged, and appropriate treatment is initiated late. Higher leukocyte counts on admission may be prognostic for longer antibiotic treatment course and suppurative complications that require surgery. Raising awareness among patients and physicians is essential.
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Affiliation(s)
- Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Aydin Adnan Menderes University, Aydin, Turkiye
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
| | - Meltem Polat
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
- Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkiye
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
- Department of Pediatric Infectious Diseases, Samsun Ondokuz Mayis University, Samsun, Turkiye
| | - Ayşe Sena Donmez
- Department of Pediatrics, Erzurum Regional Training and Research Hospital, Erzurum, Turkiye
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Maurin M, Pondérand L, Hennebique A, Pelloux I, Boisset S, Caspar Y. Tularemia treatment: experimental and clinical data. Front Microbiol 2024; 14:1348323. [PMID: 38298538 PMCID: PMC10827922 DOI: 10.3389/fmicb.2023.1348323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Tularemia is a zoonosis caused by the Gram negative, facultative intracellular bacterium Francisella tularensis. This disease has multiple clinical presentations according to the route of infection, the virulence of the infecting bacterial strain, and the underlying medical condition of infected persons. Systemic infections (e.g., pneumonic and typhoidal form) and complications are rare but may be life threatening. Most people suffer from local infection (e.g., skin ulcer, conjunctivitis, or pharyngitis) with regional lymphadenopathy, which evolve to suppuration in about 30% of patients and a chronic course of infection. Current treatment recommendations have been established to manage acute infections in the context of a biological threat and do not consider the great variability of clinical situations. This review summarizes literature data on antibiotic efficacy against F. tularensis in vitro, in animal models, and in humans. Empirical treatment with beta-lactams, most macrolides, or anti-tuberculosis agents is usually ineffective. The aminoglycosides gentamicin and streptomycin remain the gold standard for severe infections, and the fluoroquinolones and doxycycline for infections of mild severity, although current data indicate the former are usually more effective. However, the antibiotic treatments reported in the literature are highly variable in their composition and duration depending on the clinical manifestations, the age and health status of the patient, the presence of complications, and the evolution of the disease. Many patients received several antibiotics in combination or successively. Whatever the antibiotic treatment administered, variable but high rates of treatment failures and relapses are still observed, especially in patients treated more then 2-3 weeks after disease onset. In these patients, surgical treatment is often necessary for cure, including drainage or removal of suppurative lymph nodes or other infectious foci. It is currently difficult to establish therapeutic recommendations, particularly due to lack of comparative randomized studies. However, we have attempted to summarize current knowledge through proposals for improving tularemia treatment which will have to be discussed by a group of experts. A major factor in improving the prognosis of patients with tularemia is the early administration of appropriate treatment, which requires better medical knowledge and diagnostic strategy of this disease.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Léa Pondérand
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Aurélie Hennebique
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Translational Innovation in Medicine and Complexity (TIMC), Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Isabelle Pelloux
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
| | - Sandrine Boisset
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
| | - Yvan Caspar
- Centre National de Référence Francisella tularensis, CHU Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, Commissariat à l’énergie atomique (CEA), CNRS, Institut de Biologie Structurale (IBS), Grenoble, France
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Pfeil J, Heuner K, Scholz H, Strozyk T, Jacob D. Ulkus und Lymphadenitis nach Zeckenstich. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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4
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Schöbi N, Agyeman PKA, Duppenthaler A, Bartenstein A, Keller PM, Suter-Riniker F, Schmidt KM, Kopp MV, Aebi C. PEDIATRIC TULAREMIA– A CASE SERIES FROM A SINGLE CENTER IN SWITZERLAND. Open Forum Infect Dis 2022; 9:ofac292. [PMID: 35873298 PMCID: PMC9301579 DOI: 10.1093/ofid/ofac292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of tularemia has recently increased throughout Europe. Pediatric tularemia typically presents with ulceroglandular or glandular disease and requires antimicrobial therapy not used in the empirical management of childhood acute lymphadenitis. We describe the clinical presentation and course in a case series comprising 20 patients. Methods This is a retrospective analysis of a single-center case series of microbiologically confirmed tularemia in patients <16 years of age diagnosed between 2010 and 2021. Results Nineteen patients (95%) presented with ulceroglandular (n = 14) or glandular disease (n = 5), respectively. A characteristic entry site lesion (eschar) was present in 14 (74%). Fever was present at illness onset in 15 patients (75%) and disappeared in all patients before targeted therapy was initiated. The diagnosis was confirmed by serology in 18 patients (90%). While immunochromatography was positive as early as on day 7, a microagglutination test titer 1:≥160 was found no earlier than on day 13. Sixteen patients (80%) were initially treated with an antimicrobial agent ineffective against F. tularensis. The median delay (range) from illness onset to initiation of targeted therapy was 12 (6–40) days. Surgical incision and drainage were ultimately performed in 12 patients (60%). Conclusions Pediatric tularemia in Switzerland usually presents with early, self-limiting fever and a characteristic entry site lesion with regional lymphadenopathy draining the scalp or legs. Particularly in association with a tick exposure history, this presentation may allow early first-line therapy with an agent specifically targeting F. tularensis, potentially obviating the need for surgical therapy.
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Affiliation(s)
- Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Philipp KA Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Andrea Duppenthaler
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Andreas Bartenstein
- Department of Pediatric Surgery, Bern University Hospital, Inselspital, University of Bern , Switzerland
| | - Peter M Keller
- Institute for Infectious Diseases, University of Bern , Switzerland
| | | | - Kristina M Schmidt
- Spiez Laboratory, Federal Office for Civil Protection and Swiss National Reference Center for Francisella tularensis (NANT) , Spiez , Switzerland
| | - Matthias V Kopp
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
- 17 Center North (ARCN), Member of the German Lung Research Center (DZL) , 18 University of Luebeck , Germany
| | - Christoph Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern , Switzerland
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Kukla R, Kračmarová R, Ryšková L, Bavlovič J, Pellantová V, Bolehovská R, Fajfr M, Pavlík I, Boštík P. Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review. Ticks Tick Borne Dis 2021; 13:101893. [PMID: 34990926 DOI: 10.1016/j.ttbdis.2021.101893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.
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Affiliation(s)
- Rudolf Kukla
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Renata Kračmarová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Lenka Ryšková
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Jan Bavlovič
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic; Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defence, Trebešská 1575, 50001 Hradec Králové, Czech Republic
| | - Věra Pellantová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Radka Bolehovská
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Miroslav Fajfr
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Ivo Pavlík
- Faculty of Regional Development and International Studies, Mendel University in Brno, tr. Generála Píky 7, 61300, Brno, Czech Republic
| | - Pavel Boštík
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic.
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Drago F, Ciccarese G, Merlo G, Trave I, Javor S, Rebora A, Parodi A. Oral and cutaneous manifestations of viral and bacterial infections: Not only COVID-19 disease. Clin Dermatol 2021; 39:384-404. [PMID: 34517997 PMCID: PMC7849469 DOI: 10.1016/j.clindermatol.2021.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy.
| | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, Alessandria, Italy
| | - Ilaria Trave
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Sanja Javor
- Dermatology Unit, Galliera Hospital, Via Mura delle Cappuccine 14, Genoa, Italy
| | - Alfredo Rebora
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
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7
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Martinet P, Khatchatourian L, Saidani N, Fangous MS, Goulon D, Lesecq L, Le Gall F, Guerpillon B, Corre R, Bizien N, Talarmin JP. Hypermetabolic pulmonary lesions on FDG-PET/CT: Tularemia or neoplasia? Infect Dis Now 2021; 51:607-613. [PMID: 34242840 DOI: 10.1016/j.idnow.2021.06.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pulmonary tularemia is a rare and little-known disease, whose clinical and radiological presentation can be confused with those of much more frequent pathologies, such as lung cancer or B-cell lymphoma (46,000 and 5,000 new cases respectively per year in France). Furthermore, PET/CT is a powerful tool for the diagnosis of malignancies or the exploration of fever of unknown origin. The objective of this study was to describe the characteristics of pulmonary tularemia and to determine whether its PET/CT aspect could help distinguish it from neoplasia. METHODS Retrospective observational study collecting all pulmonary tularemia cases for which a PET/CT was performed between 2016 and 2020. RESULTS Twenty-seven cases of pulmonary tularemia were analyzed. The sex ratio was 4.4, and the median age was 60 years. Clinical manifestations were mainly represented by fever (n=23), arthralgia (n=7) and cough (n=6). PET/CT revealed intensely hypermetabolic mediastinal adenopathies in all cases, associated with parenchymal (n=20) or pleural (n=6) lesions, suggesting neoplastic pathology in 15 patients. Cytopuncture or lymph node biopsy was performed in 16 patients, revealing non-specific adenitis (n=8), necrotic epithelio-gigantocellular granuloma (n=3), or were non-contributory (n=5). All patients reported significant environmental exposure. The outcome was favorable for all patients, spontaneously for 8 of them and after antibiotic therapy with either doxycycline or ciprofloxacin for the other 19. CONCLUSIONS Depending on the epidemiological setting, pulmonary tularemia may be considered an alternative diagnosis to lung cancer, lymphoma, or tuberculosis, in the presence of infectious symptoms and hypermetabolic pulmonary lesions and mediastinal lymphadenopathies on PET/CT.
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Affiliation(s)
- Pauline Martinet
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Lydie Khatchatourian
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Nadia Saidani
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Marie-Sarah Fangous
- Department of Microbiology, Centre Hospitalier de Cornouaille, Quimper, France
| | - Dorothée Goulon
- Department of Nuclear Medicine, Centre Georges Charpak, Quimper, France
| | - Ludovic Lesecq
- Department of Infectious Diseases, Clinique Saint Michel, Quimper, France
| | - Florence Le Gall
- Department of Microbiology, Centre Hospitalier de Cornouaille, Quimper, France
| | - Brice Guerpillon
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France
| | - Romain Corre
- Department of Pulmonary Diseases, Centre Hospitalier de Cornouaille, Quimper, France
| | - Nicolas Bizien
- Department of Pulmonary Diseases, Centre Hospitalier de Cornouaille, Quimper, France
| | - Jean-Philippe Talarmin
- Department of Infectious Diseases, Centre Hospitalier de Cornouaille, 14, avenue Yves Thépot, 29000 Quimper, France.
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8
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Zeggay A, Anxionnat R, Chirouze C, Plésiat P, Jeannot K, Caspar Y, Potron A. An unusual digestive infection due to Francisella tularensis: A case report. Infect Dis Now 2021; 51:680-682. [PMID: 33870890 DOI: 10.1016/j.idnow.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A Zeggay
- Service de Pédiatrie, Centre Hospitalier Universitaire de Besançon, Besançon, France; Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - R Anxionnat
- Service de Pédiatrie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - C Chirouze
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Besançon, Besançon, France; UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France
| | - P Plésiat
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - K Jeannot
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Y Caspar
- Centre National de Référence des Francisella, Centre Hospitalier Universitaire de Grenoble, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France
| | - A Potron
- UMR CNRS 6249 chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Besançon, Besançon, France.
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Ahmad F, Farooq A, Ghani Khan MU, Shabbir MZ, Rabbani M, Hussain I. Identification of Most Relevant Features for Classification of Francisella tularensis using Machine Learning. Curr Bioinform 2021. [DOI: 10.2174/1574893615666200219113900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Fareed Ahmad
- Department of Computer Science and Engineering, Faculty of Electrical Engineering, University of Engineering and Technology, Lahore, Pakistan
| | - Amjad Farooq
- Department of Computer Science and Engineering, Faculty of Electrical Engineering, University of Engineering and Technology, Lahore, Pakistan
| | - Muhammad Usman Ghani Khan
- Department of Computer Science and Engineering, Faculty of Electrical Engineering, University of Engineering and Technology, Lahore, Pakistan
| | | | - Masood Rabbani
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Irshad Hussain
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Nemmour A, Bakri A, Fischer CA, Brand Y. Paediatric oropharyngeal tularaemia requiring surgical intervention. BMJ Case Rep 2019; 12:e229754. [PMID: 31494583 PMCID: PMC6731923 DOI: 10.1136/bcr-2019-229754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/04/2022] Open
Abstract
Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.
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Affiliation(s)
- Amina Nemmour
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Adzreil Bakri
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia
| | - Claude A Fischer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
| | - Yves Brand
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland
- University Basel, Basel, Switzerland
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12
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Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:489-496. [PMID: 31186166 DOI: 10.1016/j.anorl.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect. METHODS A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).
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Drago F, Javor S, Parodi A. Case Report: Atypical Cutaneous Manifestations of Tularemia after Horsefly Bite. Am J Trop Med Hyg 2018; 98:1592-1593. [DOI: 10.4269/ajtmh.17-0615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Francesco Drago
- Department of Dermatology, Department of Health Sciences, Polyclinic Hospital San Martino-IST, Genoa, Italy
| | - Sanja Javor
- Department of Dermatology, Department of Health Sciences, Polyclinic Hospital San Martino-IST, Genoa, Italy
| | - Aurora Parodi
- Department of Dermatology, Department of Health Sciences, Polyclinic Hospital San Martino-IST, Genoa, Italy
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Polat M, Karapınar T, Sırmatel F. Dermatological aspects of tularaemia: a study of 168 cases. Clin Exp Dermatol 2018; 43:770-774. [PMID: 29761532 DOI: 10.1111/ced.13548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tularaemia is a zoonotic infectious disease caused by Francisella tularensis, an aerobic, uncapsulated, gram-negative coccobacillus. Several case reports have appeared on the dermatological manifestations of tularaemia, but relatively few longer-term studies are available. AIM To identify skin features of tularaemia that aid in its diagnosis. METHODS In total, 168 patients (68 male, 100 female) diagnosed with tularaemia were retrospectively examined. All dermatological data for these patients were evaluated. RESULTS Of the 168 patients, 149 (88.69%) had tularaemia of the oropharyngeal type, 12 (7.73%) had the ulceroglandular type, 5 (2.9%) had the oculoglandular type and 2 (0.59%) had the pulmonary type. Secondary skin manifestations were found in 26 patients (15.47%). Sweet syndrome (SS) was found in 11 patients (6.54%), most of whom presented with the oropharyngeal form, while erythema nodosum (EN) was found in 7 patients (4.16%), dermatitis in 2 (1.19%), urticaria in 2 (1.19%), acneiform eruptions in 1 (0.59%), vasculitis-like eruptions in 1 (0.59%) and SS + EN in 1 (0.59%). Patients with the oropharyngeal form had a statistically significant (P < 0.001) higher number of skin findings than patients with the other forms. CONCLUSIONS In clinical practice, tularaemia may present with various cutaneous manifestations, and dermatologists who work in endemic regions must be aware of the possibility of this disease.
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Affiliation(s)
- M Polat
- Department of Dermatology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - T Karapınar
- Department of Dermatology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - F Sırmatel
- Department of Infectious Diseases, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
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Karlı A, Şensoy G, Paksu Ş, Korkmaz MF, Ertuğrul Ö, Karlı R. Treatment-failure tularemia in children. KOREAN JOURNAL OF PEDIATRICS 2018; 61:49-52. [PMID: 29563944 PMCID: PMC5854842 DOI: 10.3345/kjp.2018.61.2.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/10/2017] [Accepted: 12/15/2017] [Indexed: 01/14/2023]
Abstract
Purpose Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results Before diagnosis, the duration of symptoms in patients was 32.15±17.8 days. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10–14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.
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Affiliation(s)
- Arzu Karlı
- Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Gülnar Şensoy
- Division of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Şule Paksu
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | | | - Ömer Ertuğrul
- Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Rıfat Karlı
- Department of Otorhinolaryngology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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