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Marx GE, Curren E, Olesen M, Cronquist L, Schlosser L, Nichols M, Bye M, Cote A, McCormick DW, Nelson CA. Tularemia From Veterinary Occupational Exposure. Clin Infect Dis 2024; 78:S71-S75. [PMID: 38294113 DOI: 10.1093/cid/ciad687] [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: 02/01/2024] Open
Abstract
Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia.
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Affiliation(s)
- Grace E Marx
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Emily Curren
- Wyoming Department of Public Health, Cheyenne, Wyoming, USA
| | | | - Laura Cronquist
- North Dakota Department of Health and Human Services, Bismarck, North Dakota, USA
| | - Levi Schlosser
- North Dakota Department of Health and Human Services, Bismarck, North Dakota, USA
| | - Matthew Nichols
- Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA
| | - Maria Bye
- Minnesota Department of Health, St Paul, Minnesota, USA
| | - Andrea Cote
- Wyoming Department of Public Health, Cheyenne, Wyoming, USA
- Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, Atlanta, Georgia, USA
| | - David W McCormick
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Christina A Nelson
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
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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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Formińska K, Wołkowicz T, Brodzik K, Stefanoff P, Gołąb E, Masny A, Osiak B, Cieślik P, Bielawska-Drózd A, Zasada AA. Genetic diversity of Francisella tularensis in Poland with comments on MLVA genotyping and a proposition of a novel rapid v4-genotyping. Ticks Tick Borne Dis 2019; 11:101322. [PMID: 31711731 DOI: 10.1016/j.ttbdis.2019.101322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 01/05/2023]
Abstract
We investigated the genotypes of Francisella tularensis (F. tularensis) strains isolated in Poland during the period 1953-2013 and studied their genetic relationship to F. tularensis strains isolated in other countries using MLVA. We examined the mosquito and tick samples collected in Poland for the presence of F. tularensis DNA using PCR. Our results revealed a high genetic diversity among the strains of F. tularensis collected from Poland, suggesting that the bacterium is commonly found in the environment. However, we did not detect F. tularensis DNA in ticks and mosquitoes, showing that the arthropod bites might not be the main source of infection. We also propose the application of a practical assay called v4-genotyping that can be directly performed on the clinical and environmental samples. In addition, we discovered genetic variations among Schu S4 reference strains used in various laboratories and showed that MLVA analysis should not be based on amplicon sizes only because point mutations occurring within the MLVA loci might not always be manifested by a change in the amplicon size.
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Affiliation(s)
- Kamila Formińska
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Tomasz Wołkowicz
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Klaudia Brodzik
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Paweł Stefanoff
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Elżbieta Gołąb
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Aleksander Masny
- National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | | | - Piotr Cieślik
- Military Institute of Hygiene and Epidemiology, Puławy, Poland
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Bielawska-Drózd A, Cieślik P, Żakowska D, Głowacka P, Wlizło-Skowronek B, Zięba P, Zdun A. Detection of Coxiella burnetii and Francisella tularensis in Tissues of Wild-living Animals and in Ticks of North-west Poland. Pol J Microbiol 2019; 67:529-534. [PMID: 30550240 PMCID: PMC7256700 DOI: 10.21307/pjm-2018-059] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 01/28/2023] Open
Abstract
This work presents results of the research on the occurrence of Coxiella burnetii and Francisella tularensis in the tissues of wild-living animals and ticks collected from Drawsko County, West Pomeranian Voivodeship. The real-time PCR testing for the pathogens comprised 928 samples of animal internal organs and 1551 ticks. The presence of C. burnetii was detected in 3% of wild-living animals and in 0.45–3.45% (dependent on collection areas) of ticks. The genetic sequences of F. tularensis were present in 0.49 % of ticks (only in one location – Drawa) and were not detected in animal tissues. The results indicate respectively low proportion of animals and ticks infected with C. burnetii and F. tularensis.
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Affiliation(s)
- Agata Bielawska-Drózd
- Biological Threats Identification and Countermeasure Center, Military Institute of Hygiene and Epidemiology , Puławy , Poland
| | - Piotr Cieślik
- Biological Threats Identification and Countermeasure Center, Military Institute of Hygiene and Epidemiology , Puławy , Poland
| | - Dorota Żakowska
- Biological Threats Identification and Countermeasure Center, Military Institute of Hygiene and Epidemiology , Puławy , Poland
| | - Patrycja Głowacka
- Biological Threats Identification and Countermeasure Center, Military Institute of Hygiene and Epidemiology , Puławy , Poland
| | - Bożena Wlizło-Skowronek
- Biological Threats Identification and Countermeasure Center, Military Institute of Hygiene and Epidemiology , Puławy , Poland
| | | | - Arkadiusz Zdun
- Environmental Protection Regional Directorate, Field Department , Złocieniec , Poland
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Rastawicki W, Formińska K, Zasada AA. Development and Evaluation of a Latex Agglutination Test for the Identification of Francisella tularensis Subspecies Pathogenic for Human. Pol J Microbiol 2018; 67:241-244. [PMID: 30015465 PMCID: PMC7256844 DOI: 10.21307/pjm-2018-030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 11/11/2022] Open
Abstract
Francisella tularensis are highly infectious bacteria causing a zoonotic disease called tularemia. Identification of this bacterium is based on antigen detection or PCR. The paper presents a latex agglutination test (LAT) for rapid identification of clinically relevant F. tularensis subspecies. The test can be performed within three minutes with live or inactivated bacteria. The possibility to test the inactivated samples reduces the risk of laboratory acquired infection and allows performing the test under BSL-2 conditions.
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Affiliation(s)
- Waldemar Rastawicki
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene,Warsaw,Poland
| | - Kamila Formińska
- Department of Sera and Vaccines Evaluation, National Institute of Public Health - National Institute of Hygiene,Warsaw,Poland
| | - Aleksandra A Zasada
- Department of Sera and Vaccines Evaluation, National Institute of Public Health - National Institute of Hygiene,Warsaw,Poland
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Krzysiak MK, Iwaniak W, Kęsik-Maliszewska J, Olech W, Larska M. Serological Study of Exposure to Selected Arthropod-Borne Pathogens in European Bison (Bison bonasus) in Poland. Transbound Emerg Dis 2016; 64:1411-1423. [DOI: 10.1111/tbed.12524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 01/16/2023]
Affiliation(s)
- M. K. Krzysiak
- European Bison Breeding Centre; Białowieża National Park; Białowieża Poland
| | - W. Iwaniak
- Department of Microbiology; National Veterinary Research Institute; Puławy Poland
| | | | - W. Olech
- Department of Genetics and Animal Breeding; Warsaw University of Life Sciences; Warsaw Poland
| | - M. Larska
- Department of Virology; National Veterinary Research Institute; Puławy Poland
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