Clinical recognition and management of tularemia in Missouri: a retrospective chart review of 121 cases.
Clin Infect Dis. 2012 Aug 21;
Authors: Weber IB, Turabelidze G, Patrick S, Griffith KS, Mead PS, Kugeler KJ
Background.?Clinical recognition of tularemia is essential for initiating prompt appropriate antibiotic treatment. Although fluoroquinolones have desirable attributes as a treatment option, there are limited data on efficacy in the U.S. setting.Methods.?To define the epidemiology of tularemia in Missouri, and to evaluate practices and outcomes of tularemia management in general, we conducted a detailed retrospective review and analysis of clinical records for patients reported to the State from 2000-2007.Results.?We reviewed records of 121 (64%) of 190 patients reported with tularemia; 79 (65%) were males; the median age was 37 years. Most patients presented with ulceroglandular (37%) and glandular (25%) forms of tularemia, followed by pneumonic (12%), typhoidal (10%), oculoglandular (3%), and oropharyngeal (2%) forms. Most cases (69%) were attributed to tick bites. Median incubation period was 3 days (range 1-9 days), and patients sought care after a median of three days of illness (range 0-44 days). Systemic disease occurred more commonly in older patients. Patients were prescribed tetracyclines (49%), aminoglycosides (47%), and fluoroquinolones (41%). Nine of ten patients treated with ciprofloxacin for ? 10 days recovered uneventfully, without accompanying aminoglycosides or tetracyclines.Conclusions.?Tularemia is frequently initially misdiagnosed. A thorough exposure history, particularly for tick bites, and awareness of clinical features may prompt clinicians to consider tularemia and facilitate appropriate testing. Promising success with oral fluoroquinolones could provide an acceptable alternative to intravenous aminoglycosides or long courses of tetracyclines where clinically appropriate.
PMID: 22911645 [PubMed - as supplied by publisher]