Targeting Tularemia: Clinical, Laboratory, and Treatment Outcomes From an 11-year Retrospective Observational Cohort in Northern Sweden

被引:4
|
作者
Plymoth, Martin [1 ,2 ]
Lundquist, Robert [3 ]
Nystedt, Anders [4 ]
Sjoestedt, Anders
Gustafsson, Tomas N. [1 ,5 ]
机构
[1] Umea Univ, Dept Clin Microbiol, Sunderby Res Unit, Umea, Sweden
[2] Westmead Hosp, Dept Infect Dis, Sydney, NSW, Australia
[3] Umea Univ, Dept Publ Hlth & Clin Med, Sunderby Res Unit, Umea, Sweden
[4] Cty Council Norrbotten, Dept Communicable Dis Control, Lulea, Sweden
[5] Umea Univ, Dept Clin Microbiol, SE-90185 Umea, Sweden
关键词
Francisella tularensis; doxycycline; ciprofloxacin; treatment; outcome; OUTBREAK; DIAGNOSIS; MANIFESTATIONS; EPIDEMIOLOGY;
D O I
10.1093/cid/ciae098
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Tularemia is an important reemerging disease with a multimodal transmission pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden. Methods. Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011 and 2021 were collected through review of electronic medical records and participant questionnaires; 415 of 784 accepted participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or polymerase chain reaction). A multivariable logistic regression model was used to investigate variables associated with retreatment. Results. Median age of participants was 54 years (interquartile range [IQR], 41.5-65) and 49.2% were female. Although ulceroglandular tularemia was the predominant form (n = 215, 65.7%), there were several cases of pulmonary tularemia (n = 40; 12.2%). Inflammatory markers were largely nonspecific, with monocytosis frequently observed (n = 36/75; 48%). Tularemia was often misdiagnosed on presentation (n = 158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics and 102 (31.2%) retreated. Persistent lymphadenopathy was infrequent (n = 22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with retreatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR, 3.25-20.75] vs 7 [IQR, 4-11.25] days; adjusted P = .076), and doxycycline-based treatment regimen (vs ciprofloxacin; adjusted P = .084), although this was not significant after correction for multiple comparisons. Conclusions. We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis, and timely commencement of treatment for an appropriate duration.
引用
收藏
页码:1222 / 1231
页数:10
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