Volume 78, Issue Supplement_1, 15 February 2024

Among 1,163 case-patients with tularemia reported in the US, the most common manifestations were ulceroglandular/glandular (58.0%), pneumonic (15.8%), and typhoidal (12.6%) disease. Case-fatality rate was low (2.3%); treatment with aminoglycosides, fluoroquinolones, or tetracyclines was associated with increased odds of survival.

In an observational study of severe respiratory tularemia acquired by inhalation of Francisella tularensis aerosols, ciprofloxacin and levofloxacin appeared to be highly effective for treatment. Results were consistent between bacteremic and nonbacteremic illness.

Tularemia has been associated with adverse outcomes in pregnancies where no effective antimicrobials were administered. Possible evidence of F. tularensis in placental and fetal tissues suggests that tularemia is transmissible from mother to fetus in the absence of effective treatment.

Francisella tularensis can cause neuroinvasive infection. Clinicians should consider directed, multimodal laboratory testing in patients with central nervous system infection and epidemiologic or clinical features suggestive of tularemia. Combination antibiotic treatment can be curative.

A male patient with nodules for six years developed empyema. Francisella tularensis holarctica was isolated from thoracentesis fluid. Retrospective immunohistochemical examination of a pulmonary nodule, biopsied three years prior, was immunoreactive for F. tularensis, suggesting the potential for chronic tularemia.

Ulceroglandular tularemia in a veterinarian occurred after an accidental needlestick injury. A survey describing 20 veterinary occupational exposures to animals with confirmed tularemia identified no additional cases despite infrequent personal protective equipment usage and inadequate post-exposure prophylaxis after high-risk exposures.