You are here

Article Text

Article menu
Download PDFPDF
Infectious Diseases
Identification of Francisella tularensis in ascites in the context of typhoidal tularaemia
  1. Marco Duerig1,2,
  2. Philipp Suter1,3,
  3. Emmanuel Haefliger1,2 and
  4. Christian Chuard4
  1. 1Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
  2. 2Division of Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  3. 3Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  4. 4Departement of Infectiology, University and Hospital of Fribourg, Fribourg, Switzerland
  1. Correspondence to Dr Philipp Suter; philipp.suter{at}gmx.ch

Abstract

Tularaemia is a highly infectious, zoonotic disease caused by Francisella tularensis, which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as F. tularensis upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis.

  • Infection (gastroenterology)
  • Hepatitis and other GI infections
  • Alcoholic liver disease
  • General practice / family medicine
  • Liver disease

https://doi.org/10.1136/bcr-2023-256509

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—MD, PS, EH and CC. The following authors gave final approval of the manuscript—PS, EH, CC and MD.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.