Ulceroglandular form of tularemia after squirrel bite: a case report
Abstract Background The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. T...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03510-8 |
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| author | Hannah Sophia Borgschulte Daniela Jacob Jörg Zeeh Holger C. Scholz Klaus Heuner |
| author_facet | Hannah Sophia Borgschulte Daniela Jacob Jörg Zeeh Holger C. Scholz Klaus Heuner |
| author_sort | Hannah Sophia Borgschulte |
| collection | DOAJ |
| description | Abstract Background The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. Tularemia can lead to massively swollen lymph nodes and might even be fatal without antibiotic treatment. To our knowledge, the case described here is the first report of the disease caused by a squirrel bite in Germany. Case presentation A 59-year-old German woman with a past medical history of hypothyroidism and cutaneous lupus erythematosus presented at the emergency room at St. Katharinen Hospital with ongoing symptoms and a swollen right elbow persisting despite antibiotic therapy with cefuroxime for 7 days after she had been bitten (right hand) by a wild squirrel (Eurasian red squirrel). After another 7 days of therapy with piperacillin/tazobactam, laboratory analysis using real-time polymerase chain reaction (PCR) confirmed the suspected diagnosis of tularemia on day 14. After starting the recommended antibiotic treatment with ciprofloxacin, the patient recovered rapidly. Conclusion This is the first report of a case of tularemia caused by a squirrel bite in Germany. A naturally infected squirrel has recently been reported in Switzerland for the first time. The number of human cases of tularemia has been increasing over the last years and, therefore, tularemia should be taken into consideration as a diagnosis, especially in a patient bitten by an animal who also presents with headache, increasing pain, lymphadenitis, and fever, as well as impaired wound healing. The pathogen can easily be identified by a specific real-time PCR assay of wound swabs and/or by antibody detection, for example by enzyme-linked immunosorbent assay (ELISA), if the incident dates back longer than 2 weeks. |
| first_indexed | 2024-04-11T21:45:40Z |
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| id | doaj.art-239ff91a07da4bc68aaa5be490578df2 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-11T21:45:40Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-239ff91a07da4bc68aaa5be490578df22022-12-22T04:01:25ZengBMCJournal of Medical Case Reports1752-19472022-08-011611610.1186/s13256-022-03510-8Ulceroglandular form of tularemia after squirrel bite: a case reportHannah Sophia Borgschulte0Daniela Jacob1Jörg Zeeh2Holger C. Scholz3Klaus Heuner4Department of Internal Medicine 2, St. Katharinen-HospitalDivision of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch InstituteDepartment of Internal Medicine 2, St. Katharinen-HospitalDivision of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch InstituteDivision of Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch InstituteAbstract Background The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. Tularemia can lead to massively swollen lymph nodes and might even be fatal without antibiotic treatment. To our knowledge, the case described here is the first report of the disease caused by a squirrel bite in Germany. Case presentation A 59-year-old German woman with a past medical history of hypothyroidism and cutaneous lupus erythematosus presented at the emergency room at St. Katharinen Hospital with ongoing symptoms and a swollen right elbow persisting despite antibiotic therapy with cefuroxime for 7 days after she had been bitten (right hand) by a wild squirrel (Eurasian red squirrel). After another 7 days of therapy with piperacillin/tazobactam, laboratory analysis using real-time polymerase chain reaction (PCR) confirmed the suspected diagnosis of tularemia on day 14. After starting the recommended antibiotic treatment with ciprofloxacin, the patient recovered rapidly. Conclusion This is the first report of a case of tularemia caused by a squirrel bite in Germany. A naturally infected squirrel has recently been reported in Switzerland for the first time. The number of human cases of tularemia has been increasing over the last years and, therefore, tularemia should be taken into consideration as a diagnosis, especially in a patient bitten by an animal who also presents with headache, increasing pain, lymphadenitis, and fever, as well as impaired wound healing. The pathogen can easily be identified by a specific real-time PCR assay of wound swabs and/or by antibody detection, for example by enzyme-linked immunosorbent assay (ELISA), if the incident dates back longer than 2 weeks.https://doi.org/10.1186/s13256-022-03510-8TularemiaZoonosisFrancisella tularensis subspecies holarcticaEurasian red squirrelCase report |
| spellingShingle | Hannah Sophia Borgschulte Daniela Jacob Jörg Zeeh Holger C. Scholz Klaus Heuner Ulceroglandular form of tularemia after squirrel bite: a case report Journal of Medical Case Reports Tularemia Zoonosis Francisella tularensis subspecies holarctica Eurasian red squirrel Case report |
| title | Ulceroglandular form of tularemia after squirrel bite: a case report |
| title_full | Ulceroglandular form of tularemia after squirrel bite: a case report |
| title_fullStr | Ulceroglandular form of tularemia after squirrel bite: a case report |
| title_full_unstemmed | Ulceroglandular form of tularemia after squirrel bite: a case report |
| title_short | Ulceroglandular form of tularemia after squirrel bite: a case report |
| title_sort | ulceroglandular form of tularemia after squirrel bite a case report |
| topic | Tularemia Zoonosis Francisella tularensis subspecies holarctica Eurasian red squirrel Case report |
| url | https://doi.org/10.1186/s13256-022-03510-8 |
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