Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden
Background: Tularemia is an important re-emerging 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,...
Published in: | Clinical Infectious Diseases |
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Umeå universitet, Institutionen för klinisk mikrobiologi
2024
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Online Access: | http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-222845 https://doi.org/10.1093/cid/ciae098 |
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ftumeauniv:oai:DiVA.org:umu-222845 2024-04-28T08:32:35+00:00 Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden Plymoth, Martin Lundqvist, Robert Nystedt, Anders Sjöstedt, Anders Gustafsson, Tomas N. 2024 application/pdf http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-222845 https://doi.org/10.1093/cid/ciae098 eng eng UmeÃ¥ universitet, Institutionen för klinisk mikrobiologi UmeÃ¥ universitet, Institutionen för folkhälsa och klinisk medicin Department of Infectious Diseases, Westmead Hospital, Sydney, New South Wales, Australia Sunderby Research Unit, UmeÃ¥ University, UmeÃ¥, Sweden Department of Communicable Disease Control, County Council of Norrbotten , LuleÃ¥ , Sweden Clinical Infectious Diseases, 1058-4838, 2024 orcid:0000-0002-2036-0383 orcid:0000-0003-4059-3368 orcid:0000-0002-0768-8405 orcid:0000-0002-4495-8267 http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-222845 doi:10.1093/cid/ciae098 PMID 38393822 ISI:001188651700001 info:eu-repo/semantics/openAccess Francisella tularensis doxycycline ciprofloxacin treatment outcome Infectious Medicine Infektionsmedicin Article in journal info:eu-repo/semantics/article text 2024 ftumeauniv https://doi.org/10.1093/cid/ciae098 2024-04-03T16:47:43Z Background: Tularemia is an important re-emerging 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 2011-2021 were collected through review of electronic medical records and participant questionnaires; with 415 out of 784 accepting participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or PCR). A multivariable logistic regression model was used to investigate variables associated with re-treatment. Results: Median age of participants was 54 years (IQR 41.5-65) and 49.2% were female. While 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 non-specific, with monocytosis frequently observed (n=36/75; 48%). Tularemia was often misdiagnosed upon presentation (n=158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics, and 102 (31.2%) re-treated. Persistent lymphadenopathy was infrequent (n=22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with re-treatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR 3.25-20.75] vs. 7 [IQR 4-11.25] days; adjusted p=0.076), and doxycycline-based treatment regimen (vs. ciprofloxacin; adjusted p=0.084), although not significant after correction for multiple comparisons. Conclusion: 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. Article in Journal/Newspaper Northern Sweden Norrbotten Umeå University: Publications (DiVA) Clinical Infectious Diseases |
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Open Polar |
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Umeå University: Publications (DiVA) |
op_collection_id |
ftumeauniv |
language |
English |
topic |
Francisella tularensis doxycycline ciprofloxacin treatment outcome Infectious Medicine Infektionsmedicin |
spellingShingle |
Francisella tularensis doxycycline ciprofloxacin treatment outcome Infectious Medicine Infektionsmedicin Plymoth, Martin Lundqvist, Robert Nystedt, Anders Sjöstedt, Anders Gustafsson, Tomas N. Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
topic_facet |
Francisella tularensis doxycycline ciprofloxacin treatment outcome Infectious Medicine Infektionsmedicin |
description |
Background: Tularemia is an important re-emerging 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 2011-2021 were collected through review of electronic medical records and participant questionnaires; with 415 out of 784 accepting participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or PCR). A multivariable logistic regression model was used to investigate variables associated with re-treatment. Results: Median age of participants was 54 years (IQR 41.5-65) and 49.2% were female. While 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 non-specific, with monocytosis frequently observed (n=36/75; 48%). Tularemia was often misdiagnosed upon presentation (n=158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics, and 102 (31.2%) re-treated. Persistent lymphadenopathy was infrequent (n=22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with re-treatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR 3.25-20.75] vs. 7 [IQR 4-11.25] days; adjusted p=0.076), and doxycycline-based treatment regimen (vs. ciprofloxacin; adjusted p=0.084), although not significant after correction for multiple comparisons. Conclusion: 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. |
format |
Article in Journal/Newspaper |
author |
Plymoth, Martin Lundqvist, Robert Nystedt, Anders Sjöstedt, Anders Gustafsson, Tomas N. |
author_facet |
Plymoth, Martin Lundqvist, Robert Nystedt, Anders Sjöstedt, Anders Gustafsson, Tomas N. |
author_sort |
Plymoth, Martin |
title |
Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
title_short |
Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
title_full |
Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
title_fullStr |
Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
title_full_unstemmed |
Targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
title_sort |
targeting tularemia : clinical, laboratory, and treatment outcomes from an 11-year retrospective observational cohort in northern sweden |
publisher |
Umeå universitet, Institutionen för klinisk mikrobiologi |
publishDate |
2024 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-222845 https://doi.org/10.1093/cid/ciae098 |
genre |
Northern Sweden Norrbotten |
genre_facet |
Northern Sweden Norrbotten |
op_relation |
Clinical Infectious Diseases, 1058-4838, 2024 orcid:0000-0002-2036-0383 orcid:0000-0003-4059-3368 orcid:0000-0002-0768-8405 orcid:0000-0002-4495-8267 http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-222845 doi:10.1093/cid/ciae098 PMID 38393822 ISI:001188651700001 |
op_rights |
info:eu-repo/semantics/openAccess |
op_doi |
https://doi.org/10.1093/cid/ciae098 |
container_title |
Clinical Infectious Diseases |
_version_ |
1797589722969669632 |