Pneumonic tularaemia: experience of 58 cases from 2000 to 2012 in Northern Finland

• Published in: Infectious diseases (London, England) England), 2017-10, Vol.49 (10), p.758-764
• Main Authors: Väyrynen, Sara A., Saarela, Elina, Henry, Janne, Lahti, Sini, Harju, Terttu, Kauma, Heikki
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Bronchoscopy; Female; Finland - epidemiology; Francisella tularensis; Francisella tularensis - drug effects; Francisella tularensis - isolation & purification; Humans; Immunoglobulin G - blood; Incidence; Intensive Care Units; Male; Middle Aged; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - epidemiology; Pneumonia, Bacterial - microbiology; pneumonic tularaemia; Prognosis; Retrospective Studies; Seasons; Tomography, X-Ray Computed; tularaemia; Tularemia - diagnosis; Tularemia - drug therapy; Tularemia - epidemiology; Tularemia - microbiology
• ISSN: 2374-4235; 2374-4243
• DOI: 10.1080/23744235.2017.1341054

Background: Pneumonic tularaemia is less common clinical form of tularaemia compared with the ulceroglandular form, with only a limited number of case reports and case series in Europe. In Finland, Northern Ostrobothnia is an endemic area of tularaemia with occasional seasonal outbreaks. Methods: In our study, a consecutive series of 58 pneumonic tularaemia cases diagnosed and treated in Oulu University Hospital in 2000-2012 were retrospectively analysed in terms of epidemiology, clinical course, and prognosis. Results: The incidence of pneumonic tularaemia showed peaks in cycles of a few years and most cases were diagnosed in late summer or early autumn. Respiratory symptoms were absent in 47% of patients, and 7% had normal chest X-ray. The chest computed tomography (CT) was performed in 81% of patients, demonstrating variable findings associated with pneumonic tularaemia. Bronchoscopy was performed for 22 (38%) patients and four (18%) of these also proceeded into mediastinoscopy. Moreover, thoracoscopy was performed for one (2%) patient. Two (3%) patients were treated shortly in the intensive care unit (ICU) during their stay in hospital. No mortality was observed. Conclusions: Most cases of pneumonic tularaemia are diagnosed during the seasonal outbreaks. The lack of specific symptoms often complicates the diagnosis and leads to unnecessarily invasive examinations.