Case report

Typhoid form of tularemia: a case report

Svjetlana Grgić ; Klinika za infektivne bolesti Mostar, Mostar, Bosna i Hercegovina
Jadranka Nikolić ; Medicinski fakultet Sveučilišta u Mostaru, Mostar, Bosna i Hercegovina
Rok Čivljak ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Tomislav Maretić ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Oktavija Đaković Rode ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Miroslav Lisić ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska

Abstract

Tularemia is an acute, febrile, granulomatous zoonosis, primarily a disease of rodents. It is transmitted to humans by direct contact with sick animals, animal or insect bite, ingestion of infected meat, water, or inhalation of aerosols from infected animals or dust. The mode of transmission determines the development of clinical manifestations of this zoonosis. A 43-year-old patient from Zagreb was admitted to the University Hospital for Infectious Diseases "Dr Fran Mihaljevic" in Zagreb on the ninth day of illness manifested with remittent fever without leading symptoms. Due to fever of unknown cause the patient was treated with symptomatic as well as empirical therapy at first with parenteral co-amoxiclav, and then with a combination of ciprofloxacin and ceftriaxone. After unsuccessful empirical antimicrobial therapy, a detailed update of epidemiological history was taken from which we learned that 15 days before disease onset the patient had been working at a construction site of Rijeka-Zagreb motorway where he extracted stones from water polluted with rodents and dead animals. Based on these epidemiological data and initial treatment failure, tularemia has been taken into account in differential diagnosis, which was subsequently confirmed by serological testing. With this case report, we wanted to re-emphasize the importance of taking detailed epidemiological history and considering typhoid form of tularemia in patients with prolonged fever without leading symptoms.

Keywords

Tularemia; Francisella tularensis; typhoidal tularemia

Hrčak ID:

72562

URI

https://hrcak.srce.hr/72562

Publication date:

30.6.2011.

Article data in other languages: croatian

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