Reference | Patient characteristics | Type of graft Immunosuppressive therapy | Clinical presentation | Diagnostic method | Antibiotic therapy | Outcome |
---|---|---|---|---|---|---|
Limaye & Hooper, 1999 [11] | Male Aged 50. From USA | 3 years post-liver transplant for hepatitis C and alcohol related cirrhosis; Prednisolone; Azathioprine. | Fever, arthromyalgia and pneumonia within 72 h. | Blood cultures initially negative came back positive for F.tularensis biovar palearctica (or holarctica) after 7 days of culture. | Levofloxacin 500 mg/day for 21 days | Complete recovery |
Khoury and al, 2005 [12] | Male Aged 69. From USA (handled hay.) | 4 years post kidney transplant for end-stage renal failure secondary to polycystic kidney disease. Prednisone; Mycophenolate mofetil; Rapamycin | Fever, chills, and neck stiffness associated with fatigue, vomiting, and diarrhea. Patchy infiltrate in the left lung compatible with pneumonia on X-ray | Blood cultures grew F.tularensis biovar tularensis in 7 days. | Doxycycline for 14 days | Complete recovery |
Mittalhenkle A, Norman DJ, 2005 [13] | Age 59 From USA | 11 years post kidney transplant secondary to polycystic kidney disease. Prednisone; Mycophenolate mofetil; Cyclosporine | Persistent fever. Chest X-ray and Chest CT-scan showed multiple nodules. BAL and thoracoscopy with nodule biopsy were performed. | Biopsy culture grew a Gram negative bacilli initially identified as A. actinomycetemcomitans corrected to F.tularensis several days later. | Fluoroquinolone (dosage and duration unknown) | Clinical Improvement |
Faucon et al. 2011 [14] | Male Aged 69. From France (Hunting dog owner.) | 15 years post kidney transplant for IgA nephropathy Prednisolone; Mycophenolate mofetil; Cyclosporine A | Fever, chills, cough and sputum. Chest X-ray showed bilateral interstitial infiltrates. | Blood cultures came back positive for F.tularensis biovar holarctica after 10 days. PCR confirmed | Levofloxacin 500 mg/day for 14 days | Complete recovery |
Ozkok and al, 2012 [15] | Aged 24. From Turkey | 12 months after kidney transplant. Prednisolone; Mycophenolate mofetil; Tacrolimus | Cervical lympadenopathy. Pathologic examination of the lymph node showed chronic necrotizing granulomatous inflammation. | Real-time PCR–based test for tularemia performed on the lymph node was positive. Serology later confirmed | Doxycycline 100 mg ×2/day for 4 weeks | Complete recovery |