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Table 1 Literature review of tularemia in solid organ transplant patients

From: Severe infections due to Francisella tularensis ssp. holarctica in solid organ transplant recipient: report of two cases and review of literature

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