Skip to main content

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