Histologic and molecular diagnosis of tularemia: a potential bioterrorism agent endemic to North America.
Francisella tularensis (FT), a zoonotic bacterium that causes tularemia, has received attention as a possible bioterrorism threat. We developed a PCR assay for use in fixed, processed tissues, which are safer to handle and allow archival testing. PCR analysis for a 211-bp fragment of the FT lipoprotein gene was performed on tissues from 16 cases of tularemia. In all, 14/15 cases with intact DNA (93%) were positive for FT by PCR. Frequent histologic findings in PCR-positive tissues included irregular microabscesses and granulomas in liver, spleen, kidney, and lymph nodes, and necrotizing pneumonia. Unusual cases featuring suppurative leptomeningitis and gastrointestinal ulcers were also seen. As this disease is endemic in North America, and has been identified as a potential bioterroristic threat, awareness of the clinicopathologic spectrum of disease and available detection methods is increasingly important. This PCR assay, the first designed for use in processed tissues, is an excellent method for diagnosis of tularemia.
Lamps
Laura W
LW
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. lampslauraw@uams.edu
Havens
Jennifer M
JM
Sjostedt
Anders
A
Page
David L
DL
Scott
Margie A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001426:Bacterial Proteins / Q000235:genetics; D023482:Bioterrorism / Q000517:prevention & control; D002648:Child; D004247:DNA / Q000235:genetics / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D019353:Endemic Diseases / Q000517:prevention & control; D005260:Female; D005604:Francisella tularensis / Q000235:genetics*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000382:microbiology / Q000473:pathology; D007668:Kidney / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008074:Lipoproteins / Q000235:genetics; D008099:Liver / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008168:Lung / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008198:Lymph Nodes / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008297:Male; D008578:Meninges / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D032383:Myocytes, Cardiac / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D009656:North America; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D013154:Spleen / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D014406:Tularemia / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control
D001426:Bacterial Proteins; D004269:DNA, Bacterial; D008074:Lipoproteins; C075214:TUL4 protein, Francisella tularensis; D004247:DNA