Tularemic meningitis in the United States.
BACKGROUND
Tularemia is a zoonotic disease caused by Francisella tularensis. Tularemia presents with various clinical illnesses, but meningitis is rare.


OBJECTIVE
To describe a patient who developed typhoidal tularemia with atypical acute meningitis and to review the pathogenesis, clinical and laboratory features, and antibiotic drug treatment of reported cases of tularemic meningitis.


METHODS
Case study and literature review.


METHODS
University hospital, tertiary care center.


METHODS
A 21-year-old healthy man who had recently worked as a professional landscaper in the Albuquerque, New Mexico, metropolitan area developed fever, malaise, headache, and a stiff neck.


METHODS
Francisella tularensis cerebrospinal fluid culture, antibiotic sensitivity, transmission source, and outcome.


RESULTS
The cerebrospinal fluid contained a lymphocytic pleocytosis, negative Gram stain, and F tularensis isolation with chloramphenicol and streptomycin antibiotic sensitivities.


CONCLUSIONS
Although tularemia is uncommon and tularemic meningitis is rare in the United States, attention is drawn to the increasing number of cases in professional landscapers, the atypical cerebrospinal fluid picture, and unusual antibiotic sensitivities.
Medicine Service, New Mexico VA Health Care System, 1501 San Pedro Dr SE, Albuquerque, NM 87108, USA. dhofinger@salud.unm.edu
Diedre M
DM
Hofinger
Luzma
L
Cardona
Gregory J
GJ
Mertz
Larry E
LE
Davis
D000284:Administration, Oral; D000328:Adult; D002701:Chloramphenicol / Q000008:administration & dosage / Q000031:analogs & derivatives; D002939:Ciprofloxacin / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005604:Francisella tularensis / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy; D009516:New Mexico; D009784:Occupational Diseases / Q000175:diagnosis* / Q000188:drug therapy; D013307:Streptomycin / Q000008:administration & dosage; D014406:Tularemia / Q000175:diagnosis* / Q000188:drug therapy; D014481:United States
D002939:Ciprofloxacin; D002701:Chloramphenicol; D013307:Streptomycin; C026016:chloramphenicol succinate