title: Hunting for tularaemia - a review of cases in North Carolina.
abstract: Human infections with Francisella tularensis can be acquired via numerous routes, including ingestion, inhalation, arthropod bite or direct contact with infected animals. Since 1991, there have been 25 reported cases of tularaemia in North Carolina, most of which were associated with rabbit hunting or cat bites. We present two adults cases of pulmonary and oropharyngeal tularaemia and review the reported cases since 1991-2013. We also present the fifth case of pulmonary empyema. While cavitary pneumonias are primarily treated with drainage, we illustrate a case of cavitary pneumonia associated with tularaemia successfully treated with oral ciprofloxacin after drainage. Tularaemia should be considered in patients with a perplexing radiographic image, animal exposure and lack of response to conventional empiric broad-spectrum antibiotics. Even in serious cases of pneumonic tularaemia, fluoroquinolones may provide a suitable alternative to aminoglycosides.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Brody School of Medicine, East Carolina University, Greenville, NC, USA; Division of Pulmonary and Critical Care Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Rimawi
authors.forename: K B
authors.initials: KB
authors.lastname: Shah
authors.forename: R A
authors.initials: RA
authors.lastname: Chowdhary
authors.forename: P P
authors.initials: PP
authors.lastname: Cook
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001733:Bites and Stings; D002415:Cats; D002939:Ciprofloxacin / Q000627:therapeutic use; D005604:Francisella tularensis / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011634:Public Health; D011804:Quinolines / Q000627:therapeutic use; D014406:Tularemia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015047:Zoonoses
chemical_list: D000900:Anti-Bacterial Agents; D011804:Quinolines; D002939:Ciprofloxacin; C037219:quinoline
keywords: North Carolina; Tularaemia; cavitary pneumonia; ciprofloxacin; empyema; pulmonary