title: Tularaemia in southwest Germany: Three cases of tick-borne transmission.
abstract: Tularaemia, caused by Francisella tularensis, is an endemic zoonosis frequently occurring in southwest Germany. Since 2005 there is an increase in the number of reported cases of tularaemia in Germany. We report on two cases of ulceroglandular tularaemia and one case of glandular tularaemia that occurred in the summer of 2012 and 2013 in two counties in the Federal State of Baden-Wuerttemberg. Bacteria were transmitted through tick bites, which to date has only rarely been reported in Germany. Inadequate treatment of the patients and an aggravation of clinical symptoms were caused by a delay between disease onset and the detection of the pathogen. Although contact to or consumption of infected hares are the most often reported transmission routes of tularaemia in Germany, tick-bites should also be taken into account. Health professionals should include Francisella tularensis in the differential diagnosis of patients with fever and/or ulcerative lymphadenopathy following a tick bite.
authors.affiliation: Department of Epidemiology and Health Reporting, Baden-Wuerttemberg State Health Office, District Government Stuttgart, Nordbahnhofstr. 135, 70191, Germany; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany. Electronic address: ides_boone@yahoo.fr.
authors.forename: I
authors.initials: I
authors.lastname: Boone
authors.affiliation: Medical Office Dr. Hassler, Untere Hofstatt 1-3, 76703 Münzesheim, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hassler
authors.affiliation: Local Public Health Office, Hindenburgstr. 20/1, 71638 Ludwigsburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Bundeswehr Institute of Microbiology, German National Reference Laboratory for Tularaemia, Neuherbergstrasse 12, 80937 Munich, Germany; Institute of Medical Microbiology, Virology & Hygiene, Department of Microbiology & Hygiene, University Hospital Rostock, Schillingallee 70, Rostock, Germany.
authors.forename: W D
authors.initials: WD
authors.lastname: Splettstoesser
authors.affiliation: Department of Epidemiology and Health Reporting, Baden-Wuerttemberg State Health Office, District Government Stuttgart, Nordbahnhofstr. 135, 70191, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wagner-Wiening
authors.affiliation: Department of Epidemiology and Health Reporting, Baden-Wuerttemberg State Health Office, District Government Stuttgart, Nordbahnhofstr. 135, 70191, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Pfaff
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification; D005858:Germany / Q000453:epidemiology; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D017282:Tick-Borne Diseases / Q000453:epidemiology / Q000635:transmission*; D013997:Time Factors; D014406:Tularemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
keywords: Francisella tularensis; Germany; Surveillance; Ticks; Tularaemia