title: An unexpected cause for cavitary pneumonia and empyema.
abstract: Tularemia is an emerging zoonotic disease mainly of the Northern Hemisphere caused by the Gram-negative coccobacillus Francisella tularensis. It is affecting a wide range of animals and causes human disease after insect and tick bites, skin contact, ingestion and inhalation. A 66-year-old man presented to our clinic with cavitary pneumonia and distinct pleural effusion. After failure of empiric antibiotic therapy, thoracoscopic assisted decortication and partial excision of the middle lobe were conducted. Conventional culture methods and broad-range bacterial PCR including RipSeqMixed analysis were performed from the excised biopsies. Culture results remained negative but broad-range PCR targeting the first half of the 16S rRNA gene revealed F. tularensis DNA. This result was confirmed by F. tularensis-specific PCR and by serology. The source of infection could not be explored. To conclude, we report the rare clinical picture of a community-acquired pneumonia followed by pleural effusion and empyema due to F. tularensis. Broad range bacterial PCR proved to be a powerful diagnostic tool to detect the etiologic organism.
authors.affiliation: Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland.
authors.forename: Constantine
authors.initials: C
authors.lastname: Bloch-Infanger
authors.affiliation: Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Furrer
authors.affiliation: Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Wiese
authors.affiliation: Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hiebinger
authors.affiliation: Department of Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Bucher
authors.affiliation: Department of Radiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Kopp
authors.affiliation: Department of Clincal Microbiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Vladimira
authors.initials: V
authors.lastname: Hinić
authors.affiliation: Department of Clincal Microbiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. daniel.goldenberger@usb.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Goldenberger
mesh_terms: D000368:Aged; D004653:Empyema; D005604:Francisella tularensis; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008169:Lung Abscess; D008297:Male; D018410:Pneumonia, Bacterial; D013902:Radiography, Thoracic; D014406:Tularemia
keywords: Broad-range bacterial PCR; Cavitary pneumonia; Empyema; Francisella tularensis; Tularemia