title: Keep an Ear Out for Francisella tularensis: Otomastoiditis Cases after Canyoneering.
abstract: We report here three unusual cases of otomastoiditis due to Francisella tularensis, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we believe that F. tularensis should be considered as a possible etiology in case of otitis media, failure of the conventional antibiotic treatment, and suspicious exposure of the bacteria.
authors.affiliation: Infectious Diseases Department, Hospices civils de Lyon , Lyon , France.
authors.forename: Brice
authors.initials: B
authors.lastname: Guerpillon
authors.affiliation: Infectious Diseases Department, Hospices civils de Lyon , Lyon , France.
authors.forename: Andre
authors.initials: A
authors.lastname: Boibieux
authors.affiliation: ENT Department, Hospices civils de Lyon , Lyon , France.
authors.forename: Clemence
authors.initials: C
authors.lastname: Guenne
authors.affiliation: Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France.
authors.forename: Christine
authors.initials: C
authors.lastname: Ploton
authors.affiliation: Infectious Diseases Department, Hospices civils de Lyon , Lyon , France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.affiliation: French National Reference Center for Francisella tularensis , Grenoble , France.
authors.forename: Max
authors.initials: M
authors.lastname: Maurin
authors.affiliation: Infectious Diseases Department, Centre Hospitalier Métropole Savoie , Chambéry , France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Forestier
authors.affiliation: Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dauwalder
authors.affiliation: ENT Department, Centre Hospitalier Métropole Savoie , Chambéry , France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Manipoud
authors.affiliation: Radiology Department, Hospices civils de Lyon , Lyon , France.
authors.forename: Aicha
authors.initials: A
authors.lastname: Ltaïef-Boudrigua
authors.affiliation: ENT Department, Ludwig-Maximilians-Universität München , Munich , Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Gürkov
authors.affiliation: Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France.
authors.forename: Francois
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Bacteriology Laboratory, Hospices civils de Lyon , Lyon , France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Bouchiat
keywords: France; Francisella tularensis; canyoneering; otitis media; otomastoiditis