A Case of Tularemic Pneumonia

Gurbuz Y., Gulmez Z. D., Tutuncu E. E., Sencan I.

KLIMIK JOURNAL, vol.32, no.2, pp.210-212, 2019 (ESCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 2
  • Publication Date: 2019
  • Doi Number: 10.5152/kd.2019.46
  • Journal Name: KLIMIK JOURNAL
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Page Numbers: pp.210-212
  • Keywords: Tularemia, bacterial pneumonia, bacteremia, HUMANS
  • Gazi University Affiliated: Yes


Tularemia caused by Francisella tularensis is a zoonotic disease encountered in northern parts of Europe, Asia and America. The most common form in America is ulceroglandular form, whereas the oropharyngeal form is the most common form in Turkey. In this report, a case of tularemic pneumonia rarely observed in water-borne epidemics has been presented and the literature has been reviewed. A 72-year-old male patient living in a village of Cankiri, one of the provinces where tularemia is endemic, was treated with different antibiotics due to pneumonia, but no clinical improvement was observed. Legionella pneumophila serogroup 1 antigen in the urine, Coxiella burnetii IgM and IgG, and Brucella agglutination test results in the blood were found as negative. Tests for tularemia were performed as the patient had persistent high fever, lived in an endemic region for tularemia, had a story of drinking village water, and white plaques on the oropharynx and tonsils at the last examination. Tularemia IgG antibodies by microagglutination was positive at 1/1280 titer and F. tularensis real-time polymerase chain reaction (PCR) test in sputum was positive. PCR test in blood was negative. The patient was diagnosed as tularemic pneumonia and streptomycin 2x1 gr was administered intramuscularly. After ten days of treatment, patient's fever defervesced, clinical and radiological findings resolved. Tularemic pneumonia is usually associated with tularemic bacteremia. In our case F. tularensis could not be detected in the blood with culture and PCR, although that does not rule out the hematogenous path. As the patient also had oropharyngeal involvement, it was possible that the bacteria had reached the lungs by microaspiration from the patient's oropharynx. Tularemia should be considered in the etiology of pneumonia for patients living in endemic areas, especially if they are unresponsive to beta-lactam antibiotic treatment.