Rare Case of transmission of tularemia through a bird of prey

Introduction:

Tularemia is a zoonotic bacterial infection that can be transmitted from the animal to humans. In humans, severe and often even life-threatening courses of the disease can occur. Usually, transmission of the disease to humans is by rodents. Until now there was only one reported case of human tularemia transmitted through a buzzard. We report about a 47 year old patient with recurrent cervical abscesses after an attack of a buzzard.

Methods:

The patient presented himself 3 weeks after the attack of a bird of prey in the head region with progressive cervical lymphadenitis on both sides and a painful, reddened swelling behind the left ear. The previous intravenous antibiotic therapy showed no effect. The head injuries were unremarkable on admission. A CT scan showed an abscess behind the left ear and a starting lymph node colliquation on both sides of the neck.

Results:

The abscesses were drained. Abscess drainage fluid using conventional culture did not yield any organism. Using PCR and sequence analysis Francisella tularensis was identified. Other infectious agents were not detected. The antibiotic therapy had to be changed and the abscesses had to be drained several times. The patient was free of symptoms after 9 weeks.

Conclusions:

In such an uncommon case the interdisciplinary teamwork of ENT, clinical microbiology and infectious diseases plays an important role to find the correct diagnosis and therapy. Due to the fastidious growth conditions of F. tularensis, identificatrion of the organism usually requires the use of molecular methods. Therefore the potential pathogens transmitted by birds of prey, and – also as in this case – their prey, must be considered together with the clinical symptoms to come up with a presumptive infectious disease diagnosis.

Publication History

Publication Date:
18 April 2018 (online)