Francisella tularensis bacteraemia causing multi-organ failure

Tularemia is a zoonosis caused by the gram-negative coccobacillus Francisella tularensis. The bacterium can be transmitted in several ways including direct contact with animal reservoirs, ingestion, inhalation and bites, and typical clinical symptoms are headache, fever, diarrhea and dyspnea. Francisella tularensis has two predominant subspecies (ssp), namely ssp. tularensis and ssp. holarctica. Ssp. holarctica is less virulent and does usually not cause fatal disease. We here present a 51-year-old male with sepsis and multi-organ failure caused by F. tularensis ssp. holarctica infection suggesting that atypical agents including F. tularensis should be considered in patients presenting symptoms of infections without response to standard treatments.