Response of tularemic meningitis to antimicrobial therapy

A 60-year-old man had pyogenic meningitis due to Francisella tularensis acquired by tick bite. His disease initially improved but later relapsed after a standard course of streptomycin. Complete resolution resulted from prolonged combined therapy with streptomycin and tetracycline. Successful treatment of acute tularemic meningitis has not previously been reported. Our experience suggests that therapy should include agents that reliably penetrate the CSF, that is, tetracycline or chloramphenicol, for optimal treatment of this rare form of tularemia.