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Published on: July 17, 2010
An 8-month-old infant with hepatic tularemia: a case report
Anais Letonia1, Jennifer Frühwirth2, Herbert Kurz2
1Department of Paediatrics, Klinik Donaustadt, Vienna, Austria, Langobardenstraße 122, 1220. anais.letonia@gmail.com.
Insights
A tick bite led to tularemia in an infant, causing fever and abscesses. Prompt antibiotic treatment with ciprofloxacin successfully resolved the infection, highlighting early diagnosis and intervention for pediatric tularemia.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Medical Diagnostics
Background:
- Tick-borne illnesses pose significant risks to infants, often presenting with non-specific symptoms.
- Tularemia, caused by Francisella tularensis, is a rare but serious bacterial infection transmissible via ticks.
- Early recognition and diagnosis are crucial for effective management of pediatric tularemia.
Purpose of the Study:
- To report a case of tularemia in an infant following a tick bite.
- To describe the diagnostic challenges and clinical presentation of pediatric tularemia.
- To emphasize the importance of timely antibiotic therapy in tularemia cases.
Main Methods:
- Clinical case presentation of an 8-month-old infant.
- Diagnostic workup including sonography, lymphadenitis panel for Francisella tularensis.
- Treatment with ciprofloxacin and monitoring of clinical and serological response.
Main Results:
- Infant presented with persistent fever, vomiting, and diarrhea post-tick bite.
- Sonography revealed splenic abscesses and abdominal lymphadenopathy.
- Positive Francisella tularensis test confirmed tularemia; antibiotic treatment led to resolution of hepatic and splenic granulomas.
Conclusions:
- Tularemia should be considered in infants with febrile illness after potential tick exposure.
- Prompt diagnosis and appropriate antibiotic treatment are essential for favorable outcomes in pediatric tularemia.
- This case underscores the effectiveness of ciprofloxacin in treating disseminated tularemia in infants.
Abstract:
An 8‑month-old infant developed a fever of up to 40 °C, accompanied by vomiting and diarrhea, 1 day after a tick bite in the nuchal region; there was also local infection of the bite wound. Although treated with anti-inflammatory medication and antibiotics, the fever persisted. Sonography on day 10 of the fever showed multiple hypoechogenic abscesses in the spleen as well as lymphadenopathy in the upper abdomen, suspected of resulting from septic dissemination of the tick bite. After several tests to rule out any alternative disease etiologies yielded negative results, a lymphadenitis panel was positive for Francisella tularensis. Antibiotic therapy with ciprofloxacin was initiated accordingly. A repeat ultrasound showed new hypoechogenic lesions in the liver, in addition to those in the spleen. These were now determined to be granulomas caused by the infection with F. tularensis, consistent with previously reported cases. The patient was discharged on oral antibiotics 5 days after the diagnosis. At a follow-up appointment 1 week later, the patient's IgM antibodies against F. tularensis continued to decrease, while IgG levels continued to rise, confirming recent infection. After another 2 weeks of antibiotic treatment, the hepatic and splenic lesions had regressed significantly.
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