eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Clinical research

Francisella tularensis/Rickettsia spp. co-infections in patients with skin changes and lymphadenopathy

Tomasz Chmielewski, Beata Fiecek, Grażyna Lewandowska, Waldemar Rastawicki, Stanisława Tylewska-Wierzbanowska

Arch Med Sci 2018; 14, 2: 357–360
Online publish date: 2016/06/13
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Introduction: Tularemia and spotted fever group rickettsioses (SFG) can be transmitted by ticks and have a number of common clinical symptoms. Most characteristic are a maculopapular or vesicular rash or an eschar at the site of the tick or insect bite accompanied by painful lymph nodes. The aim of this study was to determine whether Rickettsia spp./Francisella tularensis mixed infections occurred in patients with similar symptoms who were diagnosed with either Rickettsia spp. or F. tularensis infection.

Material and methods: Thirty-six cases from 2011–2014, including 15 individuals with clinically and serologically recognized SFG and 21 with tularemia, were analyzed retrospectively using immunofluorescence for detection of Rickettsia spp. or ELISA for detection of F. tularensis.

Results: Of the 36 cases examined, specific high titers of antibodies to Rickettsia spp. were found in 1 (4.4%) patient with tularemia and specific high titers of antibodies to F. tularensis were detected in 1 (6.7%) patient with SFG.

Conclusions: The results of our study show that in infections with fever, enlarged lymph nodes and skin lesions after tick and insect bites, laboratory testing of both diseases – SFG rickettsiosis and tularemia – should be implemented. Identification of F. tularensis and Rickettsia spp. mixed infections is crucial in order to administer appropriate antibiotics and to avoid treatment failure and relapse.

rickettsiosis, tularemia, co-infection

Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev 2002; 15: 631-46.
Petersen JM, Mead PS, Schriefer ME. Francisella tularensis: an arthropod-borne pathogen. Vet Res 2009; 40: 7-10.
Brouqui P, Parola P, Fournier PE, Raoult D. Spotted fever rickettsioses in southern and eastern Europe. FEMS Immunol Med Microbiol 2007; 49: 2-12.
Parola P, Rovery C, Rolain JM, Brouqui P, Davoust B, Raoult D. Rickettsia slovaca and R. raoultii in Tick-borne Rickettsioses. Emerg Infect Dis 2009; 15: 1105-8.
Chmielewski T, Podsiadly E, Karbowiak G, Tylewska-Wierzbanowska S. Rickettsiae spp. in ticks, Poland. Emerg Inf Dis 2009; 15: 486-8.
Angelakis E, Pulcini C, Waton J, et al. Scalp eschar and neck lymphadenopathy caused by Bartonella henselae after Tick Bite. Clin Infect Dis 2010; 50: 549-51.
Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. Clin Microbiol Rev 2005; 18: 719-56.
Moniuszko A, Pancewicz SA, Czupryna P, et al. Glandular form of tularemia after arthropod bite: cases report. Przegl Epidemiol 2010; 64: 73-5.
Świtaj K, Chmielewski T, Borkowski P, Tylewska-Wierzbanowska S, Olszyńska-Krowicka M. Spotted fever rickettsiosis caused by Rickettsia raoulti – case report. Przegl Epidemiol 2012; 66: 347-50.
Maurin M, Pelloux I, Brion JP, Del Banõ JN, Picard A. Human tularemia in France, 2006-2010. Clin Infect Dis 2011; 53: 133-41.
Gurycová D, Tináková K, Výrosteková V, Gacíková E. The incidence of tularemia in Slovakia in 1997-2008. Epidemiol Mikrobiol Imunol 2010; 59: 39-44.
Franke J, Fritzsch J, Tomaso H, Straube E, Dorn W, Hildebrandt A. Coexistence of pathogens in host-seeking and feeding ticks within a single natural habitat in Central Germany. Appl Environ Microbiol 2010; 76: 6829-36.
Stanek G. Pandora’s box: pathogens in Ixodes ricinus ticks in Central Europe. Wien Klin Wochenschr 2009; 121: 673-83.
Hubalek Z, Halouzka J. Mosquitoes (Diptera: Culicidae), in contrast to ticks (Acari: Ixodidae), do not carry Francisella tularensis in a natural focus of tularemia in the Czech Republic. J Med Entomol 1997; 34: 660-3.
Wójcik-Fatla A, Zając V, Sawczyn A, Cisak E, Sroka J, Dutkiewicz J. Occurrence of Francisella spp. in Dermacentor reticulatus and Ixodes ricinus ticks collected in eastern Poland. Ticks Tick Borne Dis 2015; 6: 253-7.
Reis C, Cote M, Paul RE, Bonnet S. Questing ticks in suburban forest are infected by at least six tick-borne pathogens. Vector Borne Zoonotic Dis 2010; 11: 907-16.
Podsiadły E, Chmielewski T, Karbowiak G, Kędra E, Tylewska-Wierzbanowska S. The occurrence of spotted fever rickettsioses and other tick-borne infections in forest workers in Poland. Vector-borne and Zoonotic Diseases 2010; 11: 985-9.
Rastawicki W, Kurowska J, Hermanowska-Szpakowicz T, Pancewicz SA, Kondrusik M, Jagielski M. Prevalence of antibodies to Francisella tularensis in forest workers from different regions of Poland. Med Dosw Mikrobiol 2006; 58: 207-15.
Żukiewicz-Sobczak W, Zwoliński J, Chmielewska-Badora J, et al. Prevalence of antibodies against selected zoonotic agents in forestry workers from eastern and southern Poland. Ann Agric Environ Med 2014; 21: 767-70.
Zając V, Wójcik-Fatla A, Cisak E, Sroka J, Sawczyn A, Dutkiewicz J. Study on tick-borne rickettsiae in eastern Poland. II. Serological response of the occupationally exposed populations. Ann Agric Environ Med 2013; 20: 280-2.
Foley JE, Nieto NC. Tularemia. Vet Microbiol 2010; 140: 332-8.
Reese SM, Dietrich G, Dolan MC, et al. Transmission dynamics of Francisella tularensis subspecies and clades by nymphal Dermacentor variabilis (Acari: Ixodidae). Am J Trop Med Hyg 2010; 83: 645-52.
Reese SM, Petersen JM, Sheldon SW, et al. Transmission efficiency of Francisella tularensis by adult american dog ticks(Acari: Ixodidae). J Med Entomol 2011; 48: 884-90.
Christova I, Gladnishka T. Prevalence of infection with Francisella tularensis, Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum in rodents from an endemic focus of tularemia in Bulgaria. Ann Agric Environ Med 2005; 12: 149-52.
Výrosteková V, Khanakah G, Kocianová E, Gurycová D, Stanek G. Prevalence of coinfection with Francisella tularensis in reservoir animals of Borrelia burgdorferi sensu lato. Wien Klin Wochenschr 2002; 114: 482-8.
Carvalho CL, Lopes de Carvalho I, Zé-Zé L, Núncio MS, Duarte EL. Tularaemia: a challenging zoonosis. Comp Immunol Microbiol Infect Dis 2014; 37: 85-96.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe