Table 1. Clinical and biologic characteristics of patients with Francisella tularensis–related prosthetic joint infection*.
| Characteristic | Case |
|||||||
|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 (10) | 5 (11) | 6 (11) | 7 (12) | 8 (13) | |
| Country | France | France | France | United States | Switzerland | Czech Republic | United States | Canada |
| Region |
Vendée |
Gironde |
Aube |
Colorado |
NS |
NS |
Illinois |
Ontario |
| Age, y |
49 |
70 |
68 |
58 |
84 |
84 |
77 |
68 |
| Sex |
M |
M |
M |
M |
F |
M |
M |
M |
| Exposure factors |
Rural residence, dog |
Hunter |
Retired butcher, cooking with wild game |
Farmer, possible rabbit carcass handling |
Airborne transmission (rabbit barn in neighbor’s house) |
Walk in tularemia- endemic area |
Hunter |
Hunter, tick bite 6 mo before surgery |
| Type of surgery |
Left THR |
Left TKA |
Left THR |
Left TKA |
Right knee prosthesis |
Right TKA |
Right THR |
Right TKA |
| Delay between diagnosis and prosthesis implantation |
35 d |
12 y |
19 y |
9 mo |
12 y |
8 y |
7 d |
6 mo |
| Clinical symptoms |
Infected scar, fever |
Feverish confusion, bilateral mediastinal and hilar lymphadenopathy, knee swelling |
Joint pain |
Repeated joint effusion |
Erythema, joint pain |
Fever, abdominal pain, confusion, painful knee effusion |
Fever, joint pain and swelling, bullous skin lesion with itching |
Joint pain, warm and swollen knee |
| CRP, mg/L |
21 |
100 |
58 |
NA |
81 |
98 |
16 |
NA |
| Leukocytes, G/L |
4.45 |
4 |
NA |
NA |
NA |
NA |
NA |
NA |
| Sample type |
Abscess |
Joint aspiration |
3 tissues |
Joint aspiration |
7 tissues |
Joint aspiration |
Joint aspiration |
Joint aspiration |
| No. positive samples/total |
1/1 |
1/1 |
2/3 |
1/1 |
6/7 |
1/1 |
1/1 |
1/1 |
| Delay to positivity |
NA |
7 d |
5 d |
24 h–48 h |
12 d |
4 d |
7 d |
3 d |
| Identification |
Vitek 2 GN Biochemical assay; ISFtu2 PCR +; specific F. tularensis subspeciesholarctica PCR |
Specific Francisella PCR; ISFtu2 PCR +; 16S-23S PCR + sequencing |
MALDI-TOF MS (Microflex LT); ISFtu2 PCR +; specific F. tularensis subspecies holarctica PCR |
Sequencing |
16S rRNA gene sequencing |
16 S rRNA gene sequencing |
MALDI-TOF MS |
Sequencing |
| Serologic results | MAT 640; IFA IgG 1,280; IgM 640 | ELISA IgG 1.5; IgM 3.58; IFA IgG 640; IgM 640 | MAT 160 | ND | IgM 232.6 U/mL; IgG 126.4 U/mL | MAT 80 | Positive (titers NA) | MAT 320 |
*CRP, C-reactive protein; IFA, immunofluorescence assay; MALDI-TOF MS, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; MAT, microagglutination test; Microflex LT, Bruker Daltonics; NA, not available; ND, not done; NS, not specified; THR, total hip replacement; TKA, total knee arthroplasty; +, positive.