Table 1.
Demographic, Microbiological, Clinical, and Laboratory Manifestations of Laboratory-Diagnosed Tularemia Cases and Associated Abnormal Values (n = 327)
| Laboratory-Diagnosed Tularemia Cases (n = 327) | Values Outside Laboratory Reference Range (%) | |
|---|---|---|
| Age (y) | 54 (IQR, 41.5–65) | |
| 10–19 | 24 (7.3%) | |
| 20–39 | 50 (15.3%) | |
| 40–59 | 128 (39.1%) | |
| 60–79 | 120 (36.7%) | |
| ≥80 | 5 (1.5%) | |
| Gender | ||
| Male | 166 (50.7%) | |
| Female | 161 (49.2%) | |
| Immunosuppression | ||
| Mildly immunocompromiseda | 3 (0.9%) | |
| Severely immunocompromisedb | 6 (1.8%) | |
| Diabetes mellitus | 1 (type 1, 0.3%); 17 (type 2, 5.2%) | |
| Pregnant at time of diagnosis | 0 (0%) | |
| Clinical manifestations | ||
| Ulceroglandular | 215 (65.7%) | |
| Glandular | 34 (10.4%) | |
| Pulmonary | 40 (12.2%) | |
| Typhoidal | 24 (7.3%) | |
| Oculoglandular | 1 (0.3%) | |
| Oropharyngeal | 0 (0%) | |
| Undifferentiatedc | 23 (7.0%) | |
| Microbiological diagnosis | ||
| Positive F. tularensis serology titer (n = 311) | 298 (95.8%) | |
| Seroconversion or significant rise in titer | 114 (36.7%) | |
| PCR positive (n = 46) | 44 (95.6%) | |
| Culture grown F. tularensis | 18 (39.1%) | |
| Laboratory findings | ||
| CRP (mg/L; n = 288) | 60 (30–108) | |
| Leukocytes (×106 cells/mL; n = 198)d | 7.6 (6.2–9.3) | >8.8: 58 (29.3%) |
| Neutrophils (×106 cells/mL; n = 71) | 5.1 (3.6–6.2) | >6.1: 21 (29.6%) |
| Lymphocytes c (×106 cells/mL; n = 76) | 1.6 (1.1–2.3) | <1.1: 16 (21%) > 3.5: 3 (3.9%) |
| Monocytes c (×106 cells/mL; n = 75) | 0.7 (0.5–1.0) | >0.8: 36 (48.0%) |
| Eosinophils (×106 cells/mL; n = 74) | 0.09 (0.080–0.090) | >0.5: 0 (0%) |
| Basophils (×106 cells/mL; n = 73) | 0.03 (0.010–0.050) | >0.1: 2 (2.7%) |
| Hemoglobin (g/dL; n = 212) | 137 (128–146) | <120 (female) or <130 (male): 40 (18.9%) |
| Platelets (×106/mL; n = 204) | 216 (168–300) | <150: 28 (13.7%) > 300: 50 (24.5%) |
| Procalcitonin (ng/mL; n = 17) | 0.21 (0.13–0.34) | >0.1: 15 (88.2%) > 0.25: 6 (35.3%) |
| Urine analysis (n = 33) | ||
| Hematuria | 18 (54.5%) | Trace: 4 (12.1%) 25: 4 (12.1%) 80: 8 (24.2%) 200: 2 (6%) |
| Proteinuria | 17 (51.5%) | Trace: 1 (3%) 0.3 (+): 10 (30.3%) 1.0 (++) 6 (18.2%) |
| Pyuria | 7 (21.2%) | 15: 5 (15.2%) 70: 1 500: 1 |
Abbreviations: CRP, C-reactive peptide; F. tularensis, Francisella tularensis; PCR, polymerase chain reaction.
aLow-dose corticosteroids (equivalent to <20 mg prednisolone; n = 2); methotrexate (≤0.4 mg/kg/week; n = 1).
bInfliximab and methotrexate (n = 2); Etanercept 50 mg and methotrexate 15 mg weekly (n = 1); golimumab monthly and methotrexate 15 mg weekly (n = 1); cyclosporine (n = 1); etanercept and sulfasalazine 500 mg 4 times per day (n = 1).
cTwelve participants (3.7%) had ulcers without documented lymphadenopathy and a further 11 (3.4%) had nonspecific mild symptoms.
dParticipants aged <18 years were excluded because of alternative cutoff values.