Table 1.
Findings, treatment and clinical course of four patients suffering from pulmonary tularemia
| Patient | No 1 | No 2 | No 3 | No 4 |
|---|---|---|---|---|
| Lead symptoms | Cough, weight loss, night sweat | Fatigue, head ace, fever | Weight loss, head ace, fever | Cough, fever |
| Date of diagnosis | Jan 12 | Sep 12 | Oct 2012 | Oct 2012 |
| Duration of symptoms before/after start of therapy (weeks) | 14/NA (spontanous recovery) | 12/6 | 9/12 | 2/2 |
| Agglutination titer for F. tularensis | 1:320 | 1:5120 | 1:320 | 1:640 |
| White-cell count (per mm3)/CRP (mg/liter) at first presentation in our institution | 4.2/6 | 11.4/87 | 5.1/83 | 6/<3 |
| Nested PCR tissue for F. tularensis | positive | positive | not done | positive |
| EBUS-TBNA | necrosis, epithelioid cell aggregation | necrosis, epithelioid cell aggregation | necrosis, epithelioid cell aggregation | normal lymphocytes |
| Surgical biopsy | yes | not done | not done | yes |
| Probable vector | rabbit feces | tick | unknown | unknown |
| Treatment | 1.doxycyclin | ciprofloxacin | ciprofloxacin | ciprofloxacin |
| 2.garamycin/cipro-floxacin | ||||
| Course | recurrence after doxycyclin | remission | remission | remission |
| Length of follow up (months) | 27 | 18 | 16 | 16 |
| Initial CT scan findings | Hilar mass, enlarged lymph nodes, pulmonary nodule | Pulmonary nodules, enlarged lymph nodes | Hilar mass, enlarged lymph nodes | Mass in the middle, enlarged lymph nodes |
| CT scan findings after completed treatment | Residual lesion | Small residual parenchymal scar | unchanged | Small residual hilar scar |
CRP: C-reactive protein, EBUS-TBNA: endobronchial ultrasound guided transbronchial needle aspiration, CT: computed tomography, PCR: polymerase chain reaction; NA: not applicable.