Laboratory-Acquired Tularemia Successfully Treated With Ciprofloxacin

Abstract

Francisella tularensis continues to cause laboratory-acquired infection despite vaccination and biosafety precautions. Of the clinically relevant strains, subspecies tularensis (type A) is more virulent. Diagnosis requires a high index of suspicion, as symptoms can be nonspecific and may mimic other illnesses. Treatment can be problematic, as the drug of choice has significant adverse effects and can only be administered parenterally. We present a case of laboratory-acquired tularemia, suspected type A, in a 38-year-old female microbiologist. Her treatment course was complicated by delay in diagnosis owing to intercurrent pandemic H1N1 influenza, progression on doxycycline, and adverse effects from streptomycin. She was successfully treated with ciprofloxacin, 750 mg by mouth twice daily. Currently, there is limited clinical experience using fluoroquinolones for tularemia, especially for type A strains. The case illustrates how fluoroquinolones have great potential as an alternative agent in the treatment of tularemia.