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Background Francisella tularensis , the causative agent of tularemia, is endemic throughout the Northern Hemisphere and requires as few as 10 organisms to cause disease, making this potential bioterrorism agent one of the most infectious bacterial pathogens known. Aminoglycosides, tetracyclines, and, more recently, fluoroquinolones are used for treatment of tularemia; however, data on the relative effectiveness of these and other antimicrobial classes are limited. Methods Nine databases, including Medline, Global Health, and Embase, were systematically searched for articles containing terms related to tularemia. Articles with case-level data on tularemia diagnosis, antimicrobial treatment, and patient outcome were included. Patient demographics, clinical findings, antimicrobial administration, and outcome (eg, intubation, fatality) were abstracted using a standardized form. Results Of the 8878 publications identified and screened, 410 articles describing 870 cases from 1993 to 2023 met inclusion criteria. Cases were reported from 35 countries; more than half were from the United States, Turkey, or Spain. The most common clinical forms were ulceroglandular, oropharyngeal, glandular, and pneumonic disease. Among patients treated with aminoglycosides (n = 452 [52%]), fluoroquinolones (n = 339 [39%]), or tetracyclines (n = 419 [48%]), the fatality rate was 0.7%, 0.9%, and 1.2%, respectively. Patients with pneumonic disease who received ciprofloxacin had no fatalities and the lowest rates of thoracentesis/pleural effusion drainage and intubation compared to those who received aminoglycosides and tetracyclines. Conclusions Aminoglycosides, fluoroquinolones, and tetracyclines are effective antimicrobials for treatment of tularemia, regardless of clinical manifestation. For pneumonic disease specifically, ciprofloxacin may have slight advantages compared to other antimicrobials. [ABSTRACT FROM AUTHOR]

Introduction: Tularemia disease attracts attention as an important contagious zoonosis that has increased its impact in recent years. The aim of the study is to analyze the publications on tularemia between 1980 and 2020. Methods: We performed literature retrieval in the Web of Science (WoS) on 22 September 2021. Search terms were "Francisella tularensis" and "Tularemia" in the article title for the period between January 1980 and December 2020. We determined the number of articles, keywords, countries, authors, and institutions for each publication. We visualized the data with the VOS viewer tool. Results: After all inclusion and exclusion criteria were applied finally, 1688 articles were analyzed. The number of articles has increased in recent years. The three most productive countries in tularemia were the USA (777 articles 46.03%), Sweden (113 articles 6.69%), and Turkey (95 articles, 5.63%). Most of the articles were from the journal of Infection and Immunity (II), Plos one, Journal of Clinical Microbiology (JCM), Emerging Infectious Diseases (EID), and Vaccine. Sjostedt A. and Umea University—Sweden were the most influential author and institution. Conclusions: Productivity trend has been shown to increase in tularemia. High-income countries had a great influence on the literature in the field. Publications from the USA were in a high percentage among all articles. Related work may lead to the future direction of this dossier in the next years. [ABSTRACT FROM AUTHOR]