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Tularemia is a zoonotic infection caused by Francisella tularensis. Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica-related prosthetic joint infection that occurred in France during 2016-2019. We also reviewed relevant literature and found only 5 other cases of Francisella-related prosthetic joint infections worldwide, which we summarized. Among those 8 patients, clinical symptoms appeared 7 days to 19 years after the joint placement and were nonspecific to tularemia. Although positive cultures are typically obtained in only 10% of tularemia cases, strains grew in all 8 of the patients. F. tularensis was initially identified in 2 patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; molecular methods were used for 6 patients. Surgical treatment in conjunction with long-term antimicrobial treatment resulted in favorable outcomes; no relapses were seen after 6 months of follow-up.

Tularemia is a zoonotic infectious disease caused by the facultative intracellular Gram-negative bacterium Francisella tularensis. Depending on the transmission route of this agent tularemia can present itself as a local infection or a systemic disease. We describe herein three cases of confirmed tularemia in immunocompetent patients during the summer of 2019; two patients with unusual respiratory presentation and pulmonary nodules on imaging, following exposure to aerosols. The third patient was a hunter presenting with a classical ulceroglandular form occurring 4 days after a tick bite in Bourgogne Franche-Comté. All patients were diagnosed from the results of positive F. tularensis PCR (or universal PCR targeting the 16S ribosomal ribonucleic acid gene) and/or seroconversion. The patient with ulceroglandular form received antibiotics, with a complete recovery. The two patients with pneumonic tularemia recovered without antibiotic treatment.  However, pulmonary nodules persisted on follow-up CT months later, despite overall clinical recovery., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Although Francisella tularensis is a well-known, highly virulent bacterium that causes tularemia in humans, other Francisella species have been associated with sporadic human infections. We describe a human cutaneous infection with bacteremia caused by F. salimarina, a Francisella species recently identified from seawater and fishes, in an immunocompromised patient in France.