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Background We describe the epidemiological, clinical, and prognostic aspects of 177 tularemia cases diagnosed at the National Reference Center for rickettsioses, coxiellosis, and bartonelloses between 2008 and 2017. Methods All patients with a microbiological diagnosis of tularemia made in the laboratory were included. Clinical and epidemiological data were collected retrospectively from clinicians in charge of patients using a standardized questionnaire. Diagnostic methods used were indirect immunofluorescence serology, real-time polymerase chain reaction (PCR), and universal PCR targeting the 16S ribosomal ribonucleic acid gene. Results The series included 54 females and 123 males (sex ratio, 2.28; mean age, 47.38 years). Eighty-nine (50.2%) were confirmed as having tularemia on the basis of a positive Francisella tularensis PCR or seroconversion, and 88 (49.8%) were considered as probable due to a single positive serum. The regions of France that were most affected included Pays de la Loire (22% of cases), Nouvelle Acquitaine (18.6% of cases), and Grand Est (12.4% of cases). Patients became infected mainly through contact with rodents or game (38 cases, 21.4%), through tick-bites (23 cases, 12.9%), or during outdoor leisure activities (37 cases, 20.9%). Glandular and ulceroglandular forms were the most frequent (109 cases, 61.5%). Two aortitis, an infectious endocarditis, a myocarditis, an osteoarticular infection, and a splenic hematoma were also diagnosed. Tularemia was discovered incidentally in 54.8% of cases. Seventy-eight patients were hospitalized, and no deaths were reported. Conclusions Our data suggest that in an endemic area and/or in certain epidemiological contexts, tularemia should be sought to allow an optimized antibiotic therapy and a faster recovery. [ABSTRACT FROM AUTHOR]

Multispacer typing (MST) was used to type ten Francisella tularensis strains detected in French patients. Incorporating 79 Swedish F. tularensis strains, phylogenetic analysis demonstrated that although tularemia appears as a sporadic disease in France, it is caused by an epidemic cluster of strains. [ABSTRACT FROM AUTHOR]

To investigate the phylogeography of French Francisella tularensis ssp. holarctica isolates. Canonical SNPs and MLVA were used to genotype 103 French F. tularensis ssp. holarctica isolates. We confirmed the presence of one subclade, the central and western European group (B.Br.FTNF002-00), and identified four major MLVA genotypes with no obvious geographical differentiation. The lack of geographical resolution among MLVA genotypes suggests rapid dispersal, convergent evolution or a combination of the two. This study expands knowledge of the phylogeography of one of the two dominant European F. tularensis ssp. holarctica subclades and illustrates the need for additional SNP discovery within this subclade. [ABSTRACT FROM AUTHOR]

Francisella tularensis subsp. holarctica is widely disseminated in North America and the boreal and temperate regions of the Eurasian continent. Comparative genomic analyses identified a 1.59-kb genomic deletion specific to F. tularensis subsp. holarctica isolates from Spain and France. Phylogenetic analysis of strains carrying this deletion by multiple-locus variable-number tandem repeat analysis showed that the strains comprise a highly related set of genotypes, implying that these strains were recently introduced or recently emerged by clonal expansion in France and the Iberian Peninsula. [ABSTRACT FROM AUTHOR]

Abstract: Objective – This study had for aim to determine whether the epidemiologic features of animal and human tularemia observed in France could explain its re-emergence since 1993. Materials and methods. – A retrospective study was made of outbreaks in animals and human cases and contamination. Results. – Twenty to sixty animals outbreaks were recorded every year but the number of cases was under estimated. This indicates an increase in animal cases. Human cases or contaminations were associated with areas where animal cases had been recorded, except for a few cases more difficult to explain. Several factors are implicated: the disease is not known, except by hunters. Tularemia is more often described in hares but the disease may be present in other species. The disease and its forms should be documented for clinicians and biologists for an adequate clinical and bacteriological diagnosis. Comments. – Several factors in the epidemiology of the animal diseases have changed since 1993. It is necessary to be increasingly vigilant, for animal cases and human contamination. It is necessary to strengthen medical and veterinary supervision especially since Francisella tularensis may be used for bioterrorism. [Copyright &y& Elsevier]

A pregnant woman who had oropharyngeal tularemia underwent treatment with azithromycin and lymph node resection and recovered without obstetrical complication or infection in the child. Azithromycin represents a first-line treatment option for tularemia during pregnancy in regions where the infecting strains of Francisella tularensis have no natural resistance to macrolides. [ABSTRACT FROM AUTHOR]

Summary: We report three consecutive cases of tularemia occurring in Burgundy, France, a region previously considered not endemic for tularemia. The patients presented with varied and unspecific clinical manifestations. The epidemiological circumstances, especially the mode of contamination, were not particularly suggestive of tularemia. Serological diagnosis was delayed in two cases because of the lack of significant antibody titers at the time of admission. In contrast, a diagnosis could readily be obtained in all three cases by detection of Francisella tularensis DNA from clinical samples using PCR-based methods. These cases highlight the increased incidence and geographical spread of tularemia in France, and the usefulness of real-time PCR technology for the early diagnostic confirmation of tularemia. [Copyright &y& Elsevier]