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Table 1 Literature review of tularemia in solid organ transplant patients

From: Severe infections due to Francisella tularensis ssp. holarctica in solid organ transplant recipient: report of two cases and review of literature

Reference Patient characteristics Type of graft Immunosuppressive therapy Clinical presentation Diagnostic method Antibiotic therapy Outcome
Limaye & Hooper, 1999 [11] Male Aged 50. From USA 3 years post-liver transplant for hepatitis C and alcohol related cirrhosis; Prednisolone; Azathioprine. Fever, arthromyalgia and pneumonia within 72 h. Blood cultures initially negative came back positive for F.tularensis biovar palearctica (or holarctica) after 7 days of culture. Levofloxacin 500 mg/day for 21 days Complete recovery
Khoury and al, 2005 [12] Male Aged 69. From USA (handled hay.) 4 years post kidney transplant for end-stage renal failure secondary to polycystic kidney disease. Prednisone; Mycophenolate mofetil; Rapamycin Fever, chills, and neck stiffness associated with fatigue, vomiting, and diarrhea. Patchy infiltrate in the left lung compatible with pneumonia on X-ray Blood cultures grew F.tularensis biovar tularensis in 7 days. Doxycycline for 14 days Complete recovery
Mittalhenkle A, Norman DJ, 2005 [13] Age 59 From USA 11 years post kidney transplant secondary to polycystic kidney disease. Prednisone; Mycophenolate mofetil; Cyclosporine Persistent fever. Chest X-ray and Chest CT-scan showed multiple nodules. BAL and thoracoscopy with nodule biopsy were performed. Biopsy culture grew a Gram negative bacilli initially identified as A. actinomycetemcomitans corrected to F.tularensis several days later. Fluoroquinolone (dosage and duration unknown) Clinical Improvement
Faucon et al. 2011 [14] Male Aged 69. From France (Hunting dog owner.) 15 years post kidney transplant for IgA nephropathy Prednisolone; Mycophenolate mofetil; Cyclosporine A Fever, chills, cough and sputum. Chest X-ray showed bilateral interstitial infiltrates. Blood cultures came back positive for F.tularensis biovar holarctica after 10 days. PCR confirmed Levofloxacin 500 mg/day for 14 days Complete recovery
Ozkok and al, 2012 [15] Aged 24. From Turkey 12 months after kidney transplant. Prednisolone; Mycophenolate mofetil; Tacrolimus Cervical lympadenopathy. Pathologic examination of the lymph node showed chronic necrotizing granulomatous inflammation. Real-time PCR–based test for tularemia performed on the lymph node was positive. Serology later confirmed Doxycycline 100 mg ×2/day for 4 weeks Complete recovery