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Tularemia: diagnosis of an unexpected oculoglandular case in a non-endemic area by universal PCR
Tularemia: diagnóstico de un caso oculoglandular inesperado en un área no endémica mediante PCR universal
Paula Donate-Pérez-Molinoa, Cristian Castelló-Abietarb,f, Jonathan Fernández-Suárezb,f, Juan C. de Vicentec,d,e,
Corresponding author
jvicente@uniovi.es

Corresponding author.
a Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
b Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain
c Department Head Department of Oral and Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
d School of Medicine and Health Sciences, University of Oviedo, Asturias, Spain
e Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Spain
f Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tularemia is a zoonotic disease caused by <span class="elsevierStyleItalic">Francisella tularensis</span>&#44; a Gram-negative facultative intracellular coccobacillus<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> with four recognized subspecies<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#58; <span class="elsevierStyleItalic">tularensis</span> &#40;type A&#41;&#44; <span class="elsevierStyleItalic">holarctica</span> &#40;type B&#41;&#44; <span class="elsevierStyleItalic">mediasiatica</span> and <span class="elsevierStyleItalic">novicida</span>&#46; Type A is found in North America&#44; while type B is located&#44; but not exclusively&#44; in the northern hemisphere&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In Spain&#44; it was an uncommon disease until 1997&#44; when the first tularemia outbreak occurred in Castilla y Le&#243;n&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Until now&#44; all cases reported in Spain were caused by <span class="elsevierStyleItalic">F&#46; tularensis</span> subsp&#46; <span class="elsevierStyleItalic">holarctica&#46;</span> Clinical manifestations of tularemia fall into two main forms&#58; ulceroglandular &#40;&#62;90&#37; of cases in Europe&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and typhoidal&#46; However&#44; there are three more clinical forms&#58; oculoglandular&#44; oropharyngeal&#47;gastrointestinal and pneumonic&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We have previously published the first case of ulceroglandular tularemia in a non-endemic area &#40;Asturias&#44; Spain&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Here&#44; we present the first reported case of oculoglandular tularemia occurred in the same region which worried us&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">An 88-year-old male presented to the emergency department of our hospital in April 2017 for diagnosis and management of pain in his right eye and the presence of conjunctival discharge&#46; He did not have other symptoms&#44; history of trauma&#44; drug intake&#44; or any recently local or systemic infection&#46; His laboratory workup only showed a high value of C-reactive protein &#40;5&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and his medical and surgical histories were noncontributory&#46; A diagnostic of viral conjunctivitis was done and he was treated with lubricant and anti-inflammatory drops&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two months later&#44; he was brought to the Department of Oral and Maxillofacial Surgery with a painful cervical mass &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; weight loss and discomfort&#46; He did not declared a recent travel&#44; contact to ill people or animals although he lives in a rural area&#46; Clinical examination revealed the presence of a right neck mass measuring 30<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm&#44; with gummy consistency&#44; painful on palpation and without other appreciable alterations&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A CT scan was performed and three neck lymph nodes together with an intraparotid lymph node were seen as pathological&#44; showing necrotic areas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A universal PCR was performed in fine-needle aspiration biopsy &#40;FNAB&#41;&#44; based on amplification of the gene coding for 16S rRNA and subsequent sequencing &#40;Bigdye&#174; Terminator&#44; Thermo Fisher Scientific&#41;&#46; This evidenced the presence of <span class="elsevierStyleItalic">F&#46; tularensis</span> subsp&#46; <span class="elsevierStyleItalic">holarctica</span>&#46; A second sample of FNAB was sent 10 days later resulting also positive&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition&#44; serum samples were sent to the Spanish National Center for Microbiology &#40;Madrid&#44; Spain&#41; in order to study the presence of antibodies against <span class="elsevierStyleItalic">F&#46; tularensis</span> by microagglutination resulting positive with a titer of 1&#47;1024&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Ziehl-Neelsen stain&#44; culture and PCR for mycobacteria were negative&#46; Lymphadenopathy-causing viruses &#40;CMV&#44; EB&#44; HHV-6&#44; HHV-7&#44; HHV-8&#44; Adenovirus&#44; Picornavirus&#44; Enterovirus&#44; Mumps&#44; LCMV&#41; and <span class="elsevierStyleItalic">Toxoplasma gondii</span> were undetectable by PCR&#46; Serological tests &#40;ELISA&#41; against <span class="elsevierStyleItalic">Coxiella burnetii</span> &#40;IgG&#41;&#44; <span class="elsevierStyleItalic">Rickettsia conorii</span> &#40;IgG&#41; and <span class="elsevierStyleItalic">Borrelia burgdorferi</span> &#40;IgG&#47;IgM&#41; were negative&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Once the diagnosis was confirmed&#44; the patient was treated with a 14-day course of intravenous streptomycin at a dose of 10<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#44; with favorable evolution&#46; No surgical excision of the neck mass was needed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Oculoglandular form of tularemia is very infrequent in our environment&#46; In Spain some studies show an incidence of this form around 4&#37;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> but this microorganism should be considered in a patient with Parinaud&#39;s syndrome even in non-endemic areas&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The gold standard for the diagnosis of tularemia is the isolation of the causative agent by culture&#44; however&#44; this is difficult &#40;it requires a medium with cysteine&#41; and hazardous for the laboratory staff &#40;Biosafety Level 2 precautions&#41;&#46; Therefore diagnosis is based mainly on serology and results became positive between 10 and 14 days after onset of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Genome amplification by polymerase chain reaction &#40;PCR&#41; is more sensitive than culture and provides rapid&#44; sensitive and specific diagnosis of tularemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#8211;10</span></a> There are specific targets of <span class="elsevierStyleItalic">F&#46; tularensis</span> genes &#40;e&#46;g&#46; <span class="elsevierStyleItalic">fopA</span>&#44; <span class="elsevierStyleItalic">tul4</span>&#44; <span class="elsevierStyleItalic">ISFtu2</span> or RD1 protein-encoding gen&#41; but when there is no suspicion of a specific etiological agent&#44; it is useful to perform a universal PCR&#46; In this case&#44; if we had not performed the 16S rRNA PCR&#44; the patient wouldn&#8217;t have been correctly diagnosed&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The present case shows the importance of molecular techniques that amplify panbacterial genes&#44; especially useful for diagnosis of rare infections with great difficulty of isolation of the etiological agent like <span class="elsevierStyleItalic">Bartonella henselae</span> &#40;also causing Parinaud&#39;s syndrome&#41;&#44; <span class="elsevierStyleItalic">Tropheryma whipplei</span>&#44; <span class="elsevierStyleItalic">Borrelia</span> spp&#46; or <span class="elsevierStyleItalic">Ehrlichia</span> spp&#46; Also in those cases without bacterial growth due to antibiotic treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial disclosure and conflict of interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have not received funding to carry out this study and have no conflict of interests&#46;</p></span></span>"
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                            1 => "A&#46; McGregor"
                            2 => "L&#46; Cooley"
                            3 => "L&#46; Ng"
                            4 => "M&#46; Brown"
                            5 => "C&#46;W&#46; Ong"
                          ]
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                      ]
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                  "host" => array:1 [
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                          "autores" => array:5 [
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                            1 => "P&#46; Bachiller-Luque"
                            2 => "M&#46; Mart&#237;n-Luquero"
                            3 => "F&#46;J&#46; Mena-Mart&#237;n"
                            4 => "V&#46; Herreros"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1086/322601"
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                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "573"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11462198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "5"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cervical tularaemia in a non-endemic area"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Gallego"
                            1 => "L&#46; Junquera"
                            2 => "J&#46;J&#46; Palacios"
                            3 => "J&#46;C&#46; de Vicente"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Med Oral Patol Oral Cir Bucal"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "E180"
                        "paginaFinal" => "E182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19333186"
                            "web" => "Medline"
                          ]
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                          "issn" => "15560864"
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                  ]
                ]
              ]
            ]
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microagglutination test for early and specific serodiagnosis of tularemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46; Sato"
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                            2 => "Y&#46; Ohara"
                            3 => "M&#46; Homma"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
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                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1990"
                        "volumen" => "28"
                        "paginaInicial" => "2372"
                        "paginaFinal" => "2374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2229367"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:1 [
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                    0 => array:1 [
                      "Libro" => array:3 [
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                        "editorialLocalizacion" => "Geneva&#44; Switzerland"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;who&#46;int&#47;csr&#47;resources&#47;publications&#47;WHO&#95;CDS&#95;EPR&#95;2007&#95;7&#46;pdf"
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                    ]
                  ]
                ]
              ]
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              "etiqueta" => "8"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Tularemia&#58; clinical aspects in Europe"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Maurin"
                            1 => "M&#46; Gyuranecz"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(15)00355-2"
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                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2016"
                        "volumen" => "16"
                        "paginaInicial" => "113"
                        "paginaFinal" => "124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26738841"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Diagnostic approaches for oculoglandular tularemia&#58; advantages of PCR"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Kantardjiev"
                            1 => "P&#46; Padeshki"
                            2 => "I&#46;N&#46; Ivanov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2007.117523"
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                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "2007"
                        "volumen" => "91"
                        "paginaInicial" => "1206"
                        "paginaFinal" => "1208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17475710"
                            "web" => "Medline"
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                      ]
                    ]
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                ]
              ]
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                      "titulo" => "The class A &#946;-lactamase FTU-1 is native to <span class="elsevierStyleItalic">Francisella tularensis</span>"
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                          "etal" => false
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                            2 => "M&#46; Toth"
                            3 => "S&#46;B&#46; Vakulenko"
                          ]
                        ]
                      ]
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                        "tituloSerie" => "Antimicrob Agents Chemother"
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                        "paginaFinal" => "671"
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