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Tularemic Meningitis in the United States
Diedre M. Hofinger, MD;
Luzma Cardona, MD;
Gregory J. Mertz, MD;
Larry E. Davis, MD
Arch Neurol. 2009;66(4):523-527.
Background Tularemia is a zoonotic disease caused by Francisella tularensis. Tularemia presents with various clinical illnesses, but meningitis is rare.
Objectives To describe a patient who developed typhoidal tularemia with atypical acute meningitis and to review the pathogenesis, clinical and laboratory features, and antibiotic drug treatment of reported cases of tularemic meningitis.
Design Case study and literature review.
Setting University hospital, tertiary care center.
Patient A 21-year-old healthy man who had recently worked as a professional landscaper in the Albuquerque, New Mexico, metropolitan area developed fever, malaise, headache, and a stiff neck.
Main Outcome Measures Francisella tularensis cerebrospinal fluid culture, antibiotic sensitivity, transmission source, and outcome.
Results The cerebrospinal fluid contained a lymphocytic pleocytosis, negative Gram stain, and F tularensis isolation with chloramphenicol and streptomycin antibiotic sensitivities.
Conclusions Although tularemia is uncommon and tularemic meningitis is rare in the United States, attention is drawn to the increasing number of cases in professional landscapers, the atypical cerebrospinal fluid picture, and unusual antibiotic sensitivities.
Author Affiliations: Medicine (Dr Hofinger) and Neurology (Drs Cardona and Davis) Services, New Mexico VA Health Care System, and Departments of Internal Medicine (Drs Hofinger and Mertz) and Neurology (Drs Cardona and Davis), University of New Mexico School of Medicine, Albuquerque.
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