Case Studies and Literature Review of Francisella tularensis-Related Prosthetic Joint Infection

Abstract

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.

Keywords: France; Francisella tularensis; bacteria; prosthetic joint infection; tularemia; zoonoses; zoonotic disease.

Figure 1

Computed tomography scan of pelvis in case 1 showing large abscess of the left hip with a periosteal image compatible with an osteitis in case of Francisella tularensis–related prosthetic joint infection, France.

Figure 2

PET scan of the lung in case 2 showing the presence of bilateral mediastinohilar lymphadenopathies associated with a diffuse condensation of the upper right pulmonary lobe in case of Francisella tularensis–related prosthetic joint infection, France.