{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:56:41Z","timestamp":1789631801079,"version":"build-2803163510"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Office of the Assistant Secretary for Preparedness and Response"},{"DOI":"10.13039\/100000016","name":"US Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tularemia is caused by the gram-negative bacterium Francisella tularensis. Although rare, tularemia during pregnancy has been associated with pregnancy complications; data on efficacy of recommended antimicrobials for treatment are limited. We performed a systematic literature review to characterize clinical manifestations of tularemia during pregnancy and examine maternal, fetal, and neonatal outcomes with and without antimicrobial treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched 9 databases, including Medline, Embase, Global Health, and PubMed Central, using terms related to tularemia and pregnancy. Articles reporting cases of tularemia with \u22651 maternal or fetal outcome were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 5891 articles identified, 30 articles describing 52 cases of tularemia in pregnant patients met inclusion criteria. Cases were reported from 9 countries, and oropharyngeal and ulceroglandular tularemia were the most common presenting forms. A plurality (46%) of infections occurred in the second trimester. Six complications were observed: lymph node aspiration, lymph node excision, maternal bleeding, spontaneous abortion, intrauterine fetal demise, and preterm birth. No deaths among mothers were reported. Of 28 patients who received antimicrobial treatment, 1 pregnancy loss and 1 fetal death were reported. Among 24 untreated patients, 1 pregnancy loss and 3 fetal deaths were reported, including one where F. tularensis was detected in placental and fetal tissues.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pregnancy loss and other complications have been reported among cases of tularemia during pregnancy. However, risk of adverse outcomes may be lower when antimicrobials known to be effective are used. Without treatment, transplacental transmission appears possible. These data underscore the importance of prompt recognition and treatment of tularemia during pregnancy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad686","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T10:08:16Z","timestamp":1706695696000},"page":"S47-S54","source":"Crossref","is-referenced-by-count":9,"title":["Systematic Review of Tularemia During Pregnancy"],"prefix":"10.1093","volume":"78","author":[{"given":"Shannon","family":"Fleck-Derderian","sequence":"first","affiliation":[{"name":"Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Meryl","family":"Davis","sequence":"additional","affiliation":[{"name":"Gilstrap Obstetrics and Gynecology Fellow, CDC Foundation , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Winberg","sequence":"additional","affiliation":[{"name":"Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"},{"name":"Alaka`ina Foundation, Contracting Agency for Division of Vector-Borne Diseases, Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A","family":"Nelson","sequence":"additional","affiliation":[{"name":"Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Meaney-Delman","sequence":"additional","affiliation":[{"name":"Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2024013110074027500_ciad686-B1","first-page":"2759","volume-title":"Mandell, Douglas, and Bennett's Principles and practice of infectious diseases","author":"Auwaerter","year":"2020","edition":"9th ed"},{"key":"2024013110074027500_ciad686-B2","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1001\/jama.285.21.2763","article-title":"Tularemia as a biological weapon: medical and public health management","volume":"285","author":"Dennis","year":"2001","journal-title":"JAMA"},{"key":"2024013110074027500_ciad686-B3","author":"Centers for Disease Control and Prevention"},{"key":"2024013110074027500_ciad686-B4","author":"European Centre for Disease Prevention and Control"},{"key":"2024013110074027500_ciad686-B5","doi-asserted-by":"crossref","first-page":"ofx027","DOI":"10.1093\/ofid\/ofx027","article-title":"Variation in tularemia clinical manifestations\u2014Arkansas, 2009\u20132013","volume":"4","author":"Rothfeldt LK","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2024013110074027500_ciad686-B6","author":"Centers for Disease Control and Prevention; US Department of Agriculture"},{"key":"2024013110074027500_ciad686-B7","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1177\/104063870802000417","article-title":"Tularemia in range sheep: an overlooked syndrome?","volume":"20","author":"O\u2019Toole","year":"2008","journal-title":"J Vet Diagn Invest"},{"key":"2024013110074027500_ciad686-B8","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/bdr2.1016","article-title":"Preparing for biological threats: addressing the needs of pregnant women","volume":"109","author":"Watson","year":"2017","journal-title":"Birth Defects Res"},{"key":"2024013110074027500_ciad686-B9","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s15010-013-0456-5","article-title":"Tularemia during pregnancy","volume":"41","author":"Ata","year":"2013","journal-title":"Infection"},{"key":"2024013110074027500_ciad686-B10","volume-title":"WHO Guidelines on tularaemia","author":"World Health Organization","year":"2007"},{"key":"2024013110074027500_ciad686-B11","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1093\/cid\/ciz1231","article-title":"Safety of antimicrobials during pregnancy: a systematic review of antimicrobials considered for treatment and postexposure prophylaxis of plague","volume":"70","author":"Yu","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2024013110074027500_ciad686-B12","author":"University of York"},{"key":"2024013110074027500_ciad686-B13","author":"Council of State and Territorial Epidemiologists (CSTE)"},{"key":"2024013110074027500_ciad686-B14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1542\/peds.2011-1037","article-title":"Standard terminology for fetal, infant, and perinatal deaths","volume":"128","author":"Barfield","year":"2011","journal-title":"Pediatrics"},{"key":"2024013110074027500_ciad686-B15","author":"Wells"},{"key":"2024013110074027500_ciad686-B16","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1001\/jama.1936.92770340001007","article-title":"Tularemia and pregnancy: report of a case","volume":"107","author":"Bowe","year":"1936","journal-title":"JAMA"},{"key":"2024013110074027500_ciad686-B17","first-page":"432","article-title":"The etiopathogenesis of hydranencephaly","volume":"35","author":"Pohanka","year":"1980","journal-title":"Cesk Pediatr"},{"key":"2024013110074027500_ciad686-B18","first-page":"165","article-title":"Congenital tularemia","volume":"43","author":"Lide","year":"1947","journal-title":"Arch Pathol"},{"key":"2024013110074027500_ciad686-B19","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0151-9638(07)92827-6","article-title":"Tularaemia outbreak in Kosovo","volume":"134","author":"Boui","year":"2007","journal-title":"Ann Dermatol Venereol"},{"key":"2024013110074027500_ciad686-B20","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/00000441-194712000-00011","article-title":"Tularemia treated with streptomycin","volume":"214","author":"Johnson","year":"1947","journal-title":"Am J Med Sci"},{"key":"2024013110074027500_ciad686-B21","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1001\/archinte.1935.00160190064007","article-title":"Tularemia. A consideration of one hundred and twenty-three cases, with observations at autopsy in one","volume":"55","author":"Kavanaugh","year":"1935","journal-title":"Arch Intern Med"},{"key":"2024013110074027500_ciad686-B22"},{"key":"2024013110074027500_ciad686-B23","doi-asserted-by":"crossref","first-page":"812","DOI":"10.3855\/jidc.12312","article-title":"An outbreak of tularemia in southwestern Turkey","volume":"15","author":"Kutlu","year":"2021","journal-title":"J Infect Dev Ctries"},{"key":"2024013110074027500_ciad686-B24","first-page":"71","article-title":"A general view to tularemia cases in Turkey: on to a pure oropharyngeal type outbreak","volume":"1","author":"Turhan","year":"2007","journal-title":"Anatol J Clin Investig"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/78\/Supplement_1\/S47\/56487316\/ciad686.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/78\/Supplement_1\/S47\/56487316\/ciad686.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T10:08:33Z","timestamp":1706695713000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/78\/Supplement_1\/S47\/7593857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,31]]},"references-count":24,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2024,1,31]]},"published-print":{"date-parts":[[2024,1,31]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciad686","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,15]]},"published":{"date-parts":[[2024,1,31]]}}}