{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:25:11Z","timestamp":1791563111351,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research and Development Unit"},{"name":"Region J\u00e4mtland-H\u00e4rjedalen and Region V\u00e4sterbotten"}],"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>Fluoroquinolones lack approval for treatment of tularemia but have been used extensively for milder illness. Here, we evaluated fluoroquinolones for severe illness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In an observational study, we identified case-patients with respiratory tularemia from July to November 2010 in J\u00e4mtland County, Sweden. We defined severe tularemia by hospitalization for &amp;gt;24 hours and severe bacteremic tularemia by Francisella tularensis subsp. holarctica growth in blood or pleural fluid. Clinical data and drug dosing were retrieved from electronic medical records. Chest images were reexamined. We used Kaplan\u2013Meier curves to evaluate time to defervescence and hospital discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 67 case-patients (median age, 66 years; 81% males) 30-day mortality was 1.5% (1 of 67). Among 33 hospitalized persons (median age, 71 years; 82% males), 23 had nonbacteremic and 10 had bacteremic severe tularemia. Subpleural round consolidations, mediastinal lymphadenopathy, and unilateral pleural fluid were common on chest computed tomography. Among 29 hospitalized persons with complete outcome data, ciprofloxacin\/levofloxacin (n = 12), ciprofloxacin\/levofloxacin combinations with doxycycline and\/or gentamicin (n = 11), or doxycycline as the single drug (n = 6) was used for treatment. One disease relapse occurred with doxycycline treatment. Treatment responses were rapid, with median fever duration 41.0 hours in nonbacteremic and 115.0 hours in bacteremic tularemia. Increased age-adjusted Charlson comorbidity index predicted severe bacteremic tularemia (odds ratio, 2.7 per score-point; 95% confidence interval, 1.35\u20135.41). A 78-year-old male with comorbidities and delayed ciprofloxacin\/gentamicin treatment died.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Fluoroquinolone treatment is effective for severe tularemia. Subpleural round consolidations and mediastinal lymphadenopathy were typical findings on computed tomography among case-patients in this study.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad690","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T10:09:35Z","timestamp":1706695775000},"page":"S38-S46","source":"Crossref","is-referenced-by-count":14,"title":["Treatment Outcome of Severe Respiratory Type B Tularemia Using Fluoroquinolones"],"prefix":"10.1093","volume":"78","author":[{"given":"Micael","family":"Widerstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"M\u00f6rtberg","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u00d6stersund Hospital , \u00d6stersund , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Magnusson","sequence":"additional","affiliation":[{"name":"Department of Radiology, \u00d6stersund Hospital , \u00d6stersund , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fj\u00e4llstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0548-5943","authenticated-orcid":false,"given":"Anders F","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2024013110074637500_ciad690-B1","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":"2024013110074637500_ciad690-B2","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1016\/B978-0-443-06839-3.00227-7","author":"Penn","year":"2010","journal-title":"Mandell, Douglas, and Bennett\u2019s principles and practice of infectious diseases"},{"key":"2024013110074637500_ciad690-B3","volume-title":"WHO Guidelines on tularaemia","author":"World Health Organization","year":"2007"},{"key":"2024013110074637500_ciad690-B4","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1093\/jaoac\/93.6.1930","article-title":"Genotyping of Francisella tularensis, the causative agent of tularemia","volume":"93","author":"Johansson","year":"2010","journal-title":"J AOAC Int"},{"key":"2024013110074637500_ciad690-B5","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1086\/597261","article-title":"Molecular epidemiology of Francisella tularensis in the United States","volume":"48","author":"Kugeler","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2024013110074637500_ciad690-B6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/clinids\/19.1.42","article-title":"Streptomycin and alternative agents for the treatment of tularemia: review of the literature","volume":"19","author":"Enderlin","year":"1994","journal-title":"Clin Infect Dis"},{"key":"2024013110074637500_ciad690-B7","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/00005792-198507000-00006","article-title":"Tularemia: a 30-year experience with 88 cases","volume":"64","author":"Evans","year":"1985","journal-title":"Medicine 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