{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:31:58Z","timestamp":1780453918267,"version":"3.54.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","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>Neuroinvasive infection with Francisella tularensis, the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad719","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T10:08:35Z","timestamp":1706695715000},"page":"S55-S63","source":"Crossref","is-referenced-by-count":6,"title":["Neuroinvasive <i>Francisella tularensis<\/i> Infection: Report of 2 Cases and Review of the Literature"],"prefix":"10.1093","volume":"78","author":[{"given":"Shama","family":"Cash-Goldwasser","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta , Georgia , USA"},{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Beeson","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta , Georgia , USA"},{"name":"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":"Natalie","family":"Marzec","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment , Denver, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora Y","family":"Ho","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"Hogan","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Stanford University Medical Center , Stanford, California , USA"},{"name":"Department of Pathology, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indre","family":"Budvytiene","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Stanford University Medical Center , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niaz","family":"Banaei","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine , Stanford, California , USA"},{"name":"Clinical Microbiology Laboratory, Stanford University Medical Center , Stanford, California , USA"},{"name":"Department of Pathology, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald E","family":"Born","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie H","family":"Gephart","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jatinbhai","family":"Patel","sequence":"additional","affiliation":[{"name":"Parkview Medical Center , Pueblo, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Dietrich","sequence":"additional","affiliation":[{"name":"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":"Christina A","family":"Nelson","sequence":"additional","affiliation":[{"name":"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"}]}],"member":"286","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2024013110074191600_ciad719-B1","author":"Centers for Disease Control and Prevention"},{"key":"2024013110074191600_ciad719-B2","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2460\/javma.2003.222.725","article-title":"Tularemia","volume":"222","author":"Feldman","year":"2003","journal-title":"J Am Vet Med Assoc"},{"key":"2024013110074191600_ciad719-B3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1196\/annals.1409.009","article-title":"Tularemia: history, epidemiology, pathogen physiology, and clinical manifestations","volume":"1105","author":"Sj\u00f6stedt","year":"2007","journal-title":"Ann N Y Acad Sci"},{"key":"2024013110074191600_ciad719-B4","author":"World Health 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Tularemia: A storied history, an ongoing threat","author":"Nelson","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2024013110074191600_ciad719-B12","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/00006454-199004000-00019","article-title":"Acute bacterial meningitis caused by Francisella tularensis","volume":"9","author":"Alfes","year":"1990","journal-title":"Pediatr Infect Dis J"},{"key":"2024013110074191600_ciad719-B13","doi-asserted-by":"crossref","first-page":"3454","DOI":"10.1128\/JCM.01018-13","article-title":"Rhombencephalitis caused by Francisella tularensis","volume":"51","author":"Barbaz","year":"2013","journal-title":"J Clin Microbiol"},{"key":"2024013110074191600_ciad719-B14","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.medmal.2011.07.004","article-title":"Francisella tularensis meningitis","volume":"41","author":"Contentin","year":"2011","journal-title":"Med Mal Infect"},{"key":"2024013110074191600_ciad719-B15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.idnow.2021.06.306","article-title":"A case of Francisella tularensis meningitis in a 64-year-old man treated with quinolones","volume":"52","author":"Ducatez","year":"2022","journal-title":"Infect Dis Now"},{"key":"2024013110074191600_ciad719-B16","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/00006454-198609000-00026","article-title":"Tularemic meningitis in a child with mononuclear pleocytosis","volume":"5","author":"Harper","year":"1986","journal-title":"Pediatr Infect Dis"},{"key":"2024013110074191600_ciad719-B17","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3109\/00365549009023126","article-title":"A case of tularemia meningitis in Sweden","volume":"22","author":"Hill","year":"1990","journal-title":"Scand J Infect Dis"},{"key":"2024013110074191600_ciad719-B18","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1001\/archneurol.2009.14","article-title":"Tularemic meningitis in the United States","volume":"66","author":"Hofinger","year":"2009","journal-title":"Arch Neurol"},{"key":"2024013110074191600_ciad719-B19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/00007611-198502000-00016","article-title":"Response of tularemic meningitis to antimicrobial therapy","volume":"78","author":"Hutton","year":"1985","journal-title":"South Med J"},{"key":"2024013110074191600_ciad719-B20","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1093\/infdis\/154.5.916","article-title":"Francisella tularensis meningitis: a rare clinical entity","volume":"154","author":"Lovell","year":"1986","journal-title":"J Infect Dis"},{"key":"2024013110074191600_ciad719-B21","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1159\/000121014","article-title":"A shunt infection caused by Francisella tularensis","volume":"24","author":"Pittman","year":"1996","journal-title":"Pediatr Neurosurg"},{"key":"2024013110074191600_ciad719-B22","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/00006454-199805000-00025","article-title":"Tularemic meningitis","volume":"17","author":"Rodgers","year":"1998","journal-title":"Pediatr Infect Dis J"},{"key":"2024013110074191600_ciad719-B23","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1212\/01.wnl.0000250246.01304.98","article-title":"Tularemia with brain abscesses","volume":"68","author":"van de Beek","year":"2007","journal-title":"Neurology"},{"key":"2024013110074191600_ciad719-B24","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1002\/emp2.12037","article-title":"A rare case of tularemic meningitis in the United States from aerosolized Francisella tularensis","volume":"1","author":"Venkatesan","year":"2020","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"2024013110074191600_ciad719-B25","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1086\/597588","article-title":"An 8-year-old boy with fever, axillary ulcerative lesion, and altered mental status","volume":"48","author":"Page","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2024013110074191600_ciad719-B26","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1097\/01.inf.0000142010.24123.7d","article-title":"Variable presentation of the cause of lymphadenopathy in two children","volume":"23","author":"Weiner","year":"2004","journal-title":"Pediatr Infect Dis J"},{"key":"2024013110074191600_ciad719-B27","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1186\/s12879-019-3863-0","article-title":"Severe infections due to Francisella tularensis ssp. holarctica in solid organ transplant recipient: report of two cases and review of literature","volume":"19","author":"Bahuaud","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2024013110074191600_ciad719-B28","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1001\/jama.1989.03430190084036","article-title":"Differential diagnosis of acute meningitis. 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