{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:03:13Z","timestamp":1791511393301,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009772","name":"County Council of Norrbotten","doi-asserted-by":"publisher","award":["NLL-933177"],"award-info":[{"award-number":["NLL-933177"]}],"id":[{"id":"10.13039\/501100009772","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004885","name":"Ume\u00e5 University","doi-asserted-by":"publisher","award":["ALF Universitets-ST"],"award-info":[{"award-number":["ALF Universitets-ST"]}],"id":[{"id":"10.13039\/501100004885","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Region V\u00e4sterbotten","award":["RV-966950"],"award-info":[{"award-number":["RV-966950"]}]},{"name":"Region V\u00e4sterbotten","award":["RV-939171"],"award-info":[{"award-number":["RV-939171"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tularemia is an important reemerging disease with a multimodal transmission pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from reported tularemia cases (aged &amp;gt;10 years at time of study) in Norrbotten county between 2011 and 2021 were collected through review of electronic medical records and participant questionnaires; 415 of 784 accepted participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and\/or polymerase chain reaction). A multivariable logistic regression model was used to investigate variables associated with retreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age of participants was 54 years (interquartile range [IQR], 41.5\u201365) and 49.2% were female. Although ulceroglandular tularemia was the predominant form (n = 215, 65.7%), there were several cases of pulmonary tularemia (n = 40; 12.2%). Inflammatory markers were largely nonspecific, with monocytosis frequently observed (n = 36\/75; 48%). Tularemia was often misdiagnosed on presentation (n = 158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics and 102 (31.2%) retreated. Persistent lymphadenopathy was infrequent (n = 22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with retreatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR, 3.25\u201320.75] vs 7 [IQR, 4\u201311.25] days; adjusted P = .076), and doxycycline-based treatment regimen (vs ciprofloxacin; adjusted P = .084), although this was not significant after correction for multiple comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis, and timely commencement of treatment for an appropriate duration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciae098","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T13:47:27Z","timestamp":1708609647000},"page":"1222-1231","source":"Crossref","is-referenced-by-count":22,"title":["Targeting Tularemia: Clinical, Laboratory, and Treatment Outcomes From an 11-year Retrospective Observational Cohort in Northern Sweden"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2036-0383","authenticated-orcid":false,"given":"Martin","family":"Plymoth","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology, Sunderby Research Unit, Ume\u00e5 University , Ume\u00e5 , Sweden"},{"name":"Department of Infectious Diseases, Westmead Hospital , Sydney, New South Wales , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4059-3368","authenticated-orcid":false,"given":"Robert","family":"Lundqvist","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Sunderby Research Unit, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Nystedt","sequence":"additional","affiliation":[{"name":"Department of Communicable Disease Control, County Council of Norrbotten , Lule\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0768-8405","authenticated-orcid":false,"given":"Anders","family":"Sj\u00f6stedt","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4495-8267","authenticated-orcid":false,"given":"Tomas N","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Sunderby Research Unit, Ume\u00e5 University , Ume\u00e5 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"2024051423591016400_ciae098-B1","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":"2024051423591016400_ciae098-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12223-020-00827-z","article-title":"Tularemia: a re-emerging tick-borne infectious 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