{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:07Z","timestamp":1756311007483,"version":"3.44.0"},"reference-count":52,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,29]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>Tularaemia is a highly infectious, zoonotic disease caused by <jats:italic>Francisella tularensis<\/jats:italic>, which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as <jats:italic>F. tularensis<\/jats:italic> upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2023-256509","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T08:35:14Z","timestamp":1711701314000},"page":"e256509","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Identification of <i>Francisella tularensis<\/i> in ascites in the context of typhoidal tularaemia"],"prefix":"10.1136","volume":"17","author":[{"given":"Marco","family":"Duerig","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland"},{"name":"Division of Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1426-4544","authenticated-orcid":false,"given":"Philipp","family":"Suter","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland"},{"name":"Department of Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Haefliger","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland"},{"name":"Division of Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Chuard","sequence":"additional","affiliation":[{"name":"Departement of Infectiology, University and Hospital of Fribourg, Fribourg, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"2025082708490438000_17.3.e256509.1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540410020442"},{"key":"2025082708490438000_17.3.e256509.2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis706"},{"key":"2025082708490438000_17.3.e256509.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00088903"},{"key":"2025082708490438000_17.3.e256509.4","doi-asserted-by":"publisher","DOI":"10.3201\/eid1602.081727"},{"key":"2025082708490438000_17.3.e256509.5","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2018.00040","article-title":"Tularemia in Germany-A re-emerging zoonosis","volume":"8","author":"Faber","year":"2018","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082708490438000_17.3.e256509.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-020-05051-1","article-title":"Francisella tularensis as the cause of protracted fever","volume":"20","author":"Antonitsch","year":"2020","journal-title":"BMC Infect Dis"},{"key":"2025082708490438000_17.3.e256509.7","first-page":"181","article-title":"Tularemia--United States, 1990-2000","volume":"51","year":"2002","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082708490438000_17.3.e256509.8","unstructured":"World Health Organization . 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