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Year : 2015  |  Volume : 33  |  Issue : 2  |  Page : 329--331

Isolation of Francisella tularensis from blood culture

SD Nirkhiwale1, GS Gehlot2, AK Bandi3, AN Jasani1,  
1 Department of Laboratory Medicine, Greater Kailash Hospital, Indore, Madhya Pradesh, India
2 Department of Internal Medicine, Greater Kailash Hospital, Indore, Madhya Pradesh, India
3 Department of Urology, Greater Kailash Hospital, Indore, Madhya Pradesh, India

Correspondence Address:
S D Nirkhiwale
Department of Laboratory Medicine, Greater Kailash Hospital, Indore, Madhya Pradesh
India

How to cite this article:
Nirkhiwale S D, Gehlot G S, Bandi A K, Jasani A N. Isolation of Francisella tularensis from blood culture.Indian J Med Microbiol 2015;33:329-331

How to cite this URL:
Nirkhiwale S D, Gehlot G S, Bandi A K, Jasani A N. Isolation of Francisella tularensis from blood culture. Indian J Med Microbiol [serial online] 2015 [cited 2019 Oct 18 ];33:329-331
Available from: http://www.ijmm.org/text.asp?2015/33/2/329/154901

Full Text

Dear Editor,

Tularaemia is exclusively a disease of northern hemisphere. [1] We report the first ever isolation of Francisella tularensis from blood cultures of a febrile patient from central India.

A 33-year-old male presented to the out-patient clinic of our hospital in March 2013 with acute febrile illness suspicious of typhoid fever. Paired aerobic blood culture specimens incubated in BacT/ALERT 3D (bioMerieux, France) detected growth concurrently within 38.5 hours [Figure 1] and [Figure 2]. Sub-culture on sheep blood agar and chocolate agar yielded good growth of 2-3 mm, smooth, moist, rounded, regular, non-haemolytic, greyish colonies of thin, small, gram negative non-motile bacilli in 48 hours. Both isolates were identified by Vitek GN ID Cards (Vitek2Compact, bioMerieux France) as Francisella tularensis with 99% probability signifying excellent identification [Figure 3] and [Figure 4].{Figure 1}{Figure 2}{Figure 3}{Figure 4}

Patient was presumptively diagnosed as typhoidal tularaemia and successfully treated with intravenous gentamicin 5 mg/kg/day for 10 days in accordance with World Health Organisation (WHO) guidelines for Tularaemia. [1] On further interrogation, our patient was found to be a frequent traveler to Europe where the disease is endemic in some parts. [1] Patient also denied any history of close contact with animals, insect bite, or consumption of animal food. The source of infection was thus not traceable.

Detection of growth in blood cultures usually takes longer than 5 days, however, the same has improved with availability of sensitive blood culture systems. [2] The organism routinely requires cysteine-supplemented media for its growth, however, some strains are known to grow without cysteine. [3],[4] Confirmation of the isolate with antigen-detection or molecular methods could not be performed for want of such facilities locally, compounded with difficulties of transportation due to known association of the organism with bio-terrorism. [5] Increasing availability of sensitive and reliable blood culture equipment and microbial identification systems, raises possibility of more such presumptive isolates of F. tularensis reported in future from our population.

References

1World Health Organization. WHO Guidelines on Tularaemia. Available from: http://whqlibdoc.who.int/publications/2007/9789241547376_eng.pdf [Last accessed on 2014 Aug 16].
2Provenza JM, Klotz SA, Penn RL. Isolation of Francisella tularensis from blood. J Clin Microbiol 1986;24:453-5.
3Bernard K, Tessier S, Winstanley J, Chang D, Borczyk A. Early recognition of atypical Francisella tularensis strains lacking a cysteine requirement. J Clin Microbiol 1994;32:551-3.
4Clarridge JE 3 rd , Raich TJ, Sjösted A, Sandström G, Darouiche RO, Shawar RM, et al. Characterization of two unusual clinically significant Francisella strains. J Clin Microbiol 1996;34:1995-2000.
5Dennis DT, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, et al.; Working Group on Civilian Biodefense. Tularemia as a biological weapon: Medical and public health management. JAMA 2001;285:2763-773.