Kravdal Astrid, Stubhaug Øystein Olav, Wågø Anne Grete, Steien Sætereng Magnus, Amundsen Dag, Piekuviene Ruta, Kristiansen Annette
Dept of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
Dept of Microbiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
ERJ Open Res. 2020 Jun 29;6(2). doi: 10.1183/23120541.00093-2019. eCollection 2020 Apr.
Pulmonary manifestations of tularaemia are reported to be infrequent in previous publications. During 2016, we noticed an increase in the number of hospitalised patients with pulmonary tularaemia in Eastern Norway. We aimed to investigate primary pulmonary tularaemia in Eastern Norway in terms of symptoms, radiological and microbiological findings, incidence and risk exposure.
A retrospective analysis of consecutive primary pulmonary tularaemia cases from 2016 until 2018 was conducted.
From 1 September, 2016 until 31 December, 2018, 22 patients were diagnosed with primary pulmonary tularaemia at Innlandet Hospital Trust, representing 48% of all reported tularaemia cases in the region. A peak annual incidence of 3.4 in 100 000 was found in 2017.All 22 patients lived in, or had recently visited, rural areas. Eighteen patients reported risk exposure for tularaemia, such as wood chopping, outdoor activities and farming prior to symptom onset. All patients experienced fever, and 19 patients had respiratory symptoms. Ten patients were in spontaneous recovery at diagnosis.All patients had a chest computed tomography scan. Overall, 19 patients had pulmonary lesions and 18 had enlarged intrathoracic lymph nodes. The computed tomography images were described as suspicious of malignancy in 17 patients.
Pulmonary manifestations in tularaemia occurred more frequently in our region than expected from previous reports. Although all patients had symptoms consistent with infection, the majority were primarily investigated considering lung cancer due to the radiology report. In endemic areas, pulmonary tularaemia may be an important differential diagnosis to lung cancer.
在以往的文献报道中，兔热病的肺部表现并不常见。2016年期间，我们注意到挪威东部因肺部兔热病住院的患者数量有所增加。我们旨在从症状、放射学和微生物学检查结果、发病率及风险暴露方面对挪威东部的原发性肺部兔热病进行调查。
对2016年至2018年连续的原发性肺部兔热病病例进行回顾性分析。
从2016年9月1日至2018年12月31日，内陆医院信托基金诊断出22例原发性肺部兔热病患者，占该地区所有报告的兔热病病例的48%。2017年发现年发病率峰值为每10万人中有3.4例。所有22例患者均居住在农村地区或近期去过农村地区。18例患者报告在症状出现前有兔热病的风险暴露，如伐木、户外活动和务农。所有患者均有发热，19例患者有呼吸道症状。10例患者在诊断时处于自发恢复状态。所有患者均进行了胸部计算机断层扫描。总体而言，19例患者有肺部病变，18例患者有胸腔内淋巴结肿大。17例患者的计算机断层扫描图像被描述为怀疑有恶性肿瘤。
在我们地区，兔热病的肺部表现比以往报告预期的更为常见。尽管所有患者的症状均与感染相符，但由于放射学报告，大多数患者最初被怀疑患有肺癌。在流行地区，肺部兔热病可能是肺癌的重要鉴别诊断。
