Background Tularemia is an important re-emerging 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. Methods Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011-2021 were collected through review of electronic medical records and participant questionnaires; with 415 out of 784 accepting participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or PCR). A multivariable logistic regression model was used to investigate variables associated with re-treatment. Results Median age of participants was 54 years (IQR 41.5-65) and 49.2% were female. While 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 non-specific, with monocytosis frequently observed (n=36/75; 48%). Tularemia was often misdiagnosed upon presentation (n=158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics, and 102 (31.2%) re-treated. Persistent lymphadenopathy was infrequent (n=22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with re-treatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR 3.25-20.75] vs. 7 [IQR 4-11.25] days; adjusted p=0.076), and doxycycline-based treatment regimen (vs. ciprofloxacin; adjusted p=0.084), although not significant after correction for multiple comparisons. Conclusion 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.

中文翻译：

---

针对兔热病：瑞典北部 11 年回顾性观察队列的临床、实验室和治疗结果

背景 兔热病是一种重要的复发性疾病，具有多模式传播模式。目前推荐的抗生素方案（包括环丙沙星和强力霉素）的治疗结果仍不清楚。在这项回顾性队列研究中，我们报告了瑞典北部 11 年来实验室确诊的兔热病病例的临床、实验室、地理和治疗结果。方法 通过审查电子病历和参与者问卷，收集 2011 年至 2021 年北博滕县报告的兔热病病例（研究时年龄 > 10 岁）的数据；784 人中有 415 人接受参与（52.9%）。其中，327 例为实验室确诊病例（血清学和/或 PCR）。使用多变量逻辑回归模型来研究与再治疗相关的变量。结果 参与者的中位年龄为 54 岁（IQR 41.5-65），其中 49.2% 为女性。虽然溃疡性土拉菌病是主要形式（n=215，65.7%），但也有几例肺土拉菌病（n=40；12.2%）。炎症标志物大部分是非特异性的，经常观察到单核细胞增多（n=36/75；48%）。土拉菌病在就诊时经常被误诊（n=158 例，48.3%），其中 65 例（19.9%）最初接受了不适当的抗生素治疗，102 例（31.2%）接受了重新治疗。持续性淋巴结肿大并不常见（n=22，6.7%），其中 10 例接受了手术干预。在与再治疗相关的变量的多变量分析中，我们强调了接受适当抗生素之前的时间差异（8 [IQR 3.25-20.75] 与 7 [IQR 4-11.25] 天；调整后 p=0.076）和基于多西环素的治疗方案（与环丙沙星相比；调整后的 p=0.084），尽管在多重比较校正后并不显着。结论 我们全面总结了 B 型兔热病的临床、实验室和治疗结果。针对土拉菌病需要临床认识、早期诊断并及时开始治疗并持续适当的时间。