Tularemia meningitis occurred in a previously healthy 64-year-old man from Northern Sweden. The patient was immunocompetent and recovered without sequelae. The bacterial isolate conformed by most criteria with the Euro-Asian biovar Francisella tularensis var. palaearctica. Tularemia meningitis may mimic meningitis caused by Mycobacterium tuberculosis.
A 56-year-old man suffered from prolonged fever, sore throat and cough, followed by pleural effusion and reversible progressive ascending muscle weakness. The condition fulfilled the diagnostic criteria of Guillain-Barré syndrome. Tuberculosis was initially suspected because of lymphocyte predominance and high adenosine deaminase activity in the pleural fluid. Later, an agglutination titer of 10,240 to Francisella tularensis antigen was found and an infected hare exposure could be identified. Thus, the activity of adenosine deaminase may be high also in tularemia pleuritis.
A case of tularaemia presenting with severe septicaemia and myositis is reported. The infection was presumed to be acquired by a bite from the horse fly Haematopota pluvialis, also known as the rain fly.