DOI: 10.12890/2026_006057

An uncommon case of tularaemia in Portugal after an arthropod bite

Authors

  • João Horta Antunes Internal Medicine Department, Hospital Beatriz Ângelo, Unidade Local de Saúde Loures-Odivelas, Loures, Portugal 0009-0003-2749-1479
  • Sara Frazão de Brito Internal Medicine Department, Hospital Beatriz Ângelo, Unidade Local de Saúde Loures-Odivelas, Loures, Portugal 0009-0002-3384-3867
  • Hugo Jorge Alves Internal Medicine Department, Hospital Beatriz Ângelo, Unidade Local de Saúde Loures-Odivelas, Loures, Portugal 0009-0005-3846-6177
  • André Santos Internal Medicine Department, Hospital Beatriz Ângelo, Unidade Local de Saúde Loures-Odivelas, Loures, Portugal 0000-0002-6873-724X
  • Bárbara Picado Internal Medicine Department, Hospital Beatriz Ângelo, Unidade Local de Saúde Loures-Odivelas, Loures, Portugal 0000-0002-5303-4496

joao.antunes1226@gmail.com

Keywords

Tularaemia, Portugal, Francisella tularensis, zoonosis

Abstract

Tularaemia is a rare zoonosis caused by Francisella tularensis, with only a few reported cases in Western Europe and only 4 notified in Portugal between 2014 and 2021. We describe an imported case diagnosed in Portugal in 2023. A 40-year-old female developed a painful left inguinal lymphadenopathy after an arthropod bite in England. Despite initial treatment with doxycycline, symptoms persisted with systemic manifestations and progressive lymphadenopathy. Serology tests confirmed F. tularensis infection. The patient required prolonged follow up and antibiotic adjustment, showing gradual clinical improvement. This case highlights the diagnostic challenges of tularaemia and the importance of thorough physical examination and epidemiological history.

View the entire article

Downloads

References

  1. Cunha F, Lopes de Carvalho I, Torres C, Gonçalves R. A multidisciplinary approach to the first autochthonous case of tularemia reported in Portugal. Acta Med Port 2022;35:144–146. doi:10.20344/amp.15790
  2. Yeni DK, Büyük F, Ashraf A, Shah MSUD. Tularemia: a re-emerging tick-borne infectious disease. Folia Microbiol (Praha) 2021;66:1–14. doi:10.1007/s12223-020-00827-z
  3. Nelson CA, Winberg J, Bostic TD, Davis KM, Fleck-Derderian S. Systematic review: clinical features, antimicrobial treatment, and outcomes of human tularemia, 1993–2023. Clin Infect Dis 2024;78:S15–S28. doi:10.1093/cid/ciad736
  4. European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC). The European Union One Health 2021 Zoonoses Report. EFSA J 2022;20:e07666. doi:10.2903/j.efsa.2022.7666
  5. European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC). The European Union One Health 2022 Zoonoses Report. EFSA J 2023;21:e8442. doi:10.2903/j.efsa.2023.8442
  6. European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC). The European Union One Health 2023 Zoonoses Report. EFSA J 2024;22:e9106. doi:10.2903/j.efsa.2024.9106
  7. de Carvalho IL, Escudero R, Garcia-Amil C, Falcão H, Anda P, Núncio MS. Francisella tularensis, Portugal. Emerg Infect Dis 2007;13:666–667. doi:10.3201/eid1304.060714
  8. Thompson A, Brooks T, Houlihan C, Rampling T, Umpleby H, Hansford K, et al. Investigation of a Human Case of Francisella tularensis Infection, United Kingdom, 2023. Emerg Infect Dis 2024;30:2188–2190. doi:10.3201/eid3010.240479

Published

2026-02-20

Issue

Vol. 13 No. 3 (2026)

Categories

How to Cite

1.
Horta Antunes J, Frazão de Brito S, Jorge Alves H, Santos A, Picado B. An uncommon case of tularaemia in Portugal after an arthropod bite. EJCRIM [Internet]. 2026 Feb. 20 [cited 2026 Nov. 3];13(3). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6057