This case study is of a teenager who presented to an emergency department with itchiness on the left eye, yellow drainage, pressure on the eye, and difficulty opening the mouth coupled with pain in the left jaw. This came after attending a camp in Ohio. A on the teenager revealed the presence of preseptal cellulitis, but without the formation of an abscess. The patient received polymyxin/trimethoprim drops as well as and was discharged. However, the symptoms worsened and the patient returned to the facilities emergency department a day later with worsening symptoms that included eye redness, pain, and sore throat, together with headache, fever (101 F), and neck pain. Upon admission to a larger hospital and laboratory testing, results were as follows; platelets = 280, white blood cell count = 8.1, hemoglobin = 14.5, , hematocrit = 41.1, and . After several diagnoses, an was necessitated, which recommended testing for Bartonella, Ehrlichia, and Tularemia together with a conjunctiva swab test. The tests revealed a probable presence of Francisella tularensis.
Francisella tularensis is an infectious pathogen which is a common cause of the disease tularemia. Common agents of transmission of the infection include Mosquitoes, ticks, and other biting flies, as well as infected animals such as hares, rabbits, and rodents. Carnivores like domestic cats can also be carriers of the infection from prey. Examination by the infectious disease team revealed that the boy had handled a raccoon without gloves, which might have been the probable cause of the infection. About 20% of cases of the infection are associated with pneumonia, and the incubation period of often from 3 to 5 days, but might extend to 21 days. However, clinical manifestations of the infection may begin abruptly with fever, malaise, chills, and headaches. Effective laboratory identification requires specially enriched media by culture because F. tularensis is less commonly visualized on Gram stain.
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