Notes from the Field: Francisella tularensis Type B Infection from a Fish Hook Injury — Minnesota, 2016

Abstract

A 67-year-old immunocompetent white, non-Hispanic woman from Sherburne County, Minnesota, USA, was pricked by a fish hook while fishing on a freshwater lake in northeastern South Dakota on 18 June 2016. While removing a hook from a fish, the hook penetrated the pulp of her left middle finger. On 21 June, pain and swelling developed at the site of the puncture and was seen at an urgent care centre where she received an injection of ceftriaxone and was prescribed oral cefalexin. The pain and swelling did not improve. She was referred to an orthopaedic specialist, who saw her on 23 June, at which time an enlarged, tender left axillary lymph node was noted. The orthopedist drained the finger wound, collected a swab of cloudy, non-purulent fluid for culture, and changed the antibiotic to ciprofloxacin. The Minnesota Department of Health (MDH) Public Health Laboratory confirmed tularaemia on 28 June. She was seen again by the orthopaedist; by this time she had developed an eschar-like ulcer. Ciprofloxacin was discontinued, and a treatment course of doxycycline was initiated and continued for 5 weeks. As of 8 July, the lymphadenopathy had resolved and the ulcerated wound was improving.