Volume 25, Number 10—October 2019
Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–20151
|Diagnosis||No. (%) controls†||No. (%) with elevated CD3+/CD4–/CD8– T cells|
|Nonspecific resolving lymphadenitis||99 (28.9)||7 (7.1)|
|Fever of unknown origin or fatigue||44 (12.9)||2 (4.5)|
|Epstein-Barr virus or cytomegalovirus||26 (7.6)||3 (11.5)|
|Lymphoma or cancer||26 (7.6)||1 (3.8)|
|Chlamydia or Mycoplasma respiratory infection||25 (7.3)||5 (20.0)|
|Recurring or nonresolving tonsilitis||17 (5.0)||4 (23.5)|
|Toxoplasmosis||16 (4.7)||5 (31.3)|
|Other‡||89 (26.0)||9 (10.1)§|
*The percentage of the CD3+ T cells with a CD4–/CD8– phenotype was measured by flow cytometry and 8% was used as the cutoff value to define an elevated percentage. ANCA, anti-neutrophil cytoplasmic antibody.
†Percentages do not total 100% because of rounding.
‡Other diagnoses: 8 cases each of cellulitis or skin abscess and lower respiratory tract infection or pneumonia; 5 cases of bartonellosis; 4 cases each of ANCA-positive vasculitis, leptospirosis, purulent sialadenitis, reactive arthritis (urethritis C. trachomatis), and tick-borne encephalitis; 3 cases of cervical cyst; 2 cases each of HIV, human granulocytic anaplasmosis, other reactive arthritis, polymyalgia rheumatica, sarcoidosis, systemic lupus erythematosus, toxocariasis, and viral meningitis; and 1 case each of acute sinusitis, ankylosing spondylitis, bacterial endocarditis, Behçet disease, cholangitis, deep vein thrombosis, dental abscess, erythema nodosum, farmer’s lung, hantavirus, herpetic tonsilitis, hidradenitis suppurativa, hyperthyroidism, hypothyroidism, legionellosis, lipoma, liver abscess, Lyme disease, mumps, necrotizing lymphadenitis of Kikuchi-Fujimoto, nonspecific hepatitis, parvovirus B19, pertussis, recurrent bacterial conjunctivitis, rickettsial disease, ulcerative colitis, undetermined tumor of the brain and pancreatic head, urinary tract infection, and Yersinia enterocolitica arthritis.
§Includes 2 cases of arthralgia and 1 case each of ANCA-positive vasculitis, brain tumor, liver abscess, pneumocystis pneumonia in the setting of AIDS, rickettsial disease, skin and soft tissue infection, and toxocariasis.
1Preliminary data from this study were presented at the European Congress of Clinical Microbiology and Infectious Diseases; April 9–12, 2016; Amsterdam, the Netherlands (abstract no. O367).