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Volume 31, Number 12—December 2025

Dispatch

Case of Congenital Tularemia with Neuroinvasive Disease, Utah, USA

Brent D. NelsonComments to Author , Amara Finch, Krow Ampofo, Elizabeth L. Ryals, Andrew T. Pavia, Anne J. Blaschke, Jody L. Lin, Benjamin Kalm, Julian A. Villalba, Julu Bhatnagar, Bert Lopansri, and Elizabeth D. Knackstedt
Author affiliation: University of Utah School of Medicine, Salt Lake City, Utah, USA (B.D. Nelson, A. Finch, K. Ampofo, A.T. Pavia, A.J. Blaschke, J.L. Lin, B. Kalm, B. Lopansri, E.D. Knackstedt); Primary Children’s Hospital, Salt Lake City (E.L. Ryals); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.A. Villalba, J. Bhatnagar); Intermountain Medical Center, Murray, Utah, USA (B. Lopansri)

Main Article

Table 1

Pertinent results of laboratory tests taken during hospitalization of infant in case of congenital tularemia with neuroinvasive disease, Utah, USA*

Test Hospitalization 1
 Hospitalization 2
Admission: DOL 16 Discharge: DOL 21 Admission: DOL 30
Complete blood count
Hemoglobin, K/μL 13.8 12.6 13.1
Hematocrit, g/dL 39.8 36.7 39.6
Leukocyte, K/μL 56.8 17.6 25.2
Neutrophils, K/μL 29.0 3.3 4.8
Lymphocytes, K/μL 19.9 11.3 15.4
Monocytes, K/μL 4.5 3.0 3.5
Platelets, K/μL
 206
 149
584
Chemistry
Sodium, mmol/L 129 144 137
Total bilirubin, mg/dL 1.3 1.1 0.9
ALP, unit/L 205 139 335
AST, unit/L 898 144 57
ALT, unit/L 316 96 26
Lactic acid, mmol/L
 2.4
1.8
Inflammatory/infectious markers
C-reactive protein, mg/dL 17.1 6.8 4.7
Procalcitonin, ng/mL
 3.02
0.15
Cerebrospinal fluid
Glucose, mg/dL 44 NA 36
Total protein, mg/dL 114 NA 81
Leukocytes, cells/μL 48 NA 31
Neutrophils, % 3 NA 4
Lymphocytes, % 81 NA 71
Monocytes, % 16 NA 25
Erythrocytes, cells/μL <1 NA 7
Gram stain
 Negative
 NA
Negative
BioFire Respiratory 2.1 panel
 Positive for rhinovirus
Positive for rhinovirus
Cultures
Blood No growth × 5 d NA No growth × 5 d
Urine 1,000 colony-forming units of Staphylococcus lugdunensis NA No growth × 2 d
CSF No growth × 4 d NA No growth × 4 d

*Abnormal values in bold. ALP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate aminotransferase; DOL, day of life; NA, not applicable.

Main Article

Page created: November 18, 2025
Page updated: December 12, 2025
Page reviewed: December 12, 2025
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