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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)

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Table 2

Infant and maternal testing for Francisella tularensis in study of congenital tularemia with neuroinvasive disease, Utah, USA*

Test, specimen source Infant Mother
Microbial cell free DNA metagenomic sequencing (Karius), plasma† 4 weeks: 804 MPM F. tularensis subsp. holartica cfDNA (Appendix) NA
7 weeks: 11 MPM F. tularensis subsp. holartica cfDNA (Appendix)
F. tularensis IgM, serum 4 weeks: negative 6 weeks postpartum: positive
8 weeks: negative
F. tularensis IgG, serum 4 weeks: positive 6 weeks postpartum: positive
8 weeks: negative
Culture data (Table 1) Neck abscess (35 weeks’ gestation): no growth × 5 d
Throat culture (6 weeks postpartum): no growth × 5 d
Next-generation metagenomic sequencing, CSF‡
 4 weeks: negative
 NA
Multiplex PCR panel (BioFire), serum
 4 weeks: negative
 NA
Multiplex PCR panel, (BioFire); meningitis/encephalitis panel (Filmarray), CSF
 4 weeks: negative
 NA
Francisella tularensis immunohistochemistry, FFPE maternal fallopian tube tissue§
 NA
 Francisella spp. antigens detected (Figure 2)
Gram-negative bacteria 16S rRNA gene PCR test, FFPE maternal fallopian tube tissue§ NA Positive for Francisella spp.

*cfDNA, cell-free DNA; CSF, cerebrospinal fluid; FFPE, formalin-fixed paraffin-embedded; MPM, molecules per microliter; NA, not applicable. †Testing performed at Karius (https://kariusdx.com). ‡Testing performed at University of California, San Francisco (San Francisco, CA, USA). §Testing performed at Centers for Disease Control and Prevention (Atlanta, GA, USA).

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