1. ¹Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2. ²Department of Clinical Microbiology, University of Umeå, Umeå, Sweden
3. ³Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
4. ⁴Department of Pathology, Central Arkansas Veterans' Healthcare System, Little Rock, AR, USA

Correspondence: Dr L W Lamps, Deptartment of Pathology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 517, Little Rock, AR 72205, USA. E-mail: lampslauraw@uams.edu

Received 13 August 2003; Revised 18 December 2003; Accepted 22 December 2003; Published online 5 March 2004.

Abstract

Francisella tularensis (FT), a zoonotic bacterium that causes tularemia, has received attention as a possible bioterrorism threat. We developed a PCR assay for use in fixed, processed tissues, which are safer to handle and allow archival testing. PCR analysis for a 211-bp fragment of the FT lipoprotein gene was performed on tissues from 16 cases of tularemia. In all, 14/15 cases with intact DNA (93%) were positive for FT by PCR. Frequent histologic findings in PCR-positive tissues included irregular microabscesses and granulomas in liver, spleen, kidney, and lymph nodes, and necrotizing pneumonia. Unusual cases featuring suppurative leptomeningitis and gastrointestinal ulcers were also seen. As this disease is endemic in North America, and has been identified as a potential bioterroristic threat, awareness of the clinicopathologic spectrum of disease and available detection methods is increasingly important. This PCR assay, the first designed for use in processed tissues, is an excellent method for diagnosis of tularemia.