AUTHOR=Guerpillon Brice , Boibieux Andre , Guenne Clemence , Ploton Christine , Ferry Tristan , Maurin Max , Forestier Emmanuel , Dauwalder Olivier , Manipoud Patrick , Ltaïef-Boudrigua Aicha , Gürkov Robert , Vandenesch Francois , Bouchiat Coralie 

TITLE=Keep an Ear Out for Francisella tularensis: Otomastoiditis Cases after Canyoneering

JOURNAL=Frontiers in Medicine

VOLUME=3

YEAR=2016

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2016.00009

DOI=10.3389/fmed.2016.00009

ISSN=2296-858X

ABSTRACT=<p>We report here three unusual cases of otomastoiditis due to <italic>Francisella tularensis</italic>, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we believe that <italic>F. tularensis</italic> should be considered as a possible etiology in case of otitis media, failure of the conventional antibiotic treatment, and suspicious exposure of the bacteria.</p>