Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–20151
, Pavlína Tinavská, Olga Dvořáčková, Pavlína Filipová, Věra Hnetilová, Pavel Žampach, Květoslava Batistová, Václav Chmelík, Amanda E. Semper, and Nick J. Beeching
Author affiliations: České Budějovice Hospital, České Budějovice, Czech Republic (A. Chrdle, P. Tinavská, P. Filipová, V. Hnetilová, P. Žampach, V. Chmelík); University of South Bohemia Faculty of Health and Social Sciences, České Budějovice, Czech Republic (A. Chrdle, O. Dvořáčková); Royal Liverpool University Hospital, Liverpool, UK (A. Chrdle, N.J. Beeching); Písek Hospital, Písek, Czech Republic (K. Batistová); Public Health England, Porton Down, UK (A.E. Semper); National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK (A.E. Semper; N.J. Beeching); Liverpool School of Tropical Medicine, Liverpool (N.J. Beeching)
Figure 7. Comparison of time to first positive serologic test result for tularemia and time to raised CD3+/CD4–/CD8– T-cell percentage determined by flow cytometry relative to the time of symptom onset of 58 patients with probable or confirmed tularemia, Czech Republic, 2003–2015. Percentages of CD3+/CD4–/CD8– T cells >8% were considered raised. A positive serologic test result for tularemia was defined for probable cases as an antibody titer of >1:20 in any acute phase blood sample and for confirmed cases as a single antibody titer of >1:160 in any blood sample or a seroconversion from negative to positive (any titer) or a 4-fold increase in titer between acute and convalescent patient samples (agglutination test; Tularemia Diagnostic Set, Bioveta a.s., https://www.bioveta.eu). Boxes indicate interquartile ranges (IQRs), horizontal lines within boxes indicate medians, whiskers indicate range values <1.5× the IQR limits, and circles indicate outliers (i.e., values >1.5× times the IQR limits). The CD3+/CD4–/CD8– T cells increased before Francisella tularensis–specific antibody titers increased (Wilcoxon signed rank test, p<0.0001).
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