1371. Tularemia During Pregnancy: A Systematic Review of Treatment and Outcomes

Abstract Background Francisella tularensis, the gram-negative bacterium that causes tularemia, is endemic throughout the Northern Hemisphere and is a Tier 1 bioterrorism agent. Signs and symptoms can include fever, lymphadenopathy, pharyngitis, or pneumonia. Aminoglycosides, fluoroquinolones, and tetracyclines are effective for treatment; however, data on their use for tularemia in pregnancy is lacking. We performed a systematic review of tularemia during pregnancy to describe antimicrobial treatment and examine maternal, fetal, and neonatal outcomes. Methods We searched nine literature databases using terms related to tularemia and pregnancy and included articles describing cases of tularemia with at least one maternal or fetal outcome. Information abstracted included clinical features of tularemia; antimicrobial treatment during pregnancy; and maternal, pregnancy, and neonatal outcomes. Results Of 4,181 articles identified, 25 articles describing 47 cases of tularemia in pregnant patients were eligible for inclusion. Cases were reported between 1930 and 2021 from eight countries. Among cases with clinical form described, oropharyngeal tularemia was the most common (n=13/22, 59%), followed by ulceroglandular (n=5/22, 23%), glandular (2/22, 9%), and oculoglandular (n=2/22, 9%) forms. Patients were initially infected during the 1st trimester (26%), 2nd trimester (47%), 3rd trimester (18%), and before pregnancy (9%). Nineteen (40%) mothers were treated with at least one antimicrobial effective against F. tularensis: gentamicin (n=13), ciprofloxacin (n=6), doxycycline (n=1), and streptomycin (n=1). Four intrauterine fetal deaths (IUFD) occurred, all among pregnancies in which the mother received no effective antimicrobials. No pregnancy losses were reported among treated mothers. Among 34 live births, two were preterm and one case of hydranencephaly was identified, all among untreated mothers. No maternal deaths were reported. Conclusion Pregnancy loss and preterm birth have been documented in pregnant patients with tularemia who did not receive effective antimicrobial treatment. Prompt recognition and treatment of tularemia during pregnancy is important and could minimize risk for adverse outcomes. Disclosures All Authors: No reported disclosures.