# Case of Congenital Tularemia with Neuroinvasive Disease, Utah, USA

## TL;DR

A neonate in Utah was diagnosed with congenital tularemia, a rare infection that spread to the brain, supported by maternal history and lab tests.

## Contribution

This case provides strong evidence for congenital transmission of tularemia through maternal-fetal pathways.

## Key findings

- Neuroinvasive tularemia was detected in a neonate with brain imaging and DNA testing.
- Maternal serology and fetal tissue analysis confirmed the infection originated from the mother.
- The case highlights the importance of considering congenital tularemia in neonatal neurological symptoms.

## Abstract

We diagnosed neuroinvasive tularemia in a neonate in Utah who had culture-negative pleocytosis in cerebrospinal fluid, rim-enhancing lesions on brain magnetic resonance imaging, and blood microbial cell-free DNA Francisella tularensis detection. Maternal history, serologic testing, and Francisella sp. identified in the fallopian tube by immunohistochemistry and 16S rRNA gene PCR strongly support congenital infection.