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Implications in the Era of Managed Care

David N. Fredricks, MD; Jack S. Remington, MD

Arch Intern Med. 1996;156(18):2137-2140.

Abstract
A case of pleuropulmonary tularemia was diagnosed by sputum culture and serologic studies in a patient who did not have classic epidemiological risks for tularemia. The patient had atypical pneumonia when initially seen and his condition slowly improved with antibiotic therapy that included erythromycin lactobionate. The diagnosis of tularemia was delayed because the gram-negative rod isolated from the patient's sputum was initially not speciated in an effort to reduce laboratory costs.

Arch Intern Med. 1996;156:2137-2140

Author Affiliations
From the Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine (Drs Fredricks and Remington), and the Department of Immunology and Infectious Diseases, Research Institute, Palo Alto Medical Foundation (Dr Remington), Palo Alto, Calif.

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