Tularemia following a squirrel bite in Southern Germany: a case report

Background Tularemia is a zoonotic infection caused by Francisella tularensis . Human cases in Germany are emerging and are usually associated with hare or tick exposure. Transmission via squirrel bites has only been reported once before in Germany. Case presentation We describe a 23-year-old woman who developed tularemia 11 days after being bitten by an injured red squirrel ( Sciurus vulgaris ) in southern Germany. Initial symptoms included headache, chills and fatigue, followed by painful right axillary lymphadenopathy without fever. Empirical ciprofloxacin (500 mg twice daily) was initiated on day 10 post-bite. Francisella tularensis serology was negative at presentation but seroconversion was documented 19 days later, confirming the diagnosis. The patient recovered fully after a 10-day course of ciprofloxacin. Conclusions This case underscores the need to consider tularemia after rodent bites in endemic areas, including squirrel bites, and highlights the favourable clinical course following early fluoroquinolone therapy.