Results: From 2000-2015 a total of 57 cases of tularemia were reported in Armenia. Of these, 84.2% were male and 78.9% were from rural areas. Distribution of age groups were: ≤18-24.6%, 19-30-54.4%, 31-44-14.01%, ≥45-7.0%. The most common symptoms include: fatigue (n=52, 91%), fever (n=45, 78.9%), pharyngitis (n=40, 70.2%), headache (n=27, 47.4%), hepatomegaly (n=5, 8.8%), and splenomegaly (n=2, 3.5%). The average hospitalization stay was 35.7 days. The most frequent clinical forms were bubonic (n=28, 49.1%), oropharyngeal (n=21, 36.9%) and oculoglandular (n=8, 14%). In all patients enlargement of the lymph nodes was reported, most frequently the cervical ones (n=52, 91.2%). Ultrasound imaging showed hepatosplenomegaly in three cases (5.2%). Antibiotics were given prior to admission for 26 (45.6%) patients and during hospitalization for 54 (94.8%). Twenty-three (40.4%) received monotherapy while 31 (54.4%) received combined therapy. Diagnosis was based on agglutination reaction in most cases (n=50, 87.7%). For seven patients, diagnosis was made based on only clinical-epidemiological history without laboratory confirmation (n=7, 12.3%). Surgical treatment was used for 8.8% patients. Presence of rodents at household was mentioned by 14 (24.6%), while four (7%) noted a vector bite and three (5.3%) had contact with rodents. Over half (56.2%) had centralized water.
Conclusion:Most of the patients were male and from rural areas. People from 19-30 years of age were more likely to contract tularemia. Approximately half of the patients had the bubonic form, mainly cervical. Other potential risk factors that might explain a long hospitalization (e.g. suppressed immune system, treatment failure etc.), should be a topic for future investigations.
