Introduction: Tularemia is an uncommon but potentially fatal zoonosis. А second outbreak of tularemia in Bulgaria, about 40 years after the first, occurred in 1997 in two western regions, near the Serbian border. In 2003 tularemia reemerged in the same foci. This retrospective study aimed to evaluate the clinical characteristics and the efficacy of antibiotic therapy in a tularemia resurgence in the Slivnitza region in [2003][2004]. Methodology: A total of 26 cases were evaluated. Using medical records, the following data were collected for all patients: symptoms, physical signs, and microbiology results of agglutination tests, cultures and PCR assays. Results: Twenty-four of 26 suspected tularemia patients were laboratory confirmed by agglutination test and/or culture. Fifteen (57.7%) patients had clinical presentation compatible with oropharyngeal, 8 (30.8%) with glandular, and 3 (11.5%) with oculoglandular tularemia. The most frequent symptoms were swollen neck (84.6%) and sore throat (76.9%). Lymphadenopathy (100%) was the most common finding. Francisella tularensis (F. tularensis) was detected by PCR, providing a definitive diagnosis in 82.3% of the cases. All the patients were treated with antibiotics considered effective against F. tularensis; however, therapeutic failure was observed in 23.1% of the cases, which was related to a delay in the initiation of antibiotics. Conclusion: The tularemia outbreak in west Bulgaria near the Serbian border was probably food-borne, associated with a surge in the rodent population. The oropharyngeal form was the most common. Although the disease runs a benign course, late initiation of antimicrobial therapy might delay complete recovery.
During July 2015 a brucellosis outbreak was detected in Kyustendil district, west Bulgaria. As of 15 August, 31 patients have been diagnosed all with an epidemiological connection to Rila town. Patients have not travelled/worked abroad. Breeding family-owned goats and/or improper use of their milk appear to be the main risk factors for transmission of the infection. This second autochthonous brucellosis outbreak in Bulgaria since 2006, affects the western part of the country.
Brucellosis is still the most common zoonosis worldwide. Despite this, it is unknown and underdiagnosed infection in non-endemic areas. For some parts of the world it became a re-emerging infection. After several decades brucellosis re-emerged in Bulgaria. In 2005 an outbreak of imported human cases was detected and soon after, two autochthonous outbreaks occurred (2006 and 2015) with a total of 161 persons diagnosed.
Background: Brucellosis is a widespread zoonotic infection with significant health and socio-economic impacts. This determines the need of a reliable laboratory diagnosis both in endemic areas around the world and in countries where it is rare and under diagnosed. Due to prolongedand hazardous cultivation procedures, the diagnosis is mostly serologically confirmed. Aim: Serological study of Bulgarian citizens with clinical and/or epidemiological data compatible to brucellosis for the period 2005-2015. Materials and methods: Based on clinical and epidemiological data obtained via standard questionnaire 3394 persons suspected for brucellosis along with 106 controls were serologically studied with Rose Bengal slide test, Standard agglutination test, Coombs’ test, Brucellacapt and ELISA. Results: Brucellosis was confirmed in 174 patients. In outbreak related cases the tests listed above were positive in 127 (78.88%), 115 (71.43%), 34 (91.98%), 143 (95.33%) and 104 (96.30%), respectively. A statistically significant positive correlation was found between Coombs’ and Brucellacapt in the studied 55 sera samples (rs = 0,72; p < 0,0000). The profile of anti-Brucella antibodies was investigated in 46 patients with different duration of the disease. In 29 (63.0%) of them the initial serum sample was positive for the three classes of antibodies and in 17 (36.9%) the primary testing didn’t detect IgM, but IgG and IgA. Conclusion: None of the serological tests alone could ensure an accurate diagnosis of brucellosis. It is necessary to use a diagnostic algorithm with appropriately selected serological tests in which Brucellacapt could successfully replace Coombs' test´ for detection of incomplete antibodies in brucellosis with long duration.
Background. Legionella pneumophila is the most common cause of the potentially fatal Legionnaires’ disease with worldwide increasing incidence reports. The bacterium is fastidious and slow growing and most laboratories do not perform culture. Aim. To present results from the first culture proven cases of Legionnaires’ disease in Bulgaria. Materials and methods. Ten lower respiratory tract materials from 10 patients were cultured for legionellae with GVPC supplement. Identification was based on growth characteristics, latex agglutination and monoclonal typing. Results. Seven L.pneumophila strains (serogroup1 and serogroup6) were isolated. Five belong to monoclonal sub-types Allentown/France, Knoxville and Philadelphia. One culture positive sputum was received at the lab 5 days after sampling. Other materials were plated on the day of sampling, but three of them were obtained long after specific therapy was started and remain negative on culture. Five from the ten patients were with fatal outcome. Three were reported to ELDSNet in real-time as travel-associated. Conclusions. Isolation of legionellae from patients remains the diagnostic ‘gold standard’. The use of selective supplement designed for water samples had no obvious impact on our results in contrast with late sampling. Isolates were from the most frequent reported L. pneumophila serogroups and five of them – from the virulence-associated Pontiac sub-groups. Legionnaires’ disease is still underdiagnosed in Bulgaria. Clinicians must be encouraged to send appropriate and timely obtained respiratory materials. This should happen even in cases with other positive microbiological results, since co-infection with viral, fungal or other bacterial pulmonary pathogens might be of importance for patients’ treatment and health.
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