An outbreak of oropharyngeal tularaemia linked to natural spring water

Willke, Ayşe; Meriç, Meliha; Grunow, Roland; Sayan, Murat; Finke, Ernst-Jürgen; Splettstößer, W.; Seibold, Erik; Erdoğan, Semra; Ergönül, Önder; Yumuk, Zeki; Gedikoğlu, Suna

doi:10.1099/jmm.0.002279-0

Cited by 53 publications

(46 citation statements)

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“…Oropharyngeal form is the most commonly reported form in Turkey, while ulceroglandular form is more common in Europe and North America [1][2][3][4][5][6]. Neck mass is among common findings in oropharyngeal form [4][5][6]. In this study, we aimed to evaluate the intractable neck masses caused by tularemia and investigate clinical features and results of different treatment options.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and management of intractable neck involvement in tularemia: report of 19 patients

Kızıl

Aydíl

Cebeci

et al. 2011

Eur Arch Otorhinolaryngol

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The objective of this study is to determine the clinical characteristics and to evaluate the treatment options of intractable neck involvement in tularemia. The medical records of 19 tularemia patients with neck involvement were reviewed retrospectively. On physical examination, fluctuation indicating an abscess formation was detected in 78.9% of the patients. Bilateral involvement was seen in 15.8% of the patients. The most common clinical form was glandular form (63.1%). The most commonly involved lymph node group was upper jugular nodes (78.6%). Six patients underwent incision and drainage procedure, five patients underwent superselective neck dissection and eight patients had only medical treatment. Complete and immediate cure, and better tissue healing with less scarring could be achieved in all patients who underwent superselective neck dissections. In conclusion, intractable neck masses and an abscess can be the initial finding in tularemia, and a high index of suspicion is needed in the differential diagnosis. Superselective neck dissection is a safe and effective option in the treatment of long lasting cervical tularemia unless it responds to medical treatment.

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Section: Introductionmentioning

confidence: 99%

“…They are ulceroglandular, glandular, pneumonic, oropharyngeal, oculoglandular and systemic (typhoidal) forms. Oropharyngeal form is the most commonly reported form in Turkey, while ulceroglandular form is more common in Europe and North America [1][2][3][4][5][6]. Neck mass is among common findings in oropharyngeal form [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and management of intractable neck involvement in tularemia: report of 19 patients

Kızıl

Aydíl

Cebeci

et al. 2011

Eur Arch Otorhinolaryngol

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“…Recently, outbreaks of tularemia were associated with freshwater, particularly outbreaks of F. tularensis subsp. holarctica (type B) in Eurasia (10,78). While the most virulent subspecies, F. tularensis subsp.…”

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confidence: 99%

Contributions ofFrancisella tularensissubsp.novicidaChitinases and Sec Secretion System to Biofilm Formation on Chitin

Margolis

El-Etr

Joubert

et al. 2010

Appl Environ Microbiol

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Francisella tularensis, the zoonotic cause of tularemia, can infect numerous mammals and other eukaryotes. Although studying F. tularensis pathogenesis is essential to comprehending disease, mammalian infection is just one step in the ecology of Francisella species. F. tularensis has been isolated from aquatic environments and arthropod vectors, environments in which chitin could serve as a potential carbon source and as a surface for attachment and growth. We show that F. tularensis subsp. novicida forms biofilms during the colonization of chitin surfaces. The ability of F. tularensis to persist using chitin as a sole carbon source is dependent on chitinases, since mutants lacking chiA or chiB are attenuated for chitin colonization and biofilm formation in the absence of exogenous sugar. A genetic screen for biofilm mutants identified the Sec translocon export pathway and 14 secreted proteins. We show that these genes are important for initial attachment during biofilm formation. We generated defined deletion mutants by targeting two chaperone genes (secB1 and secB2) involved in Sec-dependent secretion and four genes that encode putative secreted proteins. All of the mutants were deficient in attachment to polystyrene and chitin surfaces and for biofilm formation compared to wild-type F. novicida. In contrast, mutations in the Sec translocon and secreted factors did not affect virulence. Our data suggest that biofilm formation by F. tularensis promotes persistence on chitin surfaces. Further study of the interaction of F. tularensis with the chitin microenvironment may provide insight into the environmental survival and transmission mechanisms of this pathogen.

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“…holarctica (15). Outbreaks linked to ingestion of contaminated natural spring waters have been reported in Black Sea, Marmara and Thrace and western regions of Turkey in the early 21st century (5,10,11,13,30). A waterborne outbreak of F.tularensis subsp.…”

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confidence: 99%