An outbreak of tularemia in southwestern Turkey

Kutlu, Murat; Ergin, Çağrı; Karadenizli, Aynur; Kutlu, Selda Sayın

doi:10.3855/jidc.12312

Cited by 7 publications

(5 citation statements)

References 24 publications

(48 reference statements)

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“…Tularemia has generally assumed greater importance in Turkey in recent years because of outbreaks deriving from water sources [20,21]. Aktas et al reported an outbreak of 55 cases of oropharyngeal tularemia detected in 2013 and derived from drinking water [13].…”

Section: Discussionmentioning

confidence: 99%

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia

Şahin

Kılıç

Sakat

et al. 2023

J Infect Dev Ctries

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Introduction: Tularemia is a zoonotic disease caused by the Gram-negative coccobacillus Francisella tularensis. It is frequently overlooked in the differential diagnosis of neck masses because of its rarity. The purpose of this study is to report cases diagnosed with tularemia among patients presenting to our clinic with neck masses and to share our experience. Methodology: Patients presented to our hospital with cervical masses and diagnosed with tularemia were included in this retrospective study. Medical files of all patients were evaluated, and physical examination findings, titration values, date of diagnosis, location of the abscess or mass, place of residence, occupation, drinking water sources, sedimentation (SED), C-reactive protein (CRP), and white blood cell (WBC) values were recorded. Results: Seventy-six patients were included in the study. Forty patients (52.6%) were living in rural villages and 36 (47.4%) in urban areas. Thirty-one (40.8%) were engaged in animal husbandry and 29 (38.2%) in agriculture. In terms of drinking water sources, 59 patients (73.6%) obtained water from the mains, while 10 (13.32%) used well water. The most frequently observed clinical findings were swelling in the neck, sore throat, lethargy, and fever. Neck swelling frequently occurred in levels II and III. Conclusions: Since tularemia is rare and there are no specific clinical findings, diagnosis may be problematic. Ear, nose and throat (ENT) specialists should be familiar with the clinical symptoms of tularemia in the head and neck region and should consider a preliminary diagnosis of tularemia in the differential diagnosis of persistent neck masses.

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Section: Discussionmentioning

confidence: 99%

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia

Şahin

Kılıç

Sakat

et al. 2023

J Infect Dev Ctries

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“…The first regional study in Turkey on tularemia seroprevalence was also conducted in the Thrace Region [ 9 ]. Although there are case reports from almost all provinces in the Aegean Region, no regional seroprevalence studies have been encountered [ 6 – 8 ]. Within the framework of the Turkey Zoonotic Diseases Action Plan (2019–2023), it is aimed to put the first step of the field research model into practice by carrying an exemplary study out following the aim of systematically revealing the current situation in the country and planning control measures with the data to be obtained [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature and unpublished data of the Ministry of Health, tularemia has been reported in all provinces of the Aegean Region except Aydın [ 6 – 8 ]. However, no regional seroprevalence research has been conducted in the Aegean Region to date.…”

Section: Introductionmentioning

confidence: 99%

Tularemia seroprevalence in humans in the region of the Hittite-Arzawa War (Inner Aegean Region), where the first biological weapon was used 3300 years ago

DAVARCI¹,

ERYILDIZ²,

RENDERS³

et al. 2023

Turkish Journal of Medical Sciences

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Background/aim According to Egyptian records, tularemia emerged in the Canaan region, where it was first identified and spread to Anatolia over the Euphrates. It was used as an active biological weapon for the first time in the Hittite-Arzawa War in 1320–1318 BC. This study aimed to investigate the seroprevalence of tularemia in the Inner Aegean Region, which is thought to be the region where this war was fought 3300 years ago. Materials and methods Tularemia seropositivity in humans was investigated in 27 villages/neighborhoods in 3 districts in each of Manisa, Kütahya, and Uşak provinces. Before the study, the participants were informed about the disease via posters, and their blood samples were taken following filling out the questionnaire. Microagglutination tests were performed using in-house tularemia antigen and V plate for serological experiments. Rose-Bengal test was also performed on seropositive sera. Results Of the total of 410 people, 226 (55.12%) were male. The mean age of the volunteers was 43.72 years. The highest participation was from Kütahya Province. According to the results of the tularemia microagglutination test, seropositivity was detected in 6 cases. It was determined that all of the seropositive volunteers were in Kütahya. When the tularemia antibody titers were examined, seropositivity was determined at 1/20–1/160 titers. No positivity was detected in the Rose-Bengal test for cross-reaction. Conclusion Kütahya has been identified as a risky region in terms of tularemia in the Inner Aegean Region. In order to use the resources in the country economically, first of all, the risk areas in terms of tularemia should be determined by serological studies in all regions. In order to increase awareness about the disease, physicians and filiation teams should be trained in risky areas. Surveillance studies should be conducted to identify and monitor possible sources in areas identified as risky.

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“…These infections occur as outbreaks with a predominance of the oropharyngeal form (Kutlu et al. 2021 ). Recently, water-borne outbreaks of tularemia have also been reported in many European countries (Hennebique et al.…”

Section: Transmission To Humansmentioning

confidence: 99%

“…In Turkey, every single human case can be traced back to a water source and is virtually certainly linked to the country’s widespread reliance on bottled water (Kutlu et al. 2021 ). The water supply was eventually linked to massive outbreaks in Kosovo and Bulgaria, each of which affected hundreds of people.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Tularemia – a re-emerging disease with growing concern

Sharma,

Patil,

Singh

et al. 2023

Veterinary Quarterly

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Tularemia caused by Gram-negative, coccobacillus bacterium, Francisella tularensis, is a highly infectious zoonotic disease. Human cases have been reported mainly from the United States, Nordic countries like Sweden and Finland, and some European and Asian countries. Naturally, the disease occurs in several vertebrates, particularly lagomorphs. Type A (subspecies tularensis ) is more virulent and causes disease mainly in North America; type B (subspecies holarctica ) is widespread, while subspecies mediasiatica is present in central Asia. F. tularensis is a possible bioweapon due to its lethality, low infectious dosage, and aerosol transmission. Small mammals like rabbits, hares, and muskrats are primary sources of human infections, but true reservoir of F. tularensis is unknown. Vector-borne tularemia primarily involves ticks and mosquitoes. The bacterial subspecies involved and mode of transmission determine the clinical picture. Early signs are flu-like illnesses that may evolve into different clinical forms of tularemia that may or may not include lymphadenopathy. Ulcero-glandular and glandular forms are acquired by arthropod bite or handling of infected animals, oculo-glandular form as a result of conjunctival infection, and oro-pharyngeal form by intake of contaminated food or water. Pulmonary form appears after inhalation of bacteria. Typhoidal form may occur after infection via different routes. Human-to-human transmission has not been known. Diagnosis can be achieved by serology, bacterial culture, and molecular methods. Treatment for tularemia typically entails use of quinolones, tetracyclines, or aminoglycosides. Preventive measures are necessary to avoid infection although difficult to implement. Research is underway for the development of effective live attenuated and subunit vaccines.

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An outbreak of tularemia in southwestern Turkey

Cited by 7 publications

References 24 publications

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia

A rare cause requiring consideration in the differential diagnosis of neck masses: tularemia

Tularemia seroprevalence in humans in the region of the Hittite-Arzawa War (Inner Aegean Region), where the first biological weapon was used 3300 years ago

Tularemia – a re-emerging disease with growing concern

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