Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey

Abstract

Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. Methodology: The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. Results: Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). Conclusions: In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Francisella tularensis Susceptibility to Antibiotics: A Comprehensive Review of the Data Obtained In vitro and in Animal Models

“…However, a number of tularaemia outbreaks have been reported, including in the last two decades (Helvaci et al, 2000; Cerný, 2001; Feldman et al, 2001; Pérez-Castrillón et al, 2001; Reintjes et al, 2002; Christova et al, 2004; Payne et al, 2005; Celebi et al, 2006; Kantardjiev et al, 2006; Siret et al, 2006; Petersen et al, 2008; Akalın et al, 2009; Barut and Cetin, 2009; Svensson et al, 2009a; Hauri et al, 2010; Mailles et al, 2010; Larssen et al, 2011, 2014; Wang et al, 2011; Karlsson et al, 2013; Johansson et al, 2014; Mengeloglu et al, 2014). Humans may be infected with F. tularensis through direct contact with infected animals (manipulation of live or dead infected animals, animal bites or scratches), consumption of contaminated food or water, exposure to contaminated environments or through arthropod bites (Keim et al, 2007).…”

“…Arthropods, such as ticks and mosquitoes may be contaminated by F. tularensis from the animal or environmental reservoirs (Sjostedt, 2007; Maurin and Gyuranecz, 2016). Large tularaemia outbreaks have occurred, for which multiple sources of contamination and several F. tularensis clones were identified (Akalın et al, 2009; Barut and Cetin, 2009; Celebi et al, 2006; Cerný, 2001; Christova et al, 2004; Feldman et al, 2001; Hauri et al, 2010; Helvaci et al, 2000; Johansson et al, 2014; Kantardjiev et al, 2006; Karlsson et al, 2013; Larssen et al, 2011, 2014; Mailles et al, 2010; Mengeloglu et al, 2014; Payne et al, 2005; Pérez-Castrillón et al, 2001; Petersen et al, 2008; Reintjes et al, 2002; Siret et al, 2006; Svensson et al, 2009a; Wang et al, 2011). Symptoms vary according to the infection route and classically correspond to six different clinical forms: ulceroglandular, glandular, oropharyngeal, oculoglandular, pneumonic and typhoidal (Tarnvik, 2007).…”

Evaluation of Clinical and Epidemiological Characteristics of Tularemia Suspected Cases in Kastamonu between 2014-2017 years

“…Supporting this idea, the frequency of similar patient in the environment was found higher (33.3%) in cases with definitive tularemia. In previous studies from our country, it was reported that tularemia is more frequently seen in adult females (above 30 years) (2,12,19,23). In our study, the median age of the cases suspected of having tularemia was 27.5, however the median age of the cases with definitive diagnosis was 31.…”

“…In our country, human tularemia cases are generally followed as small clusters, however local outbreaks are seen in every two or three years in endemic areas (2,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). At the time of outbreaks, almost half of the cases composed of intrafamily cases (2,8,18,19). In our study, since two cases detected in 2017 admitted at the same time period and came from the same place, epidemiological connection was thought to be present between these two cases.…”

Treatment of Tularemia during pregnancy

“…It has been of great interest for us to read the original article by Mengeloglu et al entitled 'Evaluation of patients with tularemia in Bolu province in northwestern Anatolia, Turkey' [1]. They have presented specific peculiarities of an epidemic that affected Bolu province, which is geographically located in northwestern Anatolia, Turkey.…”