A general overview of fnancisella tularensis and the epidem,ology of tularemia on Turkey

Fakültatif hücre içi gram-negatif bakteri olan Francisella tularensis tarafından oluşturulan tularemi, insan ve bazı hayvanların multisistemik bir hastalığıdır. Tularemi esas olarak kuzey yarım kürede 30° ve 70° enlemler arasında görülürken, güney yarım kürede nadiren tanımlanmıştır. F. tularensis çok geniş bir yelpazede yer alan hayvan türlerini infekte edebilir (250'den fazla sayıdaki hayvan türü). Tularemi için, küçük kemiriciler ana doğal konakçı ve kan emen ektoparazitler ise en önemli vektörlerdir. İnsanlar, infekte eklembacaklılar (çoğunlukla keneler) tarafından ısırılma, infekte hayvan dokuları veya sıvıları ile temas, kontamine su veya gıdaların alınması veya bakterinin inhale edilmesiyle infeksiyona yakalanabilirler. Hastalığın klinik formları ve şiddeti bulaşma yoluna, bakterinin infektif dozuna ve alttürü ile konağın bağışıklık durumuna göre değişim göstermektedir. Tularemide ülseroglandüler, glandüler, oküloglandüler, orofarengeal, tifoidal ve akciğer tularemisi olmak üzere altı klasik klinik formda açığa çıkabilir. Ülkemizde tularemi, ilk olarak Lüleburgaz bölgesinde askeri garnizon ve yakınındaki köylerde açığa çıkan salgın ile 1936 yılında tanımlanmıştır. O tarihten sonra, çoğunluğu Marmara ve Batı Karadeniz bölgesinde olmak üzere farklı bölgelerde tularemi salgınları bildirilmiştir. Bugüne kadar, serolojik olarak 2000'den fazla olgu tanımlanmıştır. Son zamanlarda özellikle ülkemizin iç bölgelerinde yer alan birçok ilde tularemi salgınları ortaya çıkmıştır. Bu derlemede, F. tularensis'in genel karakteristikleri ve Türkiye tulareminin epidemiyolojisi özetlenmiştir.

Francisella tularensis ve Türkiye’de tularemi epidemiyolojisine genel bir bakış

Tularemia, caused by the facultative intracellular gram-negative bacterium Francisella tularensis, is a multisystemic disease in humans and some animals. Tularemia occurs predominantly between 30° and 70° latitude in the northern hemisphere, but has rarely been found in the southern hemisphere. F. tularensis can infect a wide range of animals (more than 250 animal species). Small rodents are the main natural hosts, and blood-sucking ectoparasites are the most important vectors. Humans can acquire the infection through bites from infected arthropods (usually ticks), contact with infected animal tissues or fluids, ingestion of contaminated water or food, or inhalation of aerosolized bacteria. The clinical picture and severity of the disease in humans vary depending on the route of transmission, the infecting dose, the Francisella subspecies involved, and the immune status of the host. Clinical presentations include the six classic forms of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic. Tularemia was first recognized in Turkey in 1936, when an outbreak occurred in a military garrison and rural community in the Luleburgaz region. Since then, tularemia epidemics have been reported from different regions of Turkey, but the majority of outbreaks have occurred in the Marmara and western Black Sea region. To date, more than 2000 cases have been serologically confirmed. Recently, tularemia outbreaks emerged in several provinces, mainly located in the central parts of the country. In this review, general characteristics of F. tularensis and the epidemiology of tularemia in Turkey are summarized.

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