A small outbreak of tularemia in a rural area
To assess clinically and epidemiologically an outbreak of tularemia detected in a small village in Tokat Province in Turkey. Materials and methods: Recorded clinical and laboratory data of 15 serologically confirmed patients, who either presented to hospital or were diagnosed during family medicine visits to the village during the outbreak, were assessed. Forms including a questionnaire about the symptomatology and previously given treatments were filled out by the patients. In addition, the entire village was investigated to establish the origin of the outbreak. Results: Ages of the 15 individuals (9 females) ranged between 10 and 75, and the mean was 34.2 ± 12.4. Thirteen patients matched the oropharyngeal type and 2 the oculoglandular type. The field investigation of the village revealed that open-air drinking water sources were not sufficiently chlorinated, and the villagers used to consume natural spring water. The outbreak was controlled via chlorination, with advice to the people to use clean water sources and limit natural spring water consumption. Conclusion: Tularemia has become an emerging infection particularly due to the increase in water- and food-based outbreaks in recent years. The crucial step in its diagnosis is the clinical suspicion of tularemia since it is still an underestimated disease in Turkey. Therefore, clinicians should be informed about where the entity is common. It is suggested that safe drinking water sources should be provided by the authorities, and open-air natural spring water sources should be avoided for the control of outbreaks.
A small outbreak of tularemia in a rural area
To assess clinically and epidemiologically an outbreak of tularemia detected in a small village in Tokat Province in Turkey. Materials and methods: Recorded clinical and laboratory data of 15 serologically confirmed patients, who either presented to hospital or were diagnosed during family medicine visits to the village during the outbreak, were assessed. Forms including a questionnaire about the symptomatology and previously given treatments were filled out by the patients. In addition, the entire village was investigated to establish the origin of the outbreak. Results: Ages of the 15 individuals (9 females) ranged between 10 and 75, and the mean was 34.2 ± 12.4. Thirteen patients matched the oropharyngeal type and 2 the oculoglandular type. The field investigation of the village revealed that open-air drinking water sources were not sufficiently chlorinated, and the villagers used to consume natural spring water. The outbreak was controlled via chlorination, with advice to the people to use clean water sources and limit natural spring water consumption. Conclusion: Tularemia has become an emerging infection particularly due to the increase in water- and food-based outbreaks in recent years. The crucial step in its diagnosis is the clinical suspicion of tularemia since it is still an underestimated disease in Turkey. Therefore, clinicians should be informed about where the entity is common. It is suggested that safe drinking water sources should be provided by the authorities, and open-air natural spring water sources should be avoided for the control of outbreaks.
___
- Gürcan Ş, Varol Saraçoğlu, Karadenizli A, Özkayın EN, Öztürk ŞZ, Çiçek C et al. Tularemia as a result of outdoor activities for children in the countryside. Turk J Med Sci 2012; 42: 1–6.
- Gürcan Ş, Uzun C, Karagöl Ş, Karasalihoğlu AR, Otkun M. The first tularemia case in Thrace Region of Turkey in the last 60 years. Turk J Med Sci 2006; 36: 127–8.
- Meriç M, Sayan M, Willke A, Gedikoğlu S. A small water- borne tularemia outbreak. Mikrobiyol Bul 2008; 42: 49–59 (in Turkish).
- Sahin M, Atabay HI, Bicakci Z, Unver A, Otlu S. Outbreaks of tularemia in Turkey. Kobe J Med Sci 2007; 53: 37–42.
- Wilke A. Tularemi. ANKEM Derg 2006; 20: 222–6 (in Turkish).
- Helvacı S, Gedikoğlu S, Akalın H, Oral HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol 2000; 16: 271–6.
- Acicbe Ö, Aydın H, Doğancı L. Havza/Samsun bölgesinde tularemi endemisi: İzlenen olguların retrospektif analizi. İnfeksiyon Dergisi 2007; 21: 55–8 (in Turkish).
- Karadenizli A, Gurcan S, Kolayli F, Vahaboglu H. Outbreak of tularaemia in Golcuk, Turkey in 2005: Report of 5 cases and an overview of the literature from Turkey. Scand J Infect Dis 2005; 37: 712–6.
- Komitova R, Nenova R, Padeshki P, Ivanov I, Popov V, Petrov P. Tularemia in Bulgaria 2003–2004. J Infect Dev Ctries 2010; 4: 689–94.
- Kızılkaya Kaptan Z, Emir H, Uzunkulaoğlu H, Ceylan K, Bulut C. Oküloglandüler tularemi: nadir bir olgu sunumu. Turkiye Klinikleri J Int Med Sci KBB ve BBC Dergisi 2008; 16: 146–9 (in Turkish).
- Çelebi B. Tularemi: Laboratuvar tanı. Türkiye Zoonotik Hastalıklar Sempozyumu kitabı, Ankara: 2010. p. 13–8 (in Turkish).
- Bevanger L, Maeland JA, Naess AI. Agglutinins and antibodies to Francisella tularensis outer membrane antigens in the early diagnosis of disease during an outbreak of tularemia. J Clin Microbiol 1988; 26: 433–7.
- Johansson A, Berglund L, Sjöstedt A, Tärnvik A. Ciprofoxacin for treatment of tularemia. Clin Infect Dis 2001; 33: 267–8.