Turkiye Klinikleri Journal of Medical Sciences

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Tularemia Outbreak in Western Part of Turkey; Revenge of 'Mount Ida'
Türkiye'nin Batı Kesiminde Tularemi Salgını; İda Dağı'nın İntikamı
Sevil ALKAN ÇEVİKERa, Alper ŞENERa, Safiye Bilge GÜÇLÜ KAYTAa, Esen EKERb, Taylan ÖNDERb, Ebru DOĞANb
aDepartment of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, TURKEY
bDepartment of Public Health, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(2):145-9
doi: 10.5336/medsci.2020-80788
Article Language: EN
Full Text
ABSTRACT
 Objective: Tularemia is a zoonotic disease. Sporadic cases and outbreaks occur in humans. Here, we report a waterborne outbreak, its clinical presentation, and the results of treatment. Material and Methods: An increase in the frequency of patients presenting with lymphadenopathy from the same region was detected. Patients with serological diagnosis of tularemia were included in the study between December 2018 and April 2019. This case series were evaluated as an outbreak, clinical and laboratory parameters, demographic characteristics, clinical forms of tularemia and laboratory findings such as immunoglobulin M antibody titer for F. tularemia, inflammatory markers (C-reactive protein, leukocytosis, erythrocyte sedimentation rate), choice of first antibiotic treatment, total duration of treatment, initial clinical/laboratory response day, relapse and reinfection ratios have been investigated. The bacteria was investigated from drinking water fountains by polymerase chain reaction (PCR) (16sRNA Nanobiz® F. tularemia). Results: Tularemia was diagnosed serologically in 35 patients. Distribution of clinical forms was glandular (21 cases-60%); ulceroglandular (11 cases-31.4%); oropharyngeal (2 cases-5.7%) and oculoglandular (1 case-2.8%), respectively. First serologic test positivity was 80%. Inflammatory markers such as C-reactive protein, leukocytes, erythrocyte sedimentation rate were high. Antibiotic choice for treatment was streptomycin in 19 cases (54.3%), ciprofloxacin in nine cases (25.7%), gentamicin in four cases (11.4%); doxycycline in three cases (8.6%) respectively. The common suspicious contact was the use of drinking water from street fountains. F.tularemia PCR (16sRNA) was positive in 35 of these fountains (35/80, 43.75%). Conclusion: Tularemia should always be considered in head and neck lymphandenopathies that do not heal or show late recovery. We should keep in mind tularemia in a water-borne outbreak, were high it is rare.

Keywords: Tularemia; lymphadenopathy; outbreak
ÖZET
 Amaç: Tularemi, zoonotik bir hastalıktır. İnsanlarda sporadik vakalar ve salgınlar meydana gelir. Burada bir su kaynaklı salgını, klinik sunumunu ve tedavi sonuçlarını sunuyoruz. Gereç ve Yöntemler: Aynı bölgeden lenfadenopati ile başvuran hastaların sıklığında artış tespit edildi. Aralık 2018 ve Nisan 2019 tarihleri arasında serolojik tularemi tanısı alan hastalar çalışmaya dâhil edildi. Bu vaka serisi salgın olarak değerlendirildi, klinik ve laboratuvar parametreleri, demografik özellikler, tulareminin klinik formları ve F. tularemia için immünglobulin M antikor titresi gibi laboratuvar bulguları olarak değerlendirildi, inflamatuar belirteçler (C-reaktif protein, lökositoz, eritrosit sedimantasyon hızı), ilk antibiyotik tedavisi seçimi, toplam tedavi süresi, ilk klinik/laboratuvar yanıt günü, nüks ve yeniden enfeksiyon oranları araştırıldı. Bakteriler, içme suyu çeşmelerinden polimeraz zincir reaksiyonu (PCR) (16sRNA Nanobiz® F. tularemia) ile araştırıldı. Bulgular: Tularemi, 35 hastada serolojik olarak teşhis edildi. Klinik formların dağılımı glandüler (21 vaka-%60) şeklindeydi; ülseroglandüler (11 vaka-%31,4), orofaringeal (2 vaka-%5,7) ve oküloglandüler (1 vaka- %2,8). İlk serolojik test pozitifliği %80 idi. C-reaktif protein, lökositler, eritrosit sedimantasyon hızı gibi inflamatuar belirteçler yüksekti. Tedavi için antibiyotik seçimi; 19 vakada (%54,3) streptomisin, 9 vakada siprofloksasin (%25,7), 4 vakada gentamisin (%11,4), sırasıyla 3 vakada (%8,6) doksisiklin. Yaygın şüpheli temas, sokak çeşmelerinden içme suyu kullanılmasıydı. Bu çeşmelerin 35 (35/80, %43,75)'inde F. tularemia PCR (16sRNA) pozitifti. Sonuç: Tularemi, geç iyileşme göstermeyen veya iyileşmeyen baş-boyun lenfadenopatilerinde her zaman düşünülmelidir. Nadir de olsa su kaynaklı bir salgında tularemiyi akılda tutmalıyız.

Anahtar Kelimeler: Tularemi; lenfadenopati; salgın
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