Skip to main content

Advertisement

SpringerLink
Log in

Tularemia in Central Anatolia

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Background

Tularemia is a bacterial zoonosis with diverse clinical manifestations depending on bacterial subspecies and the route of the infection.

Methods

We collected data prospectively of cases diagnosed and treated for tularemia in our institution during the epidemics from December 2009 to August 2011. Specific antibodies were screened by a microagglutination test. Throat swab and lymph node aspirate cultures were obtained and polymerase chain reaction (PCR) was performed on these specimens. Lymph nodes were characterized on the basis of ultrasound reports.

Results

A total of 139 patients were confirmed with tularemia. The age range of the patients was 6–83 years (mean: 43) and 84 (60.4 %) of them were females. Patients had clinical presentations compatible with oropharyngeal (74 %), glandular (15.8 %), and oculoglandular (5.0 %) tularemia. Ultrasonography (US) was performed in 108 patients. Antibiotics (aminoglycosides, quinolones, and doxycycline) were used in 138 patients. Fine-needle aspiration (FNA) or surgical drainage of fluctuant lymph nodes were performed in 51 (39 %) patients. Therapeutic failure was observed in 43 (30.9 %) patients. Elevation of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were observed to be significantly higher in patients with therapeutic failures (p = 0.003 and 0.004, respectively). The success rate was significantly higher in patients with early treatment (p = 0.004). No difference was found between the effectiveness of aminoglycoside or quinolone treatments. The increase in the short and long axes, and the characteristics of lymph nodes detected on US were significantly associated with treatment failures (p < 0.001). Intranodal necrosis was found in 45 patients. The treatment success rate was 40 % in patients with intranodal necrosis.

Conclusion

To the best of our knowledge, this is the first study defining the US findings of patients with tularemia and its association with treatment success. Ciprofloxacin is an effective and convenient choice in epidemics of tularemia and early treatment is still the cornerstone of successful therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ellis J, Oyston PC, Green M, Titball RW. Tularemia. Clin Microbiol Rev. 2002;15:631–46.

    Article  PubMed  Google Scholar 

  2. Sjöstedt A. Tularemia: history, epidemiology, pathogen physiology, and clinical manifestations. Ann N Y Acad Sci. 2007;1105:1–29.

    Article  PubMed  Google Scholar 

  3. Tärnvik A, Chu MC. New approaches to diagnosis and therapy of tularemia. Ann N Y Acad Sci. 2007;1105:378–404.

    Article  PubMed  Google Scholar 

  4. Kılıç S. A general overview of Francisella tularensis and the epidemiology of tularemia in Turkey. Flora Derg. 2010;15:37–58.

    Google Scholar 

  5. Reintjes R, Dedushaj I, Gjini A, et al. Tularemia outbreak investigation in Kosovo: case control and environmental studies. Emerg Infect Dis. 2002;8:69–73.

    Article  PubMed  Google Scholar 

  6. Chitadze N, Kuchuloria T, Clark DV, et al. Water-borne outbreak of oropharyngeal and glandular tularemia in Georgia: investigation and follow-up. Infection. 2009;37:514–21.

    Article  PubMed  CAS  Google Scholar 

  7. Kantardjiev T, Ivanov I, Velinov T, et al. Tularemia outbreak, Bulgaria, 1997–2005. Emerg Infect Dis. 2006;12:678–80.

    Article  PubMed  Google Scholar 

  8. Akalin H, Helvaci S, Gedikoğlu S. Re-emergence of tularemia in Turkey. Int J Infect Dis. 2009;13:547–51.

    Article  PubMed  Google Scholar 

  9. Helvaci S, Gedikoğlu S, Akalin H, Oral HB. Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol. 2000;16:271–6.

    Article  PubMed  CAS  Google Scholar 

  10. Gürcan S, Otkun MT, Otkun M, Arikan OK, Ozer B. An outbreak of tularemia in Western Black Sea region of Turkey. Yonsei Med J. 2004;45:17–22.

    PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Celebi G, Baruönü F, Ayoğlu F, et al. Tularemia, a reemerging disease in Northwest Turkey: epidemiological investigation and evaluation of treatment responses. Jpn J Infect Dis. 2006;59:229–34.

    PubMed  Google Scholar 

  13. Willke A, Meric M, Grunow R, et al. An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol. 2009;58:112–6.

    Article  PubMed  CAS  Google Scholar 

  14. Ulu Kılıç A, Kılıç S, Sencan I, et al. A water-borne tularemia outbreak caused by Francisella tularensis subspecies holarctica in Central Anatolia region. Mikrobiyol Bul. 2011;45:234–47.

    PubMed  Google Scholar 

  15. Sjöstedt A, Kuoppa K, Johansson T, Sandström G. The 17 kda lipoprotein and encoding gene of Francisella tularensis lvs are conserved in strains of Francisella tularensis. Microb Pathog. 1992;13:243–9.

    Article  PubMed  Google Scholar 

  16. Khanna R, Sharma AD, Khanna S, Kumar M, Shukla RC. Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy. World J Surg Oncol. 2011;9:29.

    Article  PubMed  Google Scholar 

  17. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 2005;184:1691–9.

    Article  PubMed  Google Scholar 

  18. Cutler SJ, Fooks AR, van der Poel WH. Public health threat of new, reemerging, and neglected zoonoses in the industrialized world. Emerg Infect Dis. 2010;16:1–7.

    Article  PubMed  Google Scholar 

  19. Coker R, Rushton J, Mounier-Jack S, et al. Towards a conceptual framework to support one-health research for policy on emerging zoonoses. Lancet Infect Dis. 2011;11:326–31.

    Article  PubMed  Google Scholar 

  20. Tärnvik A, Priebe HS, Grunow R. Tularaemia in Europe: an epidemiological overview. Scand J Infect Dis. 2004;36:350–5.

    Article  PubMed  Google Scholar 

  21. Meric M, Willke A, Finke EJ, et al. Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia. APMIS. 2008;116:66–73.

    Article  PubMed  CAS  Google Scholar 

  22. Tärnvik A. WHO Guidelines on Tularaemia. WHO/CDS/EPR/2007.7. Geneva: World Health Organization (WHO), 2007. http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_7.pdf.

  23. Maurin M, Pelloux I, Brion JP, Del Banõ JN, Picard A. Human tularemia in France, 2006–2010. Clin Infect Dis. 2011;53:e133–41.

    Article  PubMed  Google Scholar 

  24. Hepburn MJ, Simpson AJ. Tularemia: current diagnosis and treatment options. Expert Rev Anti Infect Ther. 2008;6:231–40.

    Article  PubMed  CAS  Google Scholar 

  25. Yesilyurt M, Kiliç S, Celebi B, et al. Antimicrobial susceptibilities of Francisella tularensis subsp. holarctica strains isolated from humans in the Central Anatolia region of Turkey. J Antimicrob Chemother. 2011;66:2588–92.

    Article  PubMed  CAS  Google Scholar 

  26. Coşkun O, Erdem H, Avci A. Management of community-acquired acute bacterial cystitis in Turkey. Turk J Med Sci. 2011;41:149–57.

    Google Scholar 

Download references

Conflict of interest

There is no conflict of interest to this article.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases and Clinical Microbiology (IDCM), Erciyes School of Medicine, Talas-Kayseri, Turkey

    A. Ulu-Kilic

  2. Department of Infectious Diseases and Clinical Microbiology (IDCM), Diskapi Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey

    G. Gulen & I. Sencan

  3. Bacterial Zoonoses Reference Laboratory, Public Health Institution of Turkey (PHIT), Ankara, Turkey

    F. Sezen & S. Kilic

Authors
  1. A. Ulu-Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Gulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Sezen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Sencan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Ulu-Kilic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ulu-Kilic, A., Gulen, G., Sezen, F. et al. Tularemia in Central Anatolia. Infection 41, 391–399 (2013). https://doi.org/10.1007/s15010-012-0355-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-012-0355-1

Keywords

Search

Navigation