Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis. A large number of recent studies have provided an update on the disease characteristics and the distribution across Europe. In Croatia, most of the clinical cases, as well as the reports of the disease in animals, date from the 20th century. In that period, epidemic and epizootic research had given detailed information about endemic regions and their characteristics, including suspected animal hosts and vectors. The region along the middle course of the Sava River, called Middle Posavina, is described as an endemic region, i.e., a “natural focus” of tularemia, in Croatia. In the 21st century, cases of human tularemia are being reported sporadically, with ulceloglandular, oropharyngeal and typhoid forms of disease. A majority of the described cases are linked with the consumption of contaminated food or water. The disease outbreaks still occur in areas along the course of the river Sava and in northwest Croatia. In this review article, we have summarized epidemiologic and epizootic data of tularemia in the past and in recent Croatian history.
Highlights
Francisella tularensis subsp holarctica (Type B) is spread all over the northern hemisphere [1] and it is the most often-detected subspecies in Europe
Assigned to category A agents according to Centers for Disease Control and Prevention (CDC) [2,3,4], Francisella tularensis poses a huge threat to humans and animals
As a part of the mentioned program, in 2018, Mihelcicand colleagues, using quantitative real-time polymerase chain reaction (PCR) tests, reported three positive mice from the Apodemus species found in the locality of Lipovljani, Middle Posavina (Figure 3), confirming that, after decades, this might remain the natural focus of Francisella species in Croatia [59]
Summary
Francisella tularensis subsp holarctica (Type B) is spread all over the northern hemisphere [1] and it is the most often-detected subspecies in Europe. Repeated outbreaks of the disease and a lot of confirmed cases of tularemia in a relatively small geographical area, in villages near the Sava valley, directed further investigation studies to certain ecosystems Borcicand his group, at the end of the sixties and the early seventies of the 20th century, performed further epidemiological surveys. Patients suffered from the ulceroglandular form of the disease and were positive for the tularin test [45] Another tularemia outbreak in Croatia in recent history occurred at the end of 1998 and the beginning of 1999, again in the endemic area. Detailed epidemiological data about recent human tularemia cases in Croatia, such as description of the disease, source of infection or described geographic region, have not been provided
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