Abstract
BackgroundRecent seroepidemiological studies have suggested that tularemia could be an endemic bacterial zoonosis in Iran.MethodsFrom January 2016 to June 2018, disease cases characterized by fever, cervical lymphadenopathy and ocular involvement were reported in Youzband Village of Kaleybar County, in the East Azerbaijan Province, northwestern Iran. Diagnostic tests included Francisella tularensis serology (including tube agglutination test and ELISA), PCR, and culture.ResultsAmong 11 examined case-patients, the tularemia tube agglutination test was positive in ten and borderline in one. PCR detected the F. tularensisISFtu2 elements and fopA gene in one rodent and a spring water sample from the same geographic area.ConclusionsBased on the clinical manifestations of the disease suggesting an oropharyngeal form of tularemia, serology results in case patients, and F. tularensis detection in the local fauna and aquatic environment, the water supply of the village was the likely source of the tularemia outbreak. Intervention such as dredging and chlorination of the main water storage tank of the village and training of villagers and health care workers in preventive measures and treatment of the illness helped control the infection.
Highlights
Tularemia is a zoonotic disease caused by the Gramnegative bacterium Francisella tularensis [1]
In the aquatic cycle, which is more common for type B strains, small rodents contaminate the aquatic environment with F. tularensis, and tularemia can be transmitted to humans by drinking contaminated water, and in some areas (Sweden, Finland and Russia) through mosquito bites
Real-time Polymerase chain reaction (PCR) tests revealed that one out of 5 water samples belonging to one of the springs of the village was positive for ISFtu2 elements and fopA gene
Summary
Tularemia is a zoonotic disease caused by the Gramnegative bacterium Francisella tularensis [1]. Type A and type B strains are known causative agents of tularemia in human. Rabbits and hares are hosts and reservoirs of the disease, and ticks play a major role as vectors in the animal reservoir. In the aquatic cycle, which is more common for type B strains, small rodents contaminate the aquatic environment with F. tularensis, and tularemia can be transmitted to humans by drinking contaminated water, and in some areas (Sweden, Finland and Russia) through mosquito bites. Type B strains can be found in hares, rodents and other animals [3]. In regions with type B tularemia, drinking water from ponds, lakes and rivers and eating contaminated vegetables can transmit the disease [4, 6]. Recent seroepidemiological studies have suggested that tularemia could be an endemic bacterial zoonosis in Iran
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