Abstract
Tularaemia, caused by Francisella tularensis, had not been registered in Kosovo before an outbreak in 1999 and 2000. A national surveillance system has been implemented in Kosovo since 2000 to monitor a number of diseases, including tularaemia. Antibody detection in human sera was used for laboratory diagnosis of tularaemia and F. tularensis lipopolysaccharide antigen was used as a marker of infection. The purpose of this study is to describe the incidence of tularaemia in Kosovo after the 1999-00 outbreak. In 2001 and 2002, a second outbreak occurred, with 327 serologically confirmed cases. From 2001 to 2010, 25-327 cases were registered per year, giving a mean annual incidence of 5.2 per 100,000 population. The most likely sources of infection were contaminated drinking water and food. The dominant clinical manifestations were the glandular (79%) and ulcero-glandular (21%) forms. By 2010, the disease had spread throughout Kosovo. Presumably as a result of war and subsequent environmental disruption, mass population displacement and breakdown of sanitation and hygiene, the two major outbreaks of tularaemia resulted in the establishment of an active endemic area of tularaemia in Kosovo.
Highlights
The causative agent of tularaemia, a relatively rare zoonotic disease, is Francisella tularensis
F. tularensis ssp. tularensis has been isolated almost exclusively in North America, whereas F. tularensis ssp. holarctica could be found in the entire northern hemisphere [5]
This study aims to provide a follow-up on the incidence of tularaemia in Kosovo* after the first outbreak in 1999–00 until 2010
Summary
The causative agent of tularaemia, a relatively rare zoonotic disease, is Francisella tularensis. The disease is a more serious public health problem in Balkan countries and has been reported in Turkey [2,3,4]. The cells of this Gram-negative, non-motile, capsuleforming, facultative intracellular bacterium are pleomorphic, typically appearing as short rods or coccoid forms [5]. Two subspecies of F. tularensis cause tularaemia in man. Biovar A1 of the subspecies tularensis (or type A) is the most virulent type of Francisella bacteria and can be associated with lethal pulmonary infections in humans [6]. A second biovar of F. tularensis ssp. tularensis, A2, has a lower morbidity and mortality in humans than ssp. holarctica [6]
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