Nadir Bilinen Bir Hastalık: Diyarbakır ve Yöresinde Tularemi

Vector-borne diseases regularly occurred in moderate climate areas of Europe in past decades. The changing epidemiology of vector-borne diseases in Europe is caused by changes of environmental factors – amongst these climate change -and human activity (transport mobility, urbanisation, renaturation etc.). The occurrence of invasive vector species (for example the Asian tiger mosquito [ Aedes albopictus] and the Asian bush mosquito [ Aedes japonicus japonicus]) in new habitats pose a risk of pathogen transmission in naïve host populations. On the other hand, the presence of native competent vectors and adequate habitats are sufficient for the effective spread of a pathogen as seen in the Bluetongue Virus epidemic in Europe in 2006 onwards or the spread of West Nile Virus (WNV) lineage 1 in USA in 1999. The vector-borne diseases posing threat of spread are very often of viral origin (WNV fever, Chikungunya fever, Dengue fever, Tick-borne encephalitis, Yellow fever, Japanese encephalitis), but there is also the potential for parasitic (Malaria, Dirofilariosis, Piroplasmosis and Leishmaniosis) or bacterial diseases (Tularaemia, Rickettsiosis). Recently, the fast spreading epidemic of mosquito-borne Zika virus infection implicated the need of preparedness and constant monitoring of vector-borne diseases and their vectors in order to provide fast answers to emerging disease control and prevention. In this paper, we review major driving factors for the changing epidemiology of selected vector-borne diseases, provide a risk assessment for the introduction of new emerging diseases to Europe and present a new concept to face future challenges.

Tularemia, a zoonosis caused by the gram-negative coccobacillus Francisella tularensis, is spread most often through direct contact with infected feral

To perform laboratory diagnosis and tracking source of a suspected tularemia patient in Beijing. A suspected tularemia patient was reported in Beijing city on July 19, 2012. Genomic DNA was extracted from the blood sample of the patient, then general PCR and sequencing of amplicons were conducted using 3 specific genes (fopA, tul4 and 16S rRNA) Francisella tularensis (F.tularensis), and 2 genotyping primers (C1C4 and RD1). Two other laboratories repeated the PCR and sequencing of the fopA in parallel. At the same time, real-time PCR fluorescent ration was performed using 4 targets (fopA, ISFtul2, 23kDa, and tul4), and phylogenetic analysis was carried out using 11 canonical single nucleotide polymorphisms (SNPs) and 4 insertions or deletions. All the 3 specific genes were amplified positively, and sequenced fragments were 409, 407 and 1 053 bp, respectively. The patient was infected by F. tularensis comparing with the whole genome published. Next, amplicons of 151 and 924 bp were obtained by the 2 typing primers after sequencing, respectively. The segment lengths suggested that the patient was infected by the subsp. holarctica. All of the two other laboratories obtained positive data for the PCR and sequencing of the fopA. In addition, all the 4 targets tested positive by real-time PCR for F. tularensis. The Ct value of the fopA, ISFtul2, 23kDa and tul4 were 30, 25, 28, and 30, respectively. The phylogenetic analysis indicated that the whole genome of this case was assigned to a known clade from Russia, which was subgroup B3. This case was confirmed to be a tularemia patient, and a new subgroup of F. tularensis type B was found in China.

Background and purpose: Emergency physicians play an important role in the immediate diagnosis of bioterrorism activities. The present study was conducted with the purpose of comparing the effectiveness of e-learning and classroom learning in approach to bioterrorism and chemical terrorism for emergency physicians. Methods: This was a semi-empirical study, which was conducted via testing knowledge before and after the educational intervention in the field of bioterrorism and chemical terrorism on the emergency physicians in Tehran. The external validity of the questionnaire was confirmed by two academic experts in order to determine the ability to detect bioterrorist and chemical terrorist diseases. In this study, education was done in both virtual and classroom forms. The education regarded 6 bioterrorist diseases in group A (anthrax, plague, viral hemorrhagic fever, tularemia, smallpox), and 5 chemical terrorist diseases (nerve gas, mustard, lewisite, phosgene, chlorine). Results: 160 doctors participated in this study. 96 people (60%) were men and 64 people (40%) were women. The average age of the participants was 36.2±5.5 years. In e-learning method, the pre-test scores average was (30.6%), while the post-test scores average was (81.6%) (p=0.001). In classroom learning method, the pre-test scores average was (41.9%), while the post-test scores average was (72.9%), which the pre-test and post-test scores average differences in both cases are significant (p<0.001). In e-learning method, the difference was (51%), and in the classroom method it was (31%), which these two represent a 20% difference between methods. From statistical point of view, this difference indicates that the e-learning method being more effective (p=0.02). Conclusions: Based on the study results, it seems that in comparison to the classroom learning, e-learning method is more effective in helping emergency physicians to diagnose bioterrorism or chemical terrorism factors. Keywords: E-LEARNING, CLASSROOM LEARNING, CHEMICAL TERRORISM, BIOTERRORISM, EMERGENCY PHYSICIANS

Особенности проявления очагов туляремии на территории Вологодской области

The aim of the study was to determine the seroprevalence of three zoonotic infections among healthy blood donors/volunteers in Eastern Slovakia. Sera from 124 blood donors were investigated for the presence of antibodies against Borrelia burgdorferi, Francisella tularensis and Leptospira pomona. The participants also completed the questionnaire about demographic, exposure and epidemiological characteristics. Two serological methods were used for the diagnosis: the enzyme linked protein A/G assay (ELPAGA) and the Western blot (WB). First, sera were screened by ELPAGA (except for leptospirosis). The observed seroprevalence was 15% for Lyme borreliosis (LB) and 4% for tularaemia (TUL). The results were confirmed by WB. Positive IgG antibodies (WB method) were detected only in 1.6% of examined for LB and 0.8% for TUL. Our results did not identify any antibodies against Leptospira pomona agent in the examined healthy blood donors group. ELPAGA seroprevalence for TUL was significantly higher in blood donors working in the agricultural area in the direct contact with hay, straw, manure, and agricultural land. Our outputs determine tick bite as a significant risk factor for LB. The study confirms the explosion of tick-borne diseases in the healthy population of people. The exposure risk for leptospirosis seems to be minimal.

Beckground: Francisella tularensis is a gram-negative zoonotic pathogen primarily of animals and occasionally of humans. The disease is now recognized as tularemia in most parts of the world, but it has been called rabbit fever, deer-fly fever, and market men’s disease in the United States; wild hare disease (yato-byo) and Ohara’s disease in Japan; and water-rat trappers’ disease in Russia. Tularemia continues to be responsible for significant morbidity and mortality, despite the availability of numerous antibiotics active against the organism. The first cases of tularaemia in Kosovo are reported in the south-western part of Kosovo, in the region of Gjakova in April 2000 in the village of Brovina - 22 patients who were infected through contaminated well water. In the meantime disease is spread in villages of Skivjan, Korenica, Batusha and later throughout Kosovo.Aim: The aim of this study is presentation of characteristics of Tularemia in Kosovo in 2010 and analyzes of the epidemiological, clinical and treatment features of Tularaemia in Kosovo.Methods: We analyzed 53 cases of tularaemia (from 320 patients with tularaemia in Kosovo in 2010) that were from 12 municipalities of Kosovo. The largest number of patients were from Municipality of Vushtria (11 patients) and municipality of Skenderaj (9 patients). All these cases were from rural areas; this confirms that social and epidemiological conditions are very important for appearance of this disease. We have analyzed the data from their medical histories, which includes their medical anamnesis, clinical examination, laboratory tests and their treatment.Results: The mean age of patients was 22 years, 13 patients were children under the age of 10 years. Patients were hospitalized an average of 14.7 days, while incubation time of the disease was an averaging of 28 days. Social and epidemiologic conditions were important factors in the appearance of the disease; 29 patients were water supplied only from wells. All patients were from rural areas. Clinical manifestations were temperature, neck pain, neck and axillary lymphadenopathy, and apathy. Clinically, glandular form has dominated. From laboratory tests, 51 of patients had high erythrocyte sedimentation rate, 13 cases had a slight anemia, and 34 patients had leukocytosis. Other laboratory tests were in normal values. Agglutination test in all cases was positive. All cases were treated with antibiotics; 31 patient were treated with gentamicin, 8 patients were treated with streptomycin and 14 patient were treated with other antibiotic. Incision and drainage of the gland as adjuvant therapy was applied in 27 patient.Conclusions: In this late decade in our country, tularemia continues to be a disease that represents a healthcare problem. Glandular forms of tularemia dominate in Kosovo. Treatment with gentamicin has had good effects. Incision and drainage of the inflamed glands has shown to be a good method in accelerating the recovery of patient. Prophylaxis has to be applied for prevention of the disease.

Bioterrorism and Women: Tularemia in Pregnancy.

Endemic Tularemia, Sweden, 2003

Atypical organisms such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila are implicated in up to 40 percent of cases of community-acquired pneumonia. Antibiotic treatment is empiric and includes coverage for both typical and atypical organisms. Doxycycline, a fluoroquinolone with enhanced activity against Streptococcus pneumoniae, or a macrolide is appropriate for outpatient treatment of immunocompetent adult patients. Hospitalised adults should be treated with cefotaxime or ceftriaxone plus a macrolide, or with a fluoroquinolone alone. The same agents can be used in adult patients in intensive care units, although fluoroquinolone monotherapy is not recommended; ampicillin-sulbactam or piperacillin-tazobactam can be used instead of cefotaxime or ceftriaxone. Outpatient treatment of children two months to five years of age consists of high-dose amoxicillin given for seven to 10 days. A single dose of ceftriaxone can be used in infants when the first dose of antibiotic is likely to be delayed or not absorbed. Older children can be treated with a macrolide. Hospitalised children should be treated with a macrolide plus a beta-lactam inhibitor. In a bioterrorist attack, pulmonary illness may result from the organisms that cause anthrax, plague, or tularaemia. Sudden acute respiratory syndrome begins with a flu-like illness, followed two to seven days later by cough, dyspnoea and, in some instances, acute respiratory distress.

Prairie dogs, endemic to the Great Plains of North America, are sometimes trapped and sold as pets. Three recent articles describe transmission of diseases -- monkeypox and tularemia -- from these animals to humans. In the spring of 2003, prairie dogs housed with exotic African rodents became infected with monkeypox virus, resulting in transmission to humans (see Journal Watch Infectious Diseases Jul 28 2003). Guarner and colleagues performed pathologic and virologic examinations of two infected prairie dogs to assess tissue distribution …

A vaccine for tularaemia

Tularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis. Known also as "rabbit fever" and "deer fly fever," tularemia was first described in the United States in 1911 and has been reported from all states except Hawaii. Tularemia was removed from the list of nationally notifiable diseases in 1994, but increased concern about potential use of F. tularensis as a biological weapon led to its reinstatement in 2000. This report summarizes tularemia cases reported to CDC during 1990-2000, which indicate a low level of natural transmission. Understanding the epidemiology of tularemia in the United States enables clinicians and public health practitioners to recognize unusual patterns of disease occurrence that might signal an outbreak or a bioterrorism event.

Tularemia is an acute febrile bacterial illness that usually presents as a cutaneous or mucosal ulcer; if untreated, it can progress to regional lymphadenopathy, pneumonia, and death. A zoonotic illness, it is usually acquired from tick bites associated with contact with infected animals, particularly rabbits. Because …

2 間接赤血球凝集抑制反応による動物腐乱遺体の野兎病簡易検査法

Tularemia: Association with hunting and farming

1. Conolly K: 1989, First pit bulls, now ferrets. Vet Pract Manage 6:66. 2. Fox JG, Ackerman JI, Taylor N, et al.: 1987, Campylobacter jejuni infection in the ferret: an animal model of human campylobacteriosis. Am J Vet Res 48:85-90. 3. Fox JG, Claps M, Beaucage CM: 1986, Chronic diarrhea associated with Campylobacter jejuni infection in a cat. J Am Vet Med Assoc 189:455-456. 4. Fox JG, Curry C, Leathers CW: 1986, Proliferative colitis in a pet ferret. J Am Vet Med Assoc 189: 1475-1476.

The spider as a possible source of tularemia

Leads from the MMWR. Tularemia--New Jersey