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• Tularemia can be transmitted through the ingestion of contaminated grape products. • F. tularensis can be introduced into the food chain via mechanical harvesting of grapes and presumably infected rodents. • The clinical course of tularemia can be unexpectedly long and require long antibiotic treatment durations. Tularemia is caused by Francisella tularensis and can occasionally establish foodborne transmission. Patients were identified by active case detection through contact with the treating physicians and consent for publication was obtained. Clinical data were accumulated through a review of the patient charts. Serology, culture, and PCR methods were performed for confirmation of the diagnosis. A 46-year-old patient was hospitalised in the University Hospital Frankfurt (a tertiary care hospital) for pharyngitis and cervical lymphadenitis with abscess. A diagnosis of tularemia was made serologically, but treatment with ciprofloxacin initially failed. F. tularensis was detected in pus from the lymph node using a specific real-time PCR. The use of RD1 PCR led to the identification of the subspecies holarctica. Antibiotic therapy with high-dose ciprofloxacin and gentamicin was administered and was subsequently changed to ciprofloxacin and rifampicin. During a must-tasting, five other individuals became infected with tularemia by ingestion of contaminated must. All patients required treatment durations of more than 14 days. Mechanically harvested agricultural products, such as wine must, can be a source of infection, probably due to contamination with animal carcasses. The clinical course of tularemia can be complicated and prolonged and requires differentiated antibiotic treatment. [ABSTRACT FROM AUTHOR]

Summary: Background: Over the last two to three decades there has been a marked decrease in certain bacterial infections in Turkey. One of them is tuberculosis. Of note, statistics published by the Turkish Ministry of Health (MoH) show decreasing pulmonary tuberculosis (PTB), but on the other hand, increasing extrapulmonary tuberculosis (EPTB). The most common form of EPTB is tuberculous cervical lymphadenitis (TCL). The increase in the number of TCL cases despite the decline in cases of PTB is seen as a paradoxical issue. In contrast there has been an increase in the number of oropharyngeal tularemia cases in the last decade in Turkey. The aim of this study was to draw attention to the importance of differentiating between TCL and tularemia lymphadenitis, because these diseases may have a similar histopathological appearance. Methods: Thirty-two cases diagnosed as TCL were identified from the archives of a pathology laboratory (Patomer Pathology Laboratory, Bursa, Turkey). PCR tests for Francisella tularensis and Mycobacterium tuberculosis were carried out on the paraffin tissue blocks of these cases. At the same time, statistical data on PTB and EPTB for the period 1996–2010 were retrieved from the MoH and reviewed. Statistics related to tularemia, which has been diagnosed since 1988 and has been increasing in the last 10 years, were obtained from the Department of Zoonoses of the MoH. Results: Six out of 32 (19%) cases who had previously been diagnosed with ‘casseifying granulomatous lymphadenitis consistent with tuberculosis’ were found to be positive for tularemia by PCR test of the cervical lymph nodes. Conclusions: Oropharyngeal tularemia should be kept in mind in the differential diagnosis of cervical lymphadenitis in widespread geographic regions of the Northern Hemisphere, including the Asian continent. In particular, if granulomatous inflammation with necrosis is seen histopathologically, tularemia should be excluded before making the diagnosis of TCL. [ABSTRACT FROM AUTHOR]

Summary: Background: The first human case of tularemia in Iran was reported in 1980 and there have been no subsequent reports of tularemia in the country. The aim of this study was to carry out a survey of tularemia among different groups in the province of Kurdistan in western Iran. Methods: The following information was collected by means of an in-house questionnaire: participant demographic characteristics, exposure to risks, and use of appropriate personal protective equipment and disinfectant in their occupation. A blood sample was collected from each participant. Sera were tested using an ELISA kit (Virion\Serion) to detect specific IgG antibodies against Francisella tularensis. Results: Of a total of 250 serum samples, 14.40% had anti-tularemia IgG antibodies. The highest seroprevalence was found in hunters (18%) and the lowest in health care workers (12%). Age had a significant positive association with tularemia seroprevalence (p <0.001). The seroprevalence of tularemia in people exposed to foxes (hunting or eating the meat) (25%) was significantly higher than in others (8.65%) (p = 0.01). Conclusions: According to the findings of this study, it is highly recommended that physicians and health care workers are informed about bacteria circulating in this area. By sensitizing the health system, it is expected that some cases of the clinical disease will be reported in the near future. Similar studies in other parts of the country and on domestic and wild animals will clarify the epidemiology of tularemia in Iran. [Copyright &y& Elsevier]

B Methods and materials: b Two searchers were conducted using: «tularemia outbreak» and «francisella tularensis outbreak» in title and/or abstract using PubMed database for articles that had been published until 01.10.2018. B Background: b Tularemia is a highly contagious, multi-systemic zoonotic disease caused by francisella tularensis that can give rise to outbreaks. Tularemia outbreaks can occur via several transmission ways; evidence shows that even though a certain group, for example one family, is infected with the same source, individuals can develop different forms of the disease according to the port of entry. [Extracted from the article]

Background: Our studies undertaken between 2006-2015 have shown that the most frequent species of ticks in Romania is Ixodes ricinus. It was found that I. ricinus is the main vector in Romania for the Borrelia burgdorferi s.l. and for the TBEv, but no data were available for Francisella tularensis and CCHFv infectious agents occurrence into I.ricinus and Hyalomma sp. Three Romanian counties were selected as ticks sampling sites (Sibiu, Tulcea and Giurgiu), with this occasion we collected ticks from the vegetation and from the livestock and reptile fauna. Among the reptiles (Tulcea county), Testudo graeca ibera (TGI) is a well represented species. Samples of ectoparasites obtained from TGI and livestock collected during the years: 2006-2007 and 2014 - 2015 (April-June) showed that the majority of ticks are represented by Hyalomma.aegyptium and H. marginatum. Over 400 I. ricinus and Hyalomma sp. ticks were collected and analyzed by Real-Time PCR methods (including the new TicKitqPCR detection concept; project funded by the MEN-UEFISCDIPNII "Partnerships in priority areas" program, National Research Grant No. 295/2014") that give us results on Borrelia burgdorferi, Francisella tularensis, TBEv and CCHFv (BFTC) presence in the vectors. Methods & Materials: Total RNA and DNA were extracted and analized by in house real-time PCR reagents (included in the new TicKitqPCR detection concept) and 2 commercial kits for the BFTC detection in the I. ricinus and Hyalomma sp.pools. Results: Specific DNAs from B. burgdorferi sl. were detected (Fla B gene target) in 20% of I. ricinus ticks and specific DNAs for F. tularensis were detected (IS Ftu2 genomic isertion-like element) in 2% of the same vector species. Specific RNAs from TBEv were detected (3' UTR-genomic region) in < 1% of I.ricinus pools. No specific CCHFv RNAs were detected (S -genomic region) among the Hyalomma sp. pools. Conclusion: The results strengthen the concern that already exists in Romania, for the enhancement the surveillance and the control measures for the tick populations but also for the means of active information of the human population about the danger of the diseases transmitted by ticks in some risk areas. [ABSTRACT FROM AUTHOR]

Summary: We report three consecutive cases of tularemia occurring in Burgundy, France, a region previously considered not endemic for tularemia. The patients presented with varied and unspecific clinical manifestations. The epidemiological circumstances, especially the mode of contamination, were not particularly suggestive of tularemia. Serological diagnosis was delayed in two cases because of the lack of significant antibody titers at the time of admission. In contrast, a diagnosis could readily be obtained in all three cases by detection of Francisella tularensis DNA from clinical samples using PCR-based methods. These cases highlight the increased incidence and geographical spread of tularemia in France, and the usefulness of real-time PCR technology for the early diagnostic confirmation of tularemia. [Copyright &y& Elsevier]