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Objective: Tularemia is a zoonotic disease that causes epidemics in Turkey. An increase in tularemia cases was noticed in the province of Muş compared to previous years. With this study, we aimed to increase the awareness of tularemia in the region by sharing the characteristics of the cases. Methods: The epidemiological, demographic, and clinical characteristics of tularemia cases seen in the province of Muş between 2017-2019 were retrospectively analyzed. Only confirmed cases were included. Results: Fifty cases were seen between 2017-2019. 52% were male; the average age was 23 (3-66), and 44% were 18 years or younger. The average admission time to the hospital was 23 days (3-79). Lymphadenopathy (LAP) (100%), sore throat (78%), weakness (66%), and loss of appetite (60%) were among the most common symptoms and signs at the onset of the disease. Oropharyngeal form (90%) was seen in most of the cases. 96% of the patients lived in rural areas, and 84% of them were using mains water as drinking water. Mains water chlorination rate was 30%. Most cases were seen in autumn and winter (76%). Similar clinical presentations were observed in 46% of the people in the neighborhood. No mortality was seen in the patients. Conclusion: Data of two tularemia epidemics and six sporadic cases in the region within three years were presented. It should not be forgotten that tularemia is also seen in the pediatric age group in our region. Tularemia should be considered in patients of all age groups who present with complaints of LAP, sore throat, weakness, anorexia, and fever, especially during autumn and winter. Contact with contaminated water should be questioned in patients with atypically located LAP, and detailed epidemiological history should be taken. Taking sanitation measures and making prompt investigations are significant in preventing possible epidemics in areas with an increase in tularemia cases. [ABSTRACT FROM AUTHOR]

Objective: Tularemia was first detected in Thrace region in our country and the outbreaks continued in the region over the following years. The fact that the agent has been identified in mice around Kaynarca in 2012 suggests the disease poses a risk for our region. Aim of this study was to investigate tularemia incidence and presence of Francisella tularensis in streams/mains water in a risky region of Thrace. Methods: In this study, seropositivity for tularemia was investigated in 13 villages, and 1 town in risky areas of the Thrace region. In January 2016, blood was drawn from 746 people and tularemia microagglutination tests were applied. Seropositivity was not detected. In December, 464 of 746 people were reached. Seroconversion was not observed. In addition, culture and polymerase chain reaction (PCR) procedures were applied to specimens collected from mains water and streams in 13 villages and 1 town. Results: The causative agent wasn't isolated from the cultures but F. tularensis DNAs were detected by PCR method in 2 stream, and 3 mains water samples. One of the streams passed through the village of Celaliye, which was very close to the Kaynarca, in which tularemia cases were seen in the past. The other was farther, passing through the Kavaklı town in which no cases has been reported. The mains water which were positive were from Hamzabey, Ceylanköy, and Tatarköy villages located around Kaynarca. Molecular examination after chlorination was repeated in the water sources in which positivity was detected, and it was seen that the agent was eliminated. Conclusions: In this study, incidence was calculated as zero, although the causative agent was found in the water. Although no seropositivity was detected, the detection of the agent by PCR in 5 water samples showed that the agents in the nature could reach the water resources. It has been observed that surveillance studies in risky areas could be effective in preventing possible outbreaks. [ABSTRACT FROM AUTHOR]

A 58-year-old woman was admitted to our hospital with a two week history of fever, and left axillary lymphadenopathy. She was living in a village endemic for tularemia, but she had no history of any animal contact or a tick bite. She had a wound on the second finger of her left hand which was the probable port of entry for Francisella tularensis. The clinical diagnosis of tularemia was confirmed by a microagglutination test. As this case demonstrated, other forms of tularemia other than oropharyngeal form prevalent in Turkey can be encountered among patients with fever and lymphadenopathy in endemic regions. [ABSTRACT FROM AUTHOR]

Objective: Several tularemia epidemics have been reported from many provinces in our country in recent years. We report the first tularemia epidemic occurring in Sivas, and some features of the cases. Methods: Twenty-nine patients admitted to the Infectious Diseases and Clinical Microbiology Clinic of Cumhuriyet University Hospital, between January 2009 and June 2010 were retrospectively investigated. Microagglutination method was used for serological diagnosis. Patients were reviewed and recorded for demographic, clinical and laboratory features. Results: 15 of the patients were male and 14 were female. The mean age was 41.8 years. The mean time between the onset of the symptoms and diagnosis was 38 days. Francisella tularensis was detected by polymerase chain reaction in lymph node aspirate from two patients. This epidemic was thought to be waterborne. In most of the cases (75.9%), the disease presented itself in the oropharyngeal form. The majority of the patients (93.1%) had cervical lymphadenopathy. Prior to diagnosis of tularemia, several antibiotic regimens ineffective for tularemia were given to 72.4% of the patients. Streptomycin and doxycycline combination was given to most of the patients (44.8%) for treatment. No mortality or sequela except for scar was observed. Conclusions: Clinicians should be careful for tularemia, even in non-endemic regions. Tularemia should be considered in the differential diagnosis of patients with tonsillopharyngitis and/or cervical lymphadenopathy. [ABSTRACT FROM AUTHOR]

Tularemia is a zoonotic infectious disease caused by Francisella tularensis. Tularemia is endemic in the northern hemisphere and is usually seen in North America, Europe and Asia. Although the ulceroglandular tularemia is the most common form in these regions, the oropharyngeal form is more prevalent in Eastern Europe, including Turkey. The disease has importance in Turkey due to its wide geographic distribution and periodic outbreaks. The aim of this study was to determine the demographic, clinical and epidemiological characteristics of oropharyngeal tularemia patients. The demographic, clinical, epidemiological and laboratory findings of 26 tularemia patients admitted to our hospital from Erzurum and 5 neighbour provinces were analyzed retrospectively. Francisella tularensis microagglutination test (MAT) was performed for all patients whose clinical symptoms were consistent with tularemia and MAT titers ≥ 1/160 were considered positive. Twenty-six oropharyngeal tularemia patients (13 males and 13 females) were included in the study. All of the patients had cervical lymphadenopathy (LAP) at least one month period. Twenty (76.9%) of the patients included in the study were living in rural areas, and 17 (65.4%) were dealing with livestock. It was determined that 9 (34.6%) of the patients used water from municipal water supply, 9 (34.6%) of the patients used water from natural water supply and 8 (30.8%) of the patients used both of the water supplies. The most common symptoms among the patients in the study were fever in 23 (88.5%) patients, sore throat in 24 (92.3%) patients, and cervical LAP in all of the patients. Thirteen (50%) of the patients were treated with streptomycin, 7 (26.9%) with doxycycline and 6 (23.1%) with gentamicin. This is the first study showing that tularemia is present in Erzincan, Ağrı, Iğdır as well as Erzurum provinces, and it provides that the incidence has increased in this region. Tularemia diagnosis is generally underestimated due to the lack of specific symptoms. Therefore, tularemia should also be considered in patients who have complaints of sore throat and cervical LAP in non-endemic regions.