Francisella tularensis human infections in a village of northwest Iran

Abstract

Background Recent seroepidemiological studies have suggested that tularemia could be an endemic bacterial zoonosis in Iran. Methods From 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. Results Among 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. Conclusions Based 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.

First molecular detection of Francisella tularensis in turtle (Testudo graeca) and ticks (Hyalomma aegyptium) in Northwest of Iran

“…This particular subspecies of F. tularensis is frequently linked to water sources that have been contaminated, such as lakes, rivers, and ponds. A previous investigation also proposed waterborne transmission as a potential avenue for a tularemia outbreak in Iran ( Esmaeili et al, 2021 ).…”

Francisella and tularemia in western Asia, Iran: a systematic review

“…For instance, clinical manifestations included mild lymph adenopathy of the axillary lymph nodes followed by consuming the meat of a hunted hare, the development of swollen lymph nodes in the neck of patients living within an area with previous reports of tularemia with fever, fatigue, and muscle aches. Furthermore, redness of the oropharyngeal mucosa, and typical oropharyngeal tularemia through drinking contaminated water or eating food washed with contaminated water [14] , [18] , [24] . Although serological techniques such as ELISA tests, micro agglutination tests, and indirect immunofluorescence assays have weak reliability and standard, they are very applicable to epidemiological studies.…”

Tularemia treatment: experimental and clinical data

“…Large OP tularemia case series have been reported in Turkey where these infections predominate and occur as outbreaks mainly related to the consumption of contaminated water ( Meric et al, 2008 ; Ulu-Kilic et al, 2013 ; Erdem et al, 2014 ; Gozel et al, 2014 ; Table 7 ). Many other small series or sporadic OP tularemia cases have been reported involving more than 200 patients ( Arikan et al, 2003 ; Chitadze et al, 2009 ; Sencan et al, 2009 ; Komitova et al, 2010 ; Kızıl et al, 2012 ; Dentan et al, 2013 ; Eren Gok et al, 2014 ; Karakas et al, 2014 ; Uzun et al, 2015 ; Esmaeili et al, 2021 ; Binay et al, 2023 ).…”