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Francisella tularensis is the pathogen of tularemia, a zoonotic disease that have a broad range of hosts. Its epidemiology is related to aquatic environments, particularly in the subspecies holarctica. In this review, we explore the role of water and mosquitoes in the epidemiology of Francisella in Europe. F. tularensis epidemiology has been linked to natural waters, where its persistence has been associated with biofilm and amebas. In Sweden and Finland, the European countries where most human cases have been reported, mosquito bites are a main route of transmission. F. tularensis is present in other European countries, but to date positive mosquitoes have not been found. Biofilm and amebas are potential sources of Francisella for mosquito larvae, however, mosquito vector capacity has not been demonstrated experimentally, with the need to be studied using local species to uncover a potential transmission adaptation. Transstadial, for persistence through life stages, and mechanical transmission, suggesting contaminated media as a source for infection, have been studied experimentally for mosquitoes, but their natural occurrence needs to be evaluated. It is important to clear up the role of different local mosquito species in the epidemiology of F. tularensis and their importance in all areas where tularemia is present. [ABSTRACT FROM AUTHOR]

The thinning operators play a fundamental role in the construction of integer-valued autoregressive models, whereas the most common operator is binomial thinning. In this article, we introduced a novel dependent Neyman type A thinning operator with dependent Bell counting series, which is more convenient in modeling different kinds of count data, especially with excessive zeros. We provided some statistical properties of the new thinning operator. Based on the dependent Neyman type A thinning operator, we also introduced a new stationary INAR(1) process, where the innovation process is involved the randomly non-negative integer-valued Geometric variable. The unknown parameters of the new process are estimated through several estimation methods. Different estimation approaches are compared by the comprehensive Monte–Carlo simulation method. The analysis of the monthly counts of drug calls in Pittsburgh, daily counts of COVID-19 in Barbados and weekly counts of Tularemia disease in Hesse are illustrated, which induces the goodness of fit of the proposed INAR(1) process in comparison with other competitor INAR(1) models. [ABSTRACT FROM AUTHOR]

Background: Pneumonic tularaemia is less common clinical form of tularaemia compared with the ulceroglandular form, with only a limited number of case reports and case series in Europe. In Finland, Northern Ostrobothnia is an endemic area of tularaemia with occasional seasonal outbreaks. Methods: In our study, a consecutive series of 58 pneumonic tularaemia cases diagnosed and treated in Oulu University Hospital in 2000–2012 were retrospectively analysed in terms of epidemiology, clinical course, and prognosis. Results: The incidence of pneumonic tularaemia showed peaks in cycles of a few years and most cases were diagnosed in late summer or early autumn. Respiratory symptoms were absent in 47% of patients, and 7% had normal chest X-ray. The chest computed tomography (CT) was performed in 81% of patients, demonstrating variable findings associated with pneumonic tularaemia. Bronchoscopy was performed for 22 (38%) patients and four (18%) of these also proceeded into mediastinoscopy. Moreover, thoracoscopy was performed for one (2%) patient. Two (3%) patients were treated shortly in the intensive care unit (ICU) during their stay in hospital. No mortality was observed. Conclusions: Most cases of pneumonic tularaemia are diagnosed during the seasonal outbreaks. The lack of specific symptoms often complicates the diagnosis and leads to unnecessarily invasive examinations. [ABSTRACT FROM AUTHOR]

We report the first two cases of infective endocarditis caused by Francisella tularensis in Europe (two cases have previously been reported outside Europe). We suggest clinicians should consider tularemia as a possible diagnosis in endemic regions in cases of culture-negative endocarditis. [ABSTRACT FROM AUTHOR]

Conclusion:A significant association was found of oropharyngeal tularemia with SLC11A1 allele polymorphism (INT4 G/C) and MBL2 C + 4T (P/Q). These results indicate C allele and Q allele might be a risk factor for the development of oropharyngeal tularemia. Aim:This study aimed to investigate the relationship of SLC11A1, MBL, and P2X7gene polymorphism with oropharyngeal tularemia. Methods:The study included totally 120 patients who were diagnosed with oropharyngeal tularemia. Frequencies of polymorphisms in the following genes were analyzed both in the patient and control groups in the study: SLC11A1 (5’(GT)nAllele 2/3, Int4 G/C, 3’ UTR, D543N G/A), MBL (MBL2 C + 4T (P/Q), and P2X7(−762 C/T and 1513 A/C). Results:Among all polymorphisms that were investigated in this study, SLC11A1 gene showed a significance in the distriburtion of polymorphism allelle frequency at the INT4 region. Frequency of C allele was 54 (28%) in patients with oropharyngeal tularemia, and 31 (13%) in the control group (p = 0.006 and OR = 1.96 (1.21–3.20)). An association was detected between MBL2 C + 4T (P/Q) gene polymorphism and oropharyngeal tularemia (p < 0.005 and OR = 0.30 (0.19–0.48)). No significant relation was found between P2X7(−762 C/T and 1513 A/C) gene polymorphism and oropharyngeal tularemia in this study (p > 0.05). [ABSTRACT FROM PUBLISHER]

We report that all non-fed stages of the lone star tickAmblyomma americanumand blacklegged tickIxodes scapularishave reduced water loss by exposure to short days. This reduction in water loss is more pronounced in larvae and nymphs than in adults. Impressive was the rapid response: all non-fed stages could transition quickly, losing water fast (long day), then slow (short day), and back to fast (long day), with only a single day exposure to short or long day conditions. Short days did not improve the tick’s dehydration tolerance limit. Ticks under short days were capable of absorbing water vapour, so their ability to rehydrate by water vapour absorption is not inhibited by change in photoperiod. Our conclusion is that a short-day-induced temporary quiescence helps to regulate water loss that applies to any non-fed stage for overwintering. The shallow nature of this quiescence implies that ticks could easily become active at any time and re-enter quiescence. [ABSTRACT FROM AUTHOR]

Renewed interest inFrancisella tularensishas resulted in substantial new information about its pathogenesis and immunology, along with development of useful animal models. While understanding of protective immunity againstFrancisellaremains incomplete, data in both animals and humans suggest that inducing T cell-mediated immunity is crucial for successful vaccination with current candidates such as the Live Vaccine Strain (LVS), with specific antibodies and immune B cells playing supporting roles. Consistent with this idea, recent results indicate that measurements of T cell functions and relative gene expression by immune T cells predict vaccine-induced protection in animal models. Because field trials of new vaccines will be difficult to design, using such measurements to derive potential correlates of protection may be important to bridge between animal efficacy studies and people. [ABSTRACT FROM PUBLISHER]

Introduction: Outbreaks of the zoonotic disease tularemia occurred in north-east Bulgaria in the 1960s. Then came 30 years of epidemiological silence until new outbreaks occurred in west Bulgaria in the 1990s. To investigate how bacterial strains of Francisella tularensis causing tularemia in wildlife and humans in the 1960s and the 1990s were related, we explored their genetic diversity. Material and methods: Ten F. tularensis genomes from the 1960s (n=3) and the 1990s (n=7) were sequenced, assigned to canonical single-nucleotide polymorphism (canSNP) clades, and compared to reference genomes. We developed four new canSNP polymerase chain reaction (PCR) assays based on the genome sequence information. Results and discussion: The genetic analysis showed that the outbreaks in the 1960s as well as in the 1990s involved multiple clones and new genetic diversity. The smallest genetic difference found between any of the Bulgarian strains was five SNPs between the strains L2 and 81 isolated 43 years apart, indicating that F. tularensis may persist locally over long time periods without causing outbreaks. The existence of genetically highly similar strain-pairs isolated the same year in the same area from different hosts supports a hypothesis of local expansion of clones during outbreaks. Close relationship (two SNPs) was found between one strain isolated 1961 in northeast Bulgaria and one strain isolated 5 years before in USSR. Historical data coinciding with the actual time point describe the introduction of water rats from USSR into the Bulgarian outbreak area, which may explain the close genetic relationship and the origin of the outbreak. Conclusion: Genome analysis of strains from two outbreaks in the 1960s and the 1990s provided valuable information on the genetic diversity and persistence of F. tularensis in Bulgaria. [ABSTRACT FROM AUTHOR]

Background: Finland repeatedly reports some of the highest incidences of tularaemia worldwide. To determine genetic diversity of the aetiologic agent of tularaemia, Francisella tularensis, a total of 76 samples from humans (n = 15) and animals (n = 61) were analysed. Methods: We used CanSNPs and canINDEL hydrolysis or TaqMan MGB probes for the analyses, either directly from the clinical tissue samples (n = 21) or from bacterial isolates (n = 55). Results: The genotypes of the strains were assigned to three previously described basal subspecies holarctica clades. The majority of strains (n = 67) were assigned to B.12, a clade reported to dominate in Scandinavia and Eastern Europe. A single strain was assigned to clade B.4, previously reported from North America, Europe and China. The remaining strains (n = 8) were members of clade B.6. Importantly, new diversity was discovered in clade B.6. We describe two newly designed TaqMan MGB probe assays for this new B.6 subclade B.70, and its previously identified sister clade B.11, a clade dominantly found in Western Europe. Conclusions: The high genetic diversity of F. tularensis subspecies holarctica present in Finland is consistent with previous findings in Sweden. The results suggest a northern and southern division of the B.6 subclade B.10, where B.11 predominates in Western and Central Europe and B.70 is found in Fennoscandia. Further research is required to define whether the vast diversity of genotypes found is related to different habitats or reservoir species, their different postglacial immigration routes to Fennoscandia, or dynamics of the reservoir species. [ABSTRACT FROM AUTHOR]

Francisella tularensis is a category A bioterrorism agent. It is the etiological agent of tularemia, a zoonotic disease found throughout the northern hemisphere. The intentional spread of F. tularensis aerosols would probably lead to severe and often fatal pneumonia cases, but also secondary cases from contaminated animals and environments. We are not ready to face such a situation. No vaccine is currently available. A few antibiotics are active against F. tularensis, but strains resistant to these antibiotics could be used in the context of bioterrorism. We need new therapeutic strategies to fight against category A bioterrorism agents, including development of new drugs inhibiting F. tularensis growth and/or virulence, or enhancing the host response to infection by this pathogen. [ABSTRACT FROM AUTHOR]

Francisella tularensis is a gram-negative bacterium that causes the zoonotic disease tularemia. Francisella is highly infectious via the respiratory route (~10 CFUs) and pulmonary infections due to type A strains of F. tularensis are highly lethal in untreated patients (>30%). In addition, no vaccines are licensed to prevent tularemia in humans. Due to the high infectivity and mortality of pulmonary tularemia, F. tularensis has been weaponized, including via the introduction of antibiotic resistance, by several countries. Because of the lack of efficacious vaccines, and concerns about F. tularensis acquiring resistance to antibiotics via natural or illicit means, augmentation of host immunity, and humoral immunotherapy have been investigated as countermeasures against tularemia. This manuscript will review advances made and challenges in the field of immunotherapy against tularemia. [ABSTRACT FROM AUTHOR]

This study tested the lone star tick,Amblyomma americanum, vector of ehrlichiosis, tularemia, Southern tick-associated rash illness borreliosis, for arrestment to excreta from different tick species. The purpose was to explore off-host clustering along with spread and establishment into habitats occupied previously by other ticks. This response was analysed in relation to relative humidity since this is environmental. Females had the greatest responses towards natural excreta, and excreta components guanine and uric, and nymphs behaved like adults but with lower response levels. Response was poor by larvae, by showing inconsistent, or no response to excreta exposure. Clustering occurred on excreta fromAmblyomma maculatum,Dermacentor variabilis,Ixodes scapularis, andRhipicephalus sanguineus. This indicates there is unlikely a species-specific assembly component in excreta ofA.americanum. In fact, highest level of assembly byA.americanumwas toI.scapularisexcreta. Greater speed and intensity for assembly occurred at 33% RH, with more ticks engaged in clustering on excreta-coated surfaces, than at 93% RH. No avoidance reaction was observed when exposed to other tick species excreta, suggesting that excreta from heterospecifics do not repelA.americanum. We conclude that dehydrating conditions cause lone star ticks to more actively pursue optimal moisture-rich, favourable habitats signalled by tick excreta. This behaviour is more important for females and nymphs than larvae, and there is capacity to recognize excreta of overlapping tick species. This co-recognition could facilitate occurrence ofA.americanumwith other ticks such asI.scapularisthat are frequently sympatric withA.americanumthrough much of their geographic distribution. [ABSTRACT FROM PUBLISHER]

Background: Tularemia is an infection caused by Francisella tularensis, which has a wide distribution in the northern hemisphere and diverse clinical manifestations. For decades, the drug of choice for the treatment of tularemia has been streptomycin, with tetracycline and chloramphenicol being used as alternatives. The purpose of the present study was to determine the in vitro antimicrobial susceptibility of a large panel of geographically diverse F. tularensis isolates from Turkey against traditional and newer antimicrobial agents. Methods: The antibiotic susceptibilities of 250 F. tularensis strains were examined using the Epsilometer test for 9 antimicrobial agents. Each isolate was identified by conventional and molecular techniques. Results: All the strains were confirmed biochemically and using a combination of species- and subspecies-specific polymerase chain reaction (PCR) assays to be F. tularensis subsp. holarctica. One isolate was assigned to F. tularensis subsp. holarctica biovar japonica based on erythromycin susceptibility, an ability to ferment glycerol, and the nucleotide sequence of the region of difference 1 (RD1). All strains were susceptible to aminoglycosides (streptomycin and gentamicin), tetracyclines (tetracycline and doxycycline), chloramphenicol, 2 fluoroquinolones (ciprofloxacin and levofloxacin), and rifampicin. In addition, all isolates except 1 had a minimal inhibitory concentration (MIC) for erythromycin of > 256 μg/ml. Conclusions: Since the fluoroquinolones showed the lowest MIC values and have advantages such as excellent bioavailability and activity, availability of oral formulations, and lower toxicities, they represent candidate therapeutic options in the first-line treatment of tularemia. To the best of our knowledge, this is the first report of the presence of F. tularensis subsp. holarctica biovar japonica outside Japan. [ABSTRACT FROM AUTHOR]

Tularemia during pregnancy is exceedingly rare and has been reported infrequently in Europe. A review of the literature identified only 3 documented cases. Herein we report 4 tularemia cases occurring early in the second and third trimesters, which were successfully managed without any adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

A case study is presented that investigates the claim by Soviet defector Kalinin Alibek (Ken Alibek) to the U.S. that the Soviet Union's (USSR's) Red Army used biological weapons against Germany during World War II, especially during the 1942 Battle of Stalingrad. Topics include the use of single witnesses in Intelligence Studies, allegations that tularaemia was used as a biological weapon at Stalingrad, Russia, and evidence from the U.S. and British interrogation program ALSOS.

Climate change in the Russian Arctic is more pronounced than in any other part of the country. Between 1955 and 2000, the annual average air temperature in the Russian North increased by 1.2°C. During the same period, the mean temperature of upper layer of permafrost increased by 3°C. Climate change in Russian Arctic increases the risks of the emergence of zoonotic infectious diseases. This review presents data on morbidity rates among people, domestic animals and wildlife in the Russian Arctic, focusing on the potential climate related emergence of such diseases as tick-borne encephalitis, tularemia, brucellosis, leptospirosis, rabies, and anthrax. [ABSTRACT FROM AUTHOR]

Tularemia has been recognized for more than 10 y in Serbia, since the first epidemic of tularemia occurred in Sokobanja region in 1999. We report 2 cases of oropharyngeal tularemia in a father and son after the consumption of under-cooked rabbit meat. Both presented with fever, unilateral tonsillopharyngitis and cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

Tularaemia is a vector-borne infectious disease. A large majority of cases transmitted to humans by blood-feeding arthropods occur during the summer season and is linked to increased temperatures. Therefore, the effect of climate change is likely to have an effect on tularaemia transmission patterns in highly endemic areas of Sweden. In this report, we use simulated climate change scenario data and empirical data of temperatures critical to tularaemia transmission to forecast tularaemia outbreak activity. The five high-endemic counties: Dalarna, Gävleborg, Norrbotten, Värmland and Örebro represent only 14.6% of the total population of Sweden, but have recorded 40.1-81.1% of the number of annual human tularaemia in Sweden from 1997 until 2008. We project here earlier starts and a later termination of future tularaemia outbreaks for the time period 2010-2100. For five localised outbreak areas; Gagnef (Dalarna), Ljusdal (Gävleborg), Harads (Norrbotten), Karlstad (Värmland) and Örebro municipality (Örebro), the climate scenario suggests an approximately 2°C increase in monthly average summer temperatures leading to increases in outbreak durations ranging from 3.5 weeks (Harads) to 6.6 weeks (Karlstad) between 2010 and 2100. In contrast, an analysis of precipitation scenarios indicates fairly stable projected levels of precipitation during the summer months. Thus, there should not be an increased abundance of late summer mosquitoes that are believed to be main vectors for transmission to humans in these areas. In conclusion, the results indicate that the future climate changes will lead to an increased burden of tularaemia in high-endemic areas of Sweden during the coming decades. [ABSTRACT FROM AUTHOR]

Tularemia is an infection caused by Francisella tularensis with a worldwide distribution and diverse clinical manifestations. Limitations in both culture and serologic testing have led to substantial research into new diagnostic techniques and their clinical application, with PCR testing as the best example. This review focuses on the utility of culture, PCR and serologic testing for tularemia. In addition, we also review the evidence to support different therapeutic options for tularemia, highlighting both the most effective supporting evidence for therapeutic recommendations as well as gaps in current knowledge. We conclude the article with suggestions regarding potential areas for future research. [ABSTRACT FROM AUTHOR]

A retrospective study of clinical tularaemia in an emergent area in Sweden is presented. 234 patients seen during the y 2000-2004 were studied, using case files and a questionnaire. There was a predominance of ulceroglandular tularaemia (89%), occurring in late summer and early autumn, reflecting the dominance of mosquito-borne transmission. The incubation period varied from a few hours to 11 d, with a median of 3 d. Cutaneous manifestations of tularaemia, apart from primary lesions, were noted in 43% of the cases. Coughing was common, even in patients with ulceroglandular tularaemia, supporting the view that haematogenous spread to the respiratory system occurs. Regular laboratory tests, such as WBC, ESR and C-reactive protein, were in general only moderately elevated. In the earlier y studied, the Doctor's Delay was substantial as was the misdiagnosis and prescription of inadequate antibiotics. In the later y, however, the delay and misdiagnosis were significantly lower, reflecting the increased recognition of the disease by the physicians in the area. A few relapses occurred, all in patients treated with doxycycline. No lethality was seen, reflecting the benign course of tularaemia type B infection. [ABSTRACT FROM AUTHOR]

Tularemia meningitis is a distinctly rare entity with only 14 cases reported in the literature, half of which occurred prior to 1950. In this case we provide the first description of cerebral microabscesses which occurred as a complication of tularemia meningitis. [ABSTRACT FROM AUTHOR]

The Anti-plague system experienced a dramatic expansion in Soviet times. From the dozen facilities created in the Russian Empire, it grew during the Soviet period to include over 100 facilities engaged in public health activities as well as BW-related work. This article describes how this highly responsive public health system, created to respond to natural outbreaks of dangerous diseases, became a critical adjunct to the Soviet BW program. [ABSTRACT FROM AUTHOR]

Between late January and early February 1997, an outbreak of plague, associated with cervical lymphadenopathy and fever, occurred in the Jordanian village of Azraq ad-Druze, which lies about 50 km west of the border with Saudi Arabia. The 12 cases who presented at hospital were initially assumed to have tularaemia, and all were successfully treated with gentamicin. When, however, their sera were tested for evidence of Yersinia pestis or Francisella tularensis infection (using haemagglutination, enzyme immuno-assays for specific IgM or the F1 antigen of Y. pestis, and micro-agglutination tests), all 12 were found to have anti-Y. pestis IgM. Three dogs shot near the Saudi Arabian border were also found seropositive for antibodies against Y. pestis. Eleven of the 12 patients reported that, 2–4 days before their symptoms appeared, they had eaten the meat cut from the carcass of the same camel, either raw (10 cases) or cooked (one case). All 12 patients were diagnosed as cases of pharyngeal plague (the first cases of plague reported in Jordan for more than 80 years), caused by Y. pestis that most had acquired when they ate raw meat from a camel that was infected with the pathogen. [ABSTRACT FROM AUTHOR]

A retrospective analysis to evaluate the clinical use of a diagnostic PCR for Francisella tularensis in patients with suspected ulceroglandular tularaemia was performed. 154 samples, 129 from patients with definitive tularaemia and 25 from patients where tularaemia could be ruled out, were analysed. The diagnostic PCR had a specificity of 96%, a sensitivity of 78.3%, and a Positive Predictive Value of 99%. Especially samples from encrusted lesions, even up to 4 weeks old, in patients with tularaemia, were PCR positive to a high degree when taken properly. The diagnostic PCR is useful in suspected ulceroglandular tularaemia, giving a fast and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Tularaemia was diagnosed by TaqMan RT-PCR and microagglutination tests in 5 patients, all from a new settlement constructed after the earthquake of 1999. During the follow-up, 129 more cases were found in this settlement (data from the local Health Care Authority). In this study, clinical features of 5 cases are presented briefly, and the Turkish literature on past outbreaks of tularaemia is reviewed. [ABSTRACT FROM AUTHOR]

Francisella tularensis is a pathogenic bacterium causing the serious disease tularemia and is potentially considered as a bioweapon agent. The piezoelectric immunosensor for F. tularensis (Ft) assay was developed using the quartz crystal microbalance (QCM) with covalently immobilized Ft antigen. Samples containing the bacterium were preincubated with a highly diluted anti-Ft IgM, and the mixture was injected to the flow cell containing the immunosensor. IgM alone as well as Ft cells alone were not giving any response, and therefore, it is assumed that the sensor responded to the IgMx-Fty complex formed during the preincubation step. The effects of pH, time of preincubation, and IgM concentration were tested. This rapid method allowed us to detect 5.106 HP Ft cells/mL. RSD of measurements was near 1%. The total time of one analysis was 35 mm, and one sensor was used for more than 30 times without losing sensitivity. [ABSTRACT FROM AUTHOR]

During the last 40 y, 2 large tularaemia outbreaks occurred in Bulgaria. We report the second outbreak, in 1998-2003, including a total of 262 laboratory confirmed cases. The majority of the patients presented with oropharyngeal tularaemia (89.7%). Less common were the glandular, pulmonary and oculoglandular forms. The diagnosis of tularaemia was confirmed serologically. In 5 cases, F. tularensis was detected by immunofluorescent assay in lymph node biopsies. By PCR, all 5 samples yielded successful amplification of the tul4 gene and the feredoxin gene of F. tularensis. Cultivation of the biopsies resulted in 2 F. tularensis isolates. Three additional F. tularensis isolates were obtained from an open well, a dead hare and a tick. All 5 isolates were identified as F. tularensis subsp. holarctica seu palaearctica. F. tularensis was detected by PCR amplification of the tul4 gene in spleen samples from 9 (21%) of 42 captured rodents. Our study indicated food and water contamination by rodents as important sources of human infection. The high prevalence of the oropharyngeal form of tularaemia supported the assumption that humans contracted the infection by alimentary route. [ABSTRACT FROM AUTHOR]

Decades after recovery from tularemia, circulating αβ T cells are known to still recognize a variety of membrane proteins of Francisella tularensis. We studied the T cell response to 3 cytoplasmic heat shock proteins of the organism: DnaK, chaperone-60 (Cpn-60) and Cpn-10. Determination of subpopulations of responding T cells was of special interest as it has been suggested that homologs of these conserved proteins may be recognized by human gd T cells. Compared with reference subjects with no history of tularemia or tularemia vaccination, subjects who had been infected with tularemia 10-30 y earlier showed a significantly (p 0.01) higher proliferative T cell response to all 3 heat shock proteins. In general, the magnitude of responses of CD4 T cells was higher than that of CD8 T cells. By flow cytometry, blast cells were shown to express the aβ T cell receptor. Under conditions that allowed vigorous expansion of gd T cells in response to a phosphorylated non-peptide antigen, no expansion of gd T cells occurred in response to DnaK or Cpn60 of F. tularensis. In conclusion, a long-lasting recall response to heat shock proteins of F. tularensis was demonstrated in αβ T cells but not in gd T cells. The results support the assumption that human αβ T cells recognize bacterial proteins irrespective of the nature or localization of the proteins in the bacterial cell and thereby contribute to the maintenance of a long-lasting broad T cell response based on a wide variety of specificities. [ABSTRACT FROM AUTHOR]

A field investigation was undertaken following an outbreak of water-borne tularemia in Northern Norway. Francisella tularensis bacterial cellular components were analysed by rapid immunochromatography (RI)-testing, enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). Water from 1 reservoir, fed from a rapid stream, tested negative. From another reservoir, 2 of a chain of 3 wells tested negative. The third well, at the end of the chain, contained lemming (Lemmus lemmus) carcasses and gave ample proof of F. tularensis contamination. We concluded that the origin of the outbreak was dead, infective lemming carcasses in the water sources. For the various sampling materials, the RI-test proved itself particularly handy and versatile, compared with the ELISA and the PCR. [ABSTRACT FROM AUTHOR]

[ABSTRACT FROM PUBLISHER]

Tularemia is a zoonotic disease of the northern hemisphere. Oculoglandular tularemia is the rarest form, comprising 1.4-4.2% of all cases. We present a patient with oculoglandular tularemia that did not respond to gentamicin to demonstrate the need for prolonged antimicrobial treatment and surgical intervention. [ABSTRACT FROM AUTHOR]

Purpose: To describe an unusual case of oculoglandular tularemia associated with unilateral acute dacryocystitis and purulent conjunctivitis with 18 weeks pregnancy. Methods: It is difficult to culture francisella tularensis on media so serological tests such as micro-agglutination methods are used to diagnose the infection. PCR test results were weak positive. The serum sample was analyzed for the presence of f. tularensis antibody, which was determined positive with a titer of 1/160. Results: Oral amoksicilin-clavulonic acid treatment was applied to the patient because of the side-effects of other antibiotics on the fetus. Dacryocystitis was surgically drained but relapsed a few weeks later, so it was drained again and a ciprofloksasin-impregnated sponge was placed into the tissue defect that occurred after drainage. No relapses were seen after recovery of dacryocystitis. Conclusions: Oculoglandular tularemia is not only suspected in cases who complain of fever, cervical lymphadenopathy and purulent conjunctivitis, it should also be suspected in cases who are admitted to the hospital with acute dacryocystitis, which is a rare component of oculoglandular syndrome. [ABSTRACT FROM AUTHOR]

Tularemia is a zoonotic disease caused by Francisella tularensis. Francisella tularensis is transmitted to humans by direct contact or ingestion of infected animal tissues, through the bite of infected arthropods, by consumption of contaminated food or water, or from inhalation of aerolized bacteria. In this report we describe 2 cases with oropharyngeal tularemia who presented with tonsillopharyngitis and cervical lymphadenitis. [ABSTRACT FROM AUTHOR]

This inspection by the Occupational Safety and Health Administration (OSHA) was the result of a media referral. The media reported that three researchers had acquired tularemia as a result of their work activities in a research facility. The report also indicated that researchers working on a tularemia vaccine project in a Biosafety Level 2 (BSL2) research facility had possibly violated biological safety practices and that engineering controls were not used or maintained. As a result of published accounts of possible hazards to workers, an unannounced inspection of the research facility was conducted. [ABSTRACT FROM AUTHOR]

The article is a case report on making a fast laboratory diagnosis of the zoonotic disease ulceroglandular tularemia with polymerase chain reaction (PCR). Francisella tularensis is the highly virulent infecting organism that is usually acquired via a mosquito bite. Treatment of the 9-year-old boy with ciprofloxacin is discussed.

Presents a case of type B tularemia with severe septicemia and myositis. Case history; Mode of vector-borne transmission of tularemia; Treatment with aminoglycosides and ciprofloxacin.

A correction to the article “Unilateral Acute Dacryocystitis Associated with Oculoglandular Tularemia: A Case Report" that was published in the 2013 issue is presented.

Examines the incidence of tularemia in Bornholm, Denmark. Mode of disease transmission; Signs and symptoms of tularemia; Analysis on the bacterial culture from the skin.