[Tularemia--an old and a new problem in the South Moravia Region].
BACKGROUND
The first epidemic of ulceroglandular forms of tularemia acquired in coincidence with the manipulation with tularaemic hares took place in 1936 in the surroundings of Breclav and Valtice. The largest epidemic took place in the 1960's when hundreds of agricultural workers in the initial phases of the production of sugar within sugar refineries were afflicted by pulmonary forms of this disease. In the subsequent period which was interrupted only by smaller local epidemics, the number of new cases were gradually decreasing to the minimum at the beginning of 1990's. However, since 1994, the number of cases has began to increase again, namely those afflicted by ulceroglandular and oroglandular forms. OBJECTIVES [corrected]: In consequence of the long absence of this disease in clinical practice, the diagnostic awareness has decreased, and therefore the author has decided to indicate and review the current basic data on epidemiology and clinical manifestations of tularaemia.


METHODS
The author has analysed the documentation of 577 of adults afflicted by tularemia and medically treated at the clinic of the Faculty Hospital in Brno in the period form 1959 to 1999. The study reviews the onset of the disease and the pathway of transmission of infection and its clinical manifestation.


RESULTS
Following the long-termed sporadic occurrence of tularaemia after major epidemics of pulmonary forms of this disease in 1960's, interrupted only by smaller local epidemics, the incidence has began to increase again in 1994. The number of pulmonary forms has decreased whereas the occurrence of ulcerulceroglandular and oroglandular forms has increased. Hares have become the source of infection again.


CONCLUSIONS
The fact that tularemia has repeatedly become a threat in Southern Moravia should be taken into account in the assessment of diagnosis in cases with unclear lymphadenitis and febrile states which defy the penicillin treatment especially in winter. (Tab. 3, Fig. 3, Ref. 23.)
Cerny
Z
Z
Department of Infectology, School of Medicine, Masaryk University, Brno, Czech Republic. zcerny@med.muni.cz
D018153:Czech Republic / Q000453:epidemiology; D004196:Disease Outbreaks; D006801:Humans; D014406:Tularemia / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission