title: An outbreak of oropharyngeal tularaemia linked to natural spring water.
abstract: A tularaemia outbreak was investigated involving 188 suspected cases in the Kocaeli region of Turkey between December 2004 and April 2005. A case-control study comprising 135 laboratory-confirmed cases and 55 controls was undertaken to identify risk factors for the development of the outbreak and to evaluate laboratory diagnostic methods. Tularaemia was confirmed by a microagglutination test (MAT) titre of >or=1 : 160 in 90 of the patients. In MAT-negative sera, 23/44 (52 %) were positive by ELISA with Francisella tularensis LPS and 1/9 (11 %) by Western blotting with this antigen. A species-specific PCR was positive in 16/25 (64 %) throat swabs and 8/13 (62 %) lymph node aspirates. Multivariate analysis showed that drinking natural spring water was the leading risk factor for the development of tularaemia (P=0.0001, odds ratio 0.165, 95 % CI 0.790-0.346). The outbreak ceased after abandonment of the suspected natural water springs.
authors.affiliation: Kocaeli University, Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, Kocaeli, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Willke
authors.affiliation: Kocaeli University, Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, Kocaeli, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Meric
authors.affiliation: Robert Koch Institute, Centre for Biological Safety, Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Grunow
authors.affiliation: Kocaeli University, Medical Faculty, Clinical Laboratory, PCR Unit, Kocaeli, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Sayan
authors.affiliation: Bundeswehr Institute of Microbiology, Munich, Germany.
authors.forename: E J
authors.initials: EJ
authors.lastname: Finke
authors.affiliation: Bundeswehr Institute of Microbiology, Munich, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Splettstößer
authors.affiliation: Bundeswehr Institute of Microbiology, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Seibold
authors.affiliation: Istanbul University, Cerrahpasa Medical Faculty, Department of Public Health, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Erdoğan
authors.affiliation: Marmara University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Ergonul
authors.affiliation: Kocaeli University, Medical Faculty, Department of Microbiology, Kocaeli, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Yumuk
authors.affiliation: Uludag University, Medical Faculty, Department of Microbiology, Bursa, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Gedikoglu
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology*; D014406:Tularemia / Q000188:drug therapy / Q000453:epidemiology*; D014421:Turkey / Q000453:epidemiology; D014871:Water Microbiology
chemical_list: D000900:Anti-Bacterial Agents