An outbreak of oropharyngeal tularaemia linked to natural spring water.
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.
Willke
A
A
Kocaeli University, Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, Kocaeli, Turkey.
Meric
M
M
Kocaeli University, Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, Kocaeli, Turkey.
Grunow
R
R
Robert Koch Institute, Centre for Biological Safety, Berlin, Germany.
Sayan
M
M
Kocaeli University, Medical Faculty, Clinical Laboratory, PCR Unit, Kocaeli, Turkey.
Finke
E J
EJ
Bundeswehr Institute of Microbiology, Munich, Germany.
Splettstößer
W
W
Bundeswehr Institute of Microbiology, Munich, Germany.
Seibold
E
E
Bundeswehr Institute of Microbiology, Munich, Germany.
Erdoğan
S
S
Istanbul University, Cerrahpasa Medical Faculty, Department of Public Health, Istanbul, Turkey.
Ergonul
O
O
Marmara University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
Yumuk
Z
Z
Kocaeli University, Medical Faculty, Department of Microbiology, Kocaeli, Turkey.
Gedikoglu
S
S
Uludag University, Medical Faculty, Department of Microbiology, Bursa, Turkey.
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
D000900:Anti-Bacterial Agents