title: Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey.
abstract: BACKGROUND
  Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases.
  
  
  METHODS
  The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female.
  
  
  RESULTS
  Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003).
  
  
  CONCLUSIONS
  In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.
authors.affiliation: Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey. mengeloglu@gmail.com.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Mengeloglu
authors.forename: Arif
authors.initials: A
authors.lastname: Duran
authors.forename: Ismail Necati
authors.initials: IN
authors.lastname: Hakyemez
authors.forename: Tarik
authors.initials: T
authors.lastname: Ocak
authors.forename: Abdülkadir
authors.initials: A
authors.lastname: Kücükbayrak
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karadag
authors.forename: Tekin
authors.initials: T
authors.lastname: Tas
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Akdeniz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000372:Agglutination Tests; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D005604:Francisella tularensis / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012377:Rodentia; D014406:Tularemia / Q000453:epidemiology* / Q000473:pathology*; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult