title: Tularemia, a re-emerging infectious disease in Iran and neighboring countrie.
abstract: OBJECTIVE
  Tularemia is a zoonotic disease transmitted by direct contact with infected animals and through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated meat or water, and skin contact with any infected material. It is widespread throughout the northern hemisphere, including Iran and its neighbors to the north, northeast, and northwest.
  
  
  METHODS
  In this paper, the epidemiology of tularemia as a re-emerging infectious disease in the world with a focus on Iran and the neighboring countries is reviewed.
  
  
  RESULTS
  In Iran, positive serological tests were first reported in 1973, in wildlife and domestic livestock in the northwestern and southeastern parts of the country. The first human case was reported in 1980 in the southwest of Iran, and recent studies conducted among at-risk populations in the western, southeastern, and southwestern parts of Iran revealed seroprevalences of 14.4, 6.52, and 6%, respectively.
  
  
  CONCLUSIONS
  Several factors may explain the absence of reported tularemia cases in Iran since 1980. Tularemia may be underdiagnosed in Iran because Francisella tularensis subspecies holarctica is likely to be the major etiological agent and usually causes mild to moderately severe disease. Furthermore, tularemia is not a disease extensively studied in the medical educational system in Iran, and empirical therapy may be effective in many cases. Finally, it should be noted that laboratories capable of diagnosing tularemia have only been established in the last few years. Since both recent and older studies have consistently found tularemia antibodies in humans and animals, the surveillance of this disease should receive more attention. In particular, it would be worthwhile for clinical researchers to confirm tularemia cases more often by isolating F. tularensis from infected humans and animals.
authors.affiliation: Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.|Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Zargar
authors.affiliation: Centre National de Référence des Francisella, Laboratoire de Bactériologie, Département des Agents Infectieux, Institut de Biologie et Pathologie, Centre Hospitalier Universitaire de Grenoble, Université Joseph Fourier, Grenoble, France.|Laboratoire Adaptation et Pathogénie des Microorganismes, CNRS UMR 5163, Grenoble, France.
authors.forename: Max
authors.initials: M
authors.lastname: Maurin
authors.affiliation: Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.|Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Mostafavi
keywords: Bacterial infections; Francisella tularensis; Rodentia; Tularemia