1
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Mattatia C, Agyeman PKA, Schöbi N, Aebi S, Duppenthaler A, Büttcher M, Aebi C. Seroepidemiology of Human Tularemia-Systematic Review and Meta-analysis of Seroprevalence Studies. Open Forum Infect Dis 2024; 11:ofad636. [PMID: 38312214 PMCID: PMC10837002 DOI: 10.1093/ofid/ofad636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024] Open
Abstract
Background Seroepidemiologic studies of human tularemia have been conducted throughout the northern hemisphere. The purposes of this study were (1) to provide an overview of Francisella tularensis seroprevalence data, and (2) to generate an estimate of the proportion of study participants whose infection remained subclinical. Methods We conducted a systematic review of F tularensis seroprevalence studies according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, Embase, and Web of Science covering the period from 1951 to 2023. Results The weighted pooled seroprevalence among 44 486 participants recruited in 52 studies was 3.7% (95% confidence interval [CI], 2.7-5.1). Reported seroprevalences ranged between 0.2% and 31.3%. Occupational activities associated with an increased likelihood of exposure (risk ratio, 3.51 [95% CI, 3.2-3.86]) and studies from North America versus Europe and Asia (4.53 [4.15-4.94]) were associated with significantly increased seropositive rates. Twenty-eight data sets (47%) reported clinical information on a total of 965 seropositive participants. The weighted pooled estimate for subclinical seropositivity was 84.4% (95% CI, 72.9%-991.7%). Studies from F tularensis type A areas (risk ratio, 0.37 [95% CI, .27-.51) and studies from sites where pulmonary tularemia prevailed (0.38 [.28-.51]) reported lower subclinical seropositivity rates than studies from type B areas and from areas of predominance of (ulcero)glandular or oropharyngeal tularemia, respectively. Conclusions Throughout the northern hemisphere, only a small proportion of study participants showed serologic evidence of exposure to F tularensis. Eight of 10 seropositive participants had no historical evidence of past clinical tularemia.
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Affiliation(s)
- Chantal Mattatia
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp K A Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
- Risk and Resilience Team, Center for Security Studies (CSS), Eidgenössische Technische Hochschule (ETH), Zurich, Switzerland
| | - Andrea Duppenthaler
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Büttcher
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Medicine and Health Sciences, University Lucerne, Lucerne, Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, Basel, Switzerland
| | - Christoph Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
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2
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Ammam I, Brunet CD, Boukenaoui-Ferrouk N, Peyroux J, Berthier S, Boutonnat J, Rahal K, Bitam I, Maurin M. Francisella tularensis PCR detection in Cape hares (Lepus capensis) and wild rabbits (Oryctolagus cuniculus) in Algeria. Sci Rep 2022; 12:21451. [PMID: 36509808 PMCID: PMC9743112 DOI: 10.1038/s41598-022-25188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Tularemia is a zoonosis caused by the bacterium Francisella tularensis. Leporids are primary sources of human infections in the northern hemisphere. Africa is classically considered free of tularemia, but recent data indicate that this dogma might be wrong. We assessed the presence of this disease in wild leporids in Algeria. Between 2014 and 2018, we collected 74 leporids carcasses from spontaneously dead or hunted animals. Francisella tularensis DNA was detected by specific real-time PCR tests in 7/36 (19.44%) Cape hares (Lepus capensis) and 5/38 (13.15%) wild rabbits (Oryctolagus cuniculus). Known tularemia arthropod vectors infested half of the PCR-positive animals. At necropsy, F. tularensis-infected animals presented with an enlarged spleen (n = 12), enlarged adrenal glands (12), liver discoloration (12), hemorrhages (11), and pneumonia (11). Immunohistological examination of liver tissue from one animal was compatible with the presence of F. tularensis. Our study demonstrates the existence of tularemia in lagomorphs in Algeria. It should encourage investigations to detect this disease among the human population of this country.
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Affiliation(s)
- Imene Ammam
- grid.32139.3a0000 0004 0633 7931Institute of Veterinary Sciences, University of Blida 1, Blida, Algeria ,Laboratory of Biodiversity and Environment: Interactions, Genome, University of Sciences and Technology Houari Boumedienne, Algiers, Algeria
| | - Camille D. Brunet
- grid.4444.00000 0001 2112 9282University Grenoble Alpes, CNRS, TIMC, 38000 Grenoble, France
| | - Nouria Boukenaoui-Ferrouk
- grid.32139.3a0000 0004 0633 7931Institute of Veterinary Sciences, University of Blida 1, Blida, Algeria ,grid.420190.e0000 0001 2293 1293Laboratory of Research on Arid Zones Lands (LRZA), Faculty of Biological Sciences (FSB), Houari Boumediene University of Science and Technology (USTHB), BP 32, 16111 Bab Ezzouar, Algiers Algeria
| | - Julien Peyroux
- grid.4444.00000 0001 2112 9282University Grenoble Alpes, CNRS, TIMC, 38000 Grenoble, France
| | - Sylvie Berthier
- grid.410529.b0000 0001 0792 4829Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Jean Boutonnat
- grid.410529.b0000 0001 0792 4829Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Karim Rahal
- grid.32139.3a0000 0004 0633 7931Institute of Veterinary Sciences, University of Blida 1, Blida, Algeria
| | - Idir Bitam
- Laboratory of Biodiversity and Environment: Interactions, Genome, University of Sciences and Technology Houari Boumedienne, Algiers, Algeria ,Superior School of Food Sciences and Food Industries of Algiers, El Harrach, Algeria
| | - Max Maurin
- grid.4444.00000 0001 2112 9282University Grenoble Alpes, CNRS, TIMC, 38000 Grenoble, France ,grid.410529.b0000 0001 0792 4829Grenoble Alpes University Hospital, 38000 Grenoble, France
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3
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Maurin M. Francisella tularensis, Tularemia and Serological Diagnosis. Front Cell Infect Microbiol 2020; 10:512090. [PMID: 33194778 PMCID: PMC7649319 DOI: 10.3389/fcimb.2020.512090] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Tularemia is a zoonotic disease caused by the bacterium Francisella tularensis. The predominant sources, routes of infection, and clinical manifestations of human infections greatly vary according to the geographic area considered. Moreover, clinical suspicion of tularemia is often tricky because of the lack of specificity of the clinical manifestations. Because F. tularensis isolation is tedious and detection of its DNA usually requires removal of infected tissues, serological techniques are most often used for diagnostic confirmation. However, these techniques are varied and poorly standardized. The microagglutination test (MAT), the indirect immunofluorescence assay (IFA), and ELISA tests are currently the most frequently used techniques. These home-made and commercial tests are mainly used for tularemia diagnosis but also seroprevalence studies. ELISA tests detect specific antibodies within two weeks of disease evaluation, compared to 2-3 weeks for MAT and IFA. However, more false-positive results are usually reported with ELISA. The long-term persistence of anti-F. tularensis antibodies in patients with past tularemia infection hampers the diagnostic specificity of all these tests. Also, cross-reacting antibodies have been described (especially with Brucella and Yersinia species), although usually at a low level. The immunoblotting technique can highlight these serological cross-reactions. Tularemia remains an underdiagnosed disease in most endemic areas, and the clinical presentations of this disease are evolving. It is necessary to improve further speed and accuracy of tularemia diagnosis, as well as the standardization of diagnostic procedures.
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Affiliation(s)
- Max Maurin
- Centre National de Référence Francisella tularensis, Laboratoire de Bactériologie, Institut de Biologie et de Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Laboratoire Techniques de l'Ingénierie Médicale et de la Complexité Informatique-Mathématiques et Applications (TIMC-IMAG), Université Grenoble Alpes, Centre National de la Recherche Scientifique (CNRS), Grenoble, France
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4
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Appelt S, Faber M, Köppen K, Jacob D, Grunow R, Heuner K. Francisella tularensis Subspecies holarctica and Tularemia in Germany. Microorganisms 2020; 8:microorganisms8091448. [PMID: 32971773 PMCID: PMC7564102 DOI: 10.3390/microorganisms8091448] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
Tularemia is a zoonotic disease caused by Francisella tularensis a small, pleomorphic, facultative intracellular bacterium. In Europe, infections in animals and humans are caused mainly by Francisella tularensis subspecies holarctica. Humans can be exposed to the pathogen directly and indirectly through contact with sick animals, carcasses, mosquitoes and ticks, environmental sources such as contaminated water or soil, and food. So far, F. tularensis subsp. holarctica is the only Francisella species known to cause tularemia in Germany. On the basis of surveillance data, outbreak investigations, and literature, we review herein the epidemiological situation-noteworthy clinical cases next to genetic diversity of F. tularensis subsp. holarctica strains isolated from patients. In the last 15 years, the yearly number of notified cases of tularemia has increased steadily in Germany, suggesting that the disease is re-emerging. By sequencing F. tularensis subsp. holarctica genomes, knowledge has been added to recent findings, completing the picture of genotypic diversity and geographical segregation of Francisella clades in Germany. Here, we also shortly summarize the current knowledge about a new Francisella species (Francisella sp. strain W12-1067) that has been recently identified in Germany. This species is the second Francisella species discovered in Germany.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Mirko Faber
- Gastrointestinal Infections, Zoonoses and Tropical Infections (Division 35), Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany;
| | - Kristin Köppen
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, 13353 Berlin, Germany;
| | - Daniela Jacob
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS 2), Robert Koch Institute, 13353 Berlin, Germany; (S.A.); (D.J.); (R.G.)
| | - Klaus Heuner
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, 13353 Berlin, Germany;
- Correspondence: ; Tel.: +49-301-8754-2226
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5
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Jacob D, Köppen K, Radonić A, Haldemann B, Zanger P, Heuner K, Grunow R. Molecular identification of the source of an uncommon tularaemia outbreak, Germany, autumn 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 31064636 PMCID: PMC6505183 DOI: 10.2807/1560-7917.es.2019.24.18.1800419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In 2016, an uncommon outbreak of oropharyngeal tularaemia involving six human cases occurred in Germany, caused by drinking contaminated fresh must after a grape harvest. Aim We describe the details of laboratory investigations leading to identification of the outbreak strain, its characterisation by next generation sequencing (NGS) and the finding of the possible source of contamination. Methods We incubated wine samples in different media and on agar plates. NGS was performed on DNA isolated from young wine, sweet reserve and an outbreak case’s lymph node. A draft genome of the outbreak strain was generated. Vertebrate-specific PCRs using primers targeting the mitochondrial cytochrome b gene and product analyses by blast search were used to identify the putative source of must contamination. Results No bacterial isolate could be obtained. Analysis of the draft genome sequence obtained from the sweet reserve attributed this sequence to Francisella tularensis subsp. holarctica, belonging to the B.12/B.34 phylogenetic clade (erythromycin-resistant biovar II). In addition, the DNA sequence obtained from the case’s isolate supported our hypothesis that infection was caused by drinking contaminated must. The vertebrate-specific cytochrome b sequence derived from the young wine and the sweet reserve could be assigned to Apodemus sylvaticus (wood mouse), suggesting that a wood mouse infected with F. tularensis may have contaminated the must. Conclusion The discovered source of infection and the transmission scenario of F. tularensis in this outbreak have not been observed previously and suggest the need for additional hygienic precautionary measures when processing and consuming freshly pressed must.
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Affiliation(s)
- Daniela Jacob
- These authors contributed equally to this work.,Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Kristin Köppen
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, Berlin, Germany.,These authors contributed equally to this work
| | - Aleksandar Radonić
- Genome Sequencing (MF 2), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Berit Haldemann
- Bioinformatics (MF 1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Philipp Zanger
- Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Hospitals, Heidelberg, Germany.,Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Klaus Heuner
- Cellular Interactions of Bacterial Pathogens, ZBS 2, Robert Koch Institute, Berlin, Germany.,These authors contributed equally to this work
| | - Roland Grunow
- Highly Pathogenic Microorganisms (ZBS 2), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
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6
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Appelt S, Köppen K, Radonić A, Drechsel O, Jacob D, Grunow R, Heuner K. Genetic Diversity and Spatial Segregation of Francisella tularensis Subspecies holarctica in Germany. Front Cell Infect Microbiol 2019; 9:376. [PMID: 31781515 PMCID: PMC6851236 DOI: 10.3389/fcimb.2019.00376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/17/2019] [Indexed: 01/28/2023] Open
Abstract
Francisella tularensis is an intracellular pleomorphic bacterium and the causative agent of tularemia, a zoonotic disease with a wide host range. Among the F. tularensis subspecies, especially F. tularensis subsp. holarctica is of clinical relevance for European countries. The study presented herein focuses namely on genetic diversity and spatial segregation of F. tularensis subsp. holarctica in Germany, as still limited information is available. The investigation is based on the analysis of 34 F. tularensis subsp. holarctica isolates and one draft genome from an outbreak strain. The isolates were cultured from sample material being that of primarily human patients (n = 25) and free-living animals (n = 9). For six of 25 human isolates, epidemiological links between disease onset and tick bites could be established, confirming the importance of arthropod linked transmission of tularemia in Germany. The strains were assigned to three of four major F. tularensis subsp. holarctica clades: B.4, B.6, and B.12. Thereby, B.6 and B.12 clade members were predominantly found; only one human isolate was assigned to clade B.4. Also, it turned out that eight isolates which caused pneumonia in patients clustered into the B.6 clade. Altogether, eight different final subclades were assigned to clade B.6 (biovar I, erythromycin sensitive) and six to B.12 (biovar II, erythromycin resistant) in addition to one new final B.12 subclade. Moreover, for 13 human and 3 animal isolates, final subclade subdivisions were not assigned (B.12 subdivisions B.33 and B.34, and B.6 subdivision B.45) because official nomenclatures are not available yet. This gives credit to the genetic variability of F. tularensis subsp. holarctica strains in Germany. The results clearly point out that the given genetic diversity in Germany seems to be comparably high to that found in other European countries including Scandinavian regions. A spatial segregation of B.6 and B.12 strains was found and statistically confirmed, and B.12 clade members were predominantly found in eastern parts and B.6 members more in western to southern parts of Germany. The portion of B.12 clade members in northeastern parts of Germany was 78.5% and in southwestern parts 1.9%.
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Affiliation(s)
- Sandra Appelt
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Kristin Köppen
- Working Group Cellular Interactions of Bacterial Pathogens, ZBS2, Robert Koch Institute, Berlin, Germany
| | - Aleksandar Radonić
- Methodology and Research Infrastructure Genome Sequencing (MF2), Robert Koch Institute, Berlin, Germany
| | - Oliver Drechsel
- Bioinformatics (MF1), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Centre for Biological Threats and Special Pathogens (ZBS2), Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group Cellular Interactions of Bacterial Pathogens, ZBS2, Robert Koch Institute, Berlin, Germany
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7
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Cross AR, Baldwin VM, Roy S, Essex-Lopresti AE, Prior JL, Harmer NJ. Zoonoses under our noses. Microbes Infect 2019; 21:10-19. [PMID: 29913297 PMCID: PMC6386771 DOI: 10.1016/j.micinf.2018.06.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022]
Abstract
One Health is an effective approach for the management of zoonotic disease in humans, animals and environments. Examples of the management of bacterial zoonoses in Europe and across the globe demonstrate that One Health approaches of international surveillance, information-sharing and appropriate intervention methods are required to successfully prevent and control disease outbreaks in both endemic and non-endemic regions. Additionally, a One Health approach enables effective preparation and response to bioterrorism threats.
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Affiliation(s)
- Alice R Cross
- Living Systems Institute, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD United Kingdom.
| | - Victoria M Baldwin
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ United Kingdom
| | - Sumita Roy
- Living Systems Institute, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD United Kingdom
| | | | - Joann L Prior
- Living Systems Institute, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD United Kingdom; Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ United Kingdom; London School of Hygiene & Tropical Medicine, Kepple Street, London WC1E 7HT United Kingdom
| | - Nicholas J Harmer
- Living Systems Institute, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD United Kingdom
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Abstract
Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.
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Faber M, Heuner K, Jacob D, Grunow R. Tularemia in Germany-A Re-emerging Zoonosis. Front Cell Infect Microbiol 2018; 8:40. [PMID: 29503812 PMCID: PMC5821074 DOI: 10.3389/fcimb.2018.00040] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/31/2018] [Indexed: 11/17/2022] Open
Abstract
Tularemia, also known as “rabbit fever,” is a zoonosis caused by the facultative intracellular, gram-negative bacterium Francisella tularensis. Infection occurs through contact with infected animals (often hares), arthropod vectors (such as ticks or deer flies), inhalation of contaminated dust or through contaminated food and water. In this review, we would like to provide an overview of the current epidemiological situation in Germany using published studies and case reports, an analysis of recent surveillance data and our own experience from the laboratory diagnostics, and investigation of cases. While in Germany tularemia is a rarely reported disease, there is evidence of recent re-emergence. We also describe some peculiarities that were observed in Germany, such as a broad genetic diversity, and a recently discovered new genus of Francisella and protracted or severe clinical courses of infections with the subspecies holarctica. Because tularemia is a zoonosis, we also touch upon the situation in the animal reservoir and one-health aspects of this disease. Apparently, many pieces of the puzzle need to be found and put into place before the complex interaction between wildlife, the environment and humans are fully understood. Funding for investigations into rare diseases is scarce. Therefore, combining efforts in several countries in the framework of international projects may be necessary to advance further our understanding of this serious but also scientifically interesting disease.
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Affiliation(s)
- Mirko Faber
- Gastrointestinal Infections, Zoonoses and Tropical Infections (Division 35), Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Heuner
- Working Group, Cellular Interactions of Bacterial Pathogens, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany.,Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Daniela Jacob
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
| | - Roland Grunow
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Berlin, Germany
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Väyrynen SA, Saarela E, Henry J, Lahti S, Harju T, Kauma H. Pneumonic tularaemia: experience of 58 cases from 2000 to 2012 in Northern Finland. Infect Dis (Lond) 2017; 49:758-764. [PMID: 28618894 DOI: 10.1080/23744235.2017.1341054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Pneumonic tularaemia is less common clinical form of tularaemia compared with the ulceroglandular form, with only a limited number of case reports and case series in Europe. In Finland, Northern Ostrobothnia is an endemic area of tularaemia with occasional seasonal outbreaks. METHODS In our study, a consecutive series of 58 pneumonic tularaemia cases diagnosed and treated in Oulu University Hospital in 2000-2012 were retrospectively analysed in terms of epidemiology, clinical course, and prognosis. RESULTS The incidence of pneumonic tularaemia showed peaks in cycles of a few years and most cases were diagnosed in late summer or early autumn. Respiratory symptoms were absent in 47% of patients, and 7% had normal chest X-ray. The chest computed tomography (CT) was performed in 81% of patients, demonstrating variable findings associated with pneumonic tularaemia. Bronchoscopy was performed for 22 (38%) patients and four (18%) of these also proceeded into mediastinoscopy. Moreover, thoracoscopy was performed for one (2%) patient. Two (3%) patients were treated shortly in the intensive care unit (ICU) during their stay in hospital. No mortality was observed. CONCLUSIONS Most cases of pneumonic tularaemia are diagnosed during the seasonal outbreaks. The lack of specific symptoms often complicates the diagnosis and leads to unnecessarily invasive examinations.
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Affiliation(s)
- Sara A Väyrynen
- a Department of Internal Medicine, Division of Infectious Diseases , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Elina Saarela
- a Department of Internal Medicine, Division of Infectious Diseases , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Janne Henry
- b Lammi Health Centre , Hämeenlinna , Finland
| | - Sini Lahti
- c Nordlab Oulu , Oulu University Hospital , Oulu , Finland
| | - Terttu Harju
- d Respiratory Research Unit of Internal Medicine, Medical Research Centre Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Heikki Kauma
- a Department of Internal Medicine, Division of Infectious Diseases , Oulu University Hospital and University of Oulu , Oulu , Finland
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De Keukeleire M, Vanwambeke SO, Cochez C, Heyman P, Fretin D, Deneys V, Luyasu V, Kabamba B, Robert A. Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples. Vector Borne Zoonotic Dis 2016; 17:108-115. [PMID: 27828762 DOI: 10.1089/vbz.2016.1954] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To estimate the seroprevalence of Borrelia burgdorferi (Bb), Anaplasma phagocytophilum (Ap), and Francisella tularensis (Ft) in Belgium, we tested sera from three population-based samples in which exposure to pathogen is assumed to vary: 148 samples from workers professionally exposed, 209 samples from rural blood donors, and 193 samples from urban blood donors. Sera were tested using ELISA or the immunofluorescence assay test. The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors, which is similar to other studies. The fraction of negative results decreases significantly from urban blood donors and rural blood donors to workers. Regarding the seroprevalence of Ap, the cutoff titer of 1:64 recommended by the manufacturer may be set too low and produces artificially high seroprevalence rates. Using a cutoff titer of 1:128, the seroprevalence of Ap was estimated at 8.1% for workers professionally exposed, 6.2% for rural blood donors, and 5.7% for urban blood donors. Tularemia sera confirmed the presence of the pathogen in Belgium at 2.0% for workers and 0.5% for rural and urban blood donors. Our study is one of the few providing an estimation of the seroprevalences of Bb, Ap, and Ft in three different populations in Belgium, filling the gap in seroprevalence data among those groups. Our findings provide evidence that the entire Belgian population is exposed to Bb, Ap, and Ft infections, but a higher exposure is noticed for professionals at risk. Education on the risk factors for tick bites and preventive measures for both professionals exposed and the general population is needed.
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Affiliation(s)
- Mathilde De Keukeleire
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium .,2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Sophie O Vanwambeke
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Christel Cochez
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - Paul Heyman
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - David Fretin
- 4 Veterinary and Agrochemical Research Center (CERVA) , Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Brussels, Belgium
| | - Véronique Deneys
- 5 Blood Transfusion Service of Mont-Godinne and CHU UCL Namur, Yvoir, Belgium
| | - Victor Luyasu
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Benoît Kabamba
- 6 Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL) , Brussels, Belgium
| | - Annie Robert
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
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12
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SCHULZE C, HEUNER K, MYRTENNÄS K, KARLSSON E, JACOB D, KUTZER P, GROßE K, FORSMAN M, GRUNOW R. High and novel genetic diversity of Francisella tularensis in Germany and indication of environmental persistence. Epidemiol Infect 2016; 144:3025-3036. [PMID: 27356883 PMCID: PMC9150394 DOI: 10.1017/s0950268816001175] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/11/2016] [Accepted: 05/22/2016] [Indexed: 11/06/2022] Open
Abstract
In Germany tularemia is a re-emerging zoonotic disease. Therefore, we investigated wild animals and environmental water samples for the presence and phylogenetic diversity of Francisella tularensis in the poorly studied Berlin/Brandenburg region. The phylogenomic analysis of three isolates from wild animals revealed three new subclades within the phylogenetic tree of F. tularensis [B.71 from a raccoon dog (Nyctereutes procyonoides); B.74 from a red fox (Vulpes vulpes), and B.75 from a Eurasian beaver (Castor fiber albicus)]. The results from histological, PCR, and genomic investigations on the dead beaver showed that the animal suffered from a systemic infection. Indications were found that the bacteria were released from the beaver carcass into the surrounding environment. We demonstrated unexpectedly high and novel phylogenetic diversity of F. tularensis in Germany and the fact that the bacteria persist in the environment for at least one climatic season. These findings support a broader host species diversity than previously known regarding Germany. Our data further support the assumption derived from previous serological studies of an underestimated frequency of occurrence of the pathogen in the environment and in wild animals. F. tularensis was isolated from animal species not previously reported as natural hosts in Germany.
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Affiliation(s)
- C. SCHULZE
- Landeslabor Berlin-Brandenburg, Frankfurt (Oder), Germany
| | - K. HEUNER
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Highly Pathogenic Microorganisms, Berlin, Germany
| | - K. MYRTENNÄS
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), Umeå, Sweden
| | - E. KARLSSON
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), Umeå, Sweden
| | - D. JACOB
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Highly Pathogenic Microorganisms, Berlin, Germany
| | - P. KUTZER
- Landeslabor Berlin-Brandenburg, Frankfurt (Oder), Germany
| | - K. GROßE
- Stadt Brandenburg an der Havel, Veterinär- und Lebensmittelüberwachungsamt, Germany
| | - M. FORSMAN
- CBRN Defence and Security, Swedish Defence Research Agency (FOI), Umeå, Sweden
| | - R. GRUNOW
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Highly Pathogenic Microorganisms, Berlin, Germany
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13
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Maurin M, Gyuranecz M. Tularaemia: clinical aspects in Europe. THE LANCET. INFECTIOUS DISEASES 2016; 16:113-124. [PMID: 26738841 DOI: 10.1016/s1473-3099(15)00355-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
Abstract
Tularaemia is a zoonotic disease caused by Francisella tularensis, a Gram-negative, facultative intracellular bacterium. Typically, human and animal infections are caused by F tularensis subspecies tularensis (type A) strains mainly in Canada and USA, and F tularensis subspecies holarctica (type B) strains throughout the northern hemisphere, including Europe. In the past, the epidemiological, clinical, therapeutic, and prognostic aspects of tularaemia reported in the English medical literature were mainly those that had been reported in the USA, where the disease was first described. Tularaemia has markedly changed in the past decade, and a large number of studies have provided novel data for the disease characteristics in Europe. In this Review we aim to emphasise the specific and variable aspects of tularaemia in different European countries. In particular, two natural lifecycles of F tularensis have been described in this continent, although not fully characterised, which are associated with different modes of transmission, clinical features, and public health burdens of tularaemia.
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Affiliation(s)
- Max Maurin
- Centre National de Référence des Francisella, Département des Agents Infectieux, Institut de Biologie et Pathologie, CHU de Grenoble, Grenoble, cedex 9, France; Université Grenoble Alpes and Centre National de la Recherche Scientifique, Laboratoire Adaptation et Pathogénie des Microorganismes, IMR 5163, Grenoble, France.
| | - Miklós Gyuranecz
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Budapest, Hungary; OIE Reference Laboratory for Tularemia, Budapest, Country
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14
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Bloch-Infanger C, Furrer K, Wiese M, Hiebinger A, Bucher CM, Kopp S, Hinić V, Goldenberger D. An unexpected cause for cavitary pneumonia and empyema. Infection 2015; 44:539-41. [PMID: 26621335 DOI: 10.1007/s15010-015-0861-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/14/2015] [Indexed: 12/27/2022]
Abstract
Tularemia is an emerging zoonotic disease mainly of the Northern Hemisphere caused by the Gram-negative coccobacillus Francisella tularensis. It is affecting a wide range of animals and causes human disease after insect and tick bites, skin contact, ingestion and inhalation. A 66-year-old man presented to our clinic with cavitary pneumonia and distinct pleural effusion. After failure of empiric antibiotic therapy, thoracoscopic assisted decortication and partial excision of the middle lobe were conducted. Conventional culture methods and broad-range bacterial PCR including RipSeqMixed analysis were performed from the excised biopsies. Culture results remained negative but broad-range PCR targeting the first half of the 16S rRNA gene revealed F. tularensis DNA. This result was confirmed by F. tularensis-specific PCR and by serology. The source of infection could not be explored. To conclude, we report the rare clinical picture of a community-acquired pneumonia followed by pleural effusion and empyema due to F. tularensis. Broad range bacterial PCR proved to be a powerful diagnostic tool to detect the etiologic organism.
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Affiliation(s)
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Mark Wiese
- Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Andreas Hiebinger
- Department of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Sébastien Kopp
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Vladimira Hinić
- Department of Clincal Microbiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Daniel Goldenberger
- Department of Clincal Microbiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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15
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Jurke A, Bannert N, Brehm K, Fingerle V, Kempf VAJ, Kömpf D, Lunemann M, Mayer-Scholl A, Niedrig M, Nöckler K, Scholz H, Splettstoesser W, Tappe D, Fischer SF. Serological survey of Bartonella spp., Borrelia burgdorferi, Brucella spp., Coxiella burnetii, Francisella tularensis, Leptospira spp., Echinococcus, Hanta-, TBE- and XMR-virus infection in employees of two forestry enterprises in North Rhine-Westphalia, Germany, 2011-2013. Int J Med Microbiol 2015; 305:652-62. [PMID: 26422407 DOI: 10.1016/j.ijmm.2015.08.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We initiated a survey to collect basic data on the frequency and regional distribution of various zoonoses in 722 employees of forestry enterprises in the German state of North Rhine-Westphalia (NRW) from 2011 to 2013. Exposures associated with seropositivity were identified to give insight into the possible risk factors for infection with each pathogen. 41.2% of participants were found to be seropositive for anti-Bartonella IgG, 30.6% for anti-Borrelia burgdorferi IgG, 14.2% for anti-Leptospira IgG, 6.5% for anti-Coxiella burnetii IgG, 6.0% for anti-Hantavirus IgG, 4.0% for anti-Francisella tularensis IgG, 3.4% for anti-TBE-virus IgG, 1.7% for anti-Echinococcus IgG, 0.0% for anti-Brucella IgG and anti-XMRV IgG. Participants seropositive for B. burgdorferi were 3.96 times more likely to be professional forestry workers (univariable analysis: OR 3.96; 95% CI 2.60-6.04; p<0.001); and participants seropositive for Hantavirus 3.72 times more likely (univariable analysis: OR 3.72; 95% CI 1.44-9.57; p=0.007). This study found a surprisingly high percentage of participants seropositive for anti-B. henselae IgG and for anti-F. tularensis IgG. The relatively high seroprevalence for anti-Leptospira IgG seen in this study could be related to living conditions rather than to exposure at work. No specific risk for exposure to C. burnetii and Echinococcus was identified, indicating that neither forestry workers nor office workers represent a risk population and that NRW is not a typical endemic area. Forestry workers appear to have higher risk for contact with B. burgdorferi-infected ticks and a regionally diverse risk for acquiring Hantavirus-infection. The regional epidemiology of zoonoses is without question of great importance for public health. Knowledge of the regional risk factors facilitates the development of efficient prevention strategies and the implementation of such prevention measures in a sustainable manner.
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Affiliation(s)
- Annette Jurke
- Department of Infectiology and Hygiene, NRW Centre for Health, Münster, Germany
| | - N Bannert
- Consultant Laboratory for Diagnostic Electron Microscopy of Infectious Pathogens, Robert Koch-Institute, Berlin, Germany
| | - K Brehm
- Consultant Laboratory for Echinococcus, Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - V Fingerle
- National Reference Centre for Borrelia, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim, Germany
| | - V A J Kempf
- Consultant Laboratory for Bartonella, Institute for Medical Microbiology and Infection Control, University Hospital of Goethe, University Frankfurt am Main, Frankfurt, Germany
| | - D Kömpf
- Consultant Laboratory for Coxiella, Baden-Württemberg State Health Office, Stuttgart, Germany
| | - M Lunemann
- Department of Infectiology and Hygiene, NRW Centre for Health, Münster, Germany
| | - A Mayer-Scholl
- Consultant Laboratory for Leptospira, Federal Institute for Risk Assessment, Berlin, Germany
| | - M Niedrig
- Consultant Laboratory for Tick-borne Encephalitis, Robert Koch-Institute, Berlin, Germany
| | - K Nöckler
- Consultant Laboratory for Leptospira, Federal Institute for Risk Assessment, Berlin, Germany
| | - H Scholz
- Consultant Laboratory for Brucella, Bacteriology and Toxicology, Bundeswehr Institute of Microbiology, München, Germany
| | - W Splettstoesser
- Consultant Laboratory for Francisella, Bundeswehr Institute of Microbiology, München, Germany
| | - D Tappe
- Consultant Laboratory for Echinococcus, Institute of Hygiene and Microbiology University of Würzburg, Würzburg, Germany
| | - Silke F Fischer
- Consultant Laboratory for Coxiella, Baden-Württemberg State Health Office, Stuttgart, Germany.
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16
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Rossow H, Ollgren J, Hytonen J, Rissanen H, Huitu O, Henttonen H, Kuusi M, Vapalahti O. Incidence and seroprevalence of tularaemia in Finland, 1995 to 2013: regional epidemics with cyclic pattern. ACTA ACUST UNITED AC 2015; 20:21209. [PMID: 26314404 DOI: 10.2807/1560-7917.es2015.20.33.21209] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied the incidence of reported tularaemia by year and region and the prevalence of antibodies against Francisella tularensis in the adult general population in Finland. Moreover, we assessed the correlation between vole population cycles and human tularaemia outbreaks. The seroprevalence study made use of serum samples from a nationwide population-based health survey (Health 2000). The samples of 1,045 randomly selected persons, representative for the Finnish population in each region, were screened with an enzyme-linked immunosorbent assay (ELISA) for the presence of IgG antibodies against F. tularensis, and positive results were further confirmed by immunoblotting. A serological response to F. tularensis was found in 2% (95% confidence interval: 1.1–3.5) of the population. Incidence and seroprevalence were highest in the same areas, and vole population peaks clearly preceded tularaemia outbreaks one year later.
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Affiliation(s)
- H Rossow
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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17
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Boone I, Hassler D, Nguyen T, Splettstoesser W, Wagner-Wiening C, Pfaff G. Tularaemia in southwest Germany: Three cases of tick-borne transmission. Ticks Tick Borne Dis 2015; 6:611-4. [DOI: 10.1016/j.ttbdis.2015.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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18
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Mölsä M, Hemmilä H, Katz A, Niemimaa J, Forbes KM, Huitu O, Stuart P, Henttonen H, Nikkari S. Monitoring biothreat agents (Francisella tularensis, Bacillus anthracis and Yersinia pestis) with a portable real-time PCR instrument. J Microbiol Methods 2015; 115:89-93. [PMID: 26043838 DOI: 10.1016/j.mimet.2015.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/17/2022]
Abstract
In the event of suspected releases or natural outbreaks of contagious pathogens, rapid identification of the infectious agent is essential for appropriate medical intervention and disease containment. The purpose of this study was to compare the performance of a novel portable real-time PCR thermocycler, PikoReal™, to the standard real-time PCR thermocycler, Applied Biosystems® 7300 (ABI 7300), for the detection of three high-risk biothreat bacterial pathogens: Francisella tularensis, Bacillus anthracis and Yersinia pestis. In addition, a novel confirmatory real-time PCR assay for the detection of F. tularensis is presented and validated. The results show that sensitivity of the assays, based on a dilution series, for the three infectious agents ranged from 1 to 100 fg of target DNA with both instruments. No cross-reactivity was revealed in specificity testing. Duration of the assays with the PikoReal and ABI 7300 systems were 50 and 100 min, respectively. In field testing for F. tularensis, results were obtained with the PikoReal system in 95 min, as the pre-PCR preparation, including DNA extraction, required an additional 45 min. We conclude that the PikoReal system enables highly sensitive and rapid on-site detection of biothreat agents under field conditions, and may be a more efficient alternative to conventional diagnostic methods.
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Affiliation(s)
- Markos Mölsä
- Centres for Military Medicine and for Biological Threat Preparedness, Helsinki, Finland.
| | - Heidi Hemmilä
- Centres for Military Medicine and for Biological Threat Preparedness, Helsinki, Finland.
| | - Anna Katz
- Centres for Military Medicine and for Biological Threat Preparedness, Helsinki, Finland.
| | | | | | - Otso Huitu
- Natural Resources Institute Finland, Suonenjoki, Finland.
| | - Peter Stuart
- Natural Resources Institute Finland, Suonenjoki, Finland.
| | | | - Simo Nikkari
- Centres for Military Medicine and for Biological Threat Preparedness, Helsinki, Finland.
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19
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Strehl J, Schoerner C, Hartmann A, Agaimy A. [Tularemia lymphadenitis. An emerging differential diagnosis of necrotizing granulomatous cervical lymphadenitis]. DER PATHOLOGE 2014; 35:166-72. [PMID: 24619527 DOI: 10.1007/s00292-013-1851-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tularemia is emerging as an important differential diagnosis of necrotizing granulomatous lymphadenitis, particularly in the head and neck region. The causal organism, Francisella tularensis is a Gram-negative coccoid bacterium. Tularemia usually presents with necrotizing granulomatous purulent lymphadenitis featuring multiple mostly small granulomas with geographic necrosis bordered by palisades of histiocytes. Diagnosis is mainly based on these characteristic but non-pathognomonic histological features in conjunction with negative tests for mycobacterial infections and serological confirmation of tularemia-specific antibodies or detection by polymerase chain reaction (PCR). This article describes our experiences with five patients with tularemia lymphadenitis and gives an overview of the diverse histopathological features and the differential diagnosis of this uncommon but possibly underrecognized disease.
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Affiliation(s)
- J Strehl
- Institut für Pathologie, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland,
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20
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Rossow H, Forbes KM, Tarkka E, Kinnunen PM, Hemmilä H, Huitu O, Nikkari S, Henttonen H, Kipar A, Vapalahti O. Experimental Infection of voles with Francisella tularensis indicates their amplification role in tularemia outbreaks. PLoS One 2014; 9:e108864. [PMID: 25271640 PMCID: PMC4182746 DOI: 10.1371/journal.pone.0108864] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/26/2014] [Indexed: 11/21/2022] Open
Abstract
Tularemia outbreaks in humans have been linked to fluctuations in rodent population density, but the mode of bacterial maintenance in nature is unclear. Here we report on an experiment to investigate the pathogenesis of Francisella tularensis infection in wild rodents, and thereby assess their potential to spread the bacterium. We infected 20 field voles (Microtus agrestis) and 12 bank voles (Myodes glareolus) with a strain of F. tularensis ssp. holarctica isolated from a human patient. Upon euthanasia or death, voles were necropsied and specimens collected for histological assessment and identification of bacteria by immunohistology and PCR. Bacterial excretion and a rapid lethal clinical course with pathological changes consistent with bacteremia and tissue necrosis were observed in infected animals. The results support a role for voles as an amplification host of F. tularensis, as excreta and, in particular, carcasses with high bacterial burden could serve as a source for environmental contamination.
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Affiliation(s)
- Heidi Rossow
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Kristian M. Forbes
- Department of Biological and Environmental Science, University of Jyväskylä, Jyväskylä, Finland
- Finnish Forest Research Institute, Vantaa, Finland
| | - Eveliina Tarkka
- Division of Clinical Microbiology, Helsinki University Hospital Laboratory (HUSLAB), Helsinki, Finland
| | - Paula M. Kinnunen
- Centre for Biothreat Preparedness, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Heidi Hemmilä
- Centre for Biothreat Preparedness, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Otso Huitu
- Finnish Forest Research Institute, Vantaa, Finland
| | - Simo Nikkari
- Centre for Biothreat Preparedness, Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | | | - Anja Kipar
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Finnish Centre for Laboratory Animal Pathology, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- School of Veterinary Science and Department of Infection Biology, Institute of Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Olli Vapalahti
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Division of Clinical Microbiology, Helsinki University Hospital Laboratory (HUSLAB), Helsinki, Finland
- Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland
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21
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Abstract
The bacterium Francisella tularensis causes the vector-borne zoonotic disease tularemia, and may infect a wide range of hosts including invertebrates, mammals and birds. Transmission to humans occurs through contact with infected animals or contaminated environments, or through arthropod vectors. Tularemia has a broad geographical distribution, and there is evidence which suggests local emergence or re-emergence of this disease in Europe. This review was developed to provide an update on the geographical distribution of F. tularensis in humans, wildlife, domestic animals and vector species, to identify potential public health hazards, and to characterize the epidemiology of tularemia in Europe. Information was collated on cases in humans, domestic animals and wildlife, and on reports of detection of the bacterium in arthropod vectors, from 38 European countries for the period 1992-2012. Multiple international databases on human and animal health were consulted, as well as published reports in the literature. Tularemia is a disease of complex epidemiology that is challenging to understand and therefore to control. Many aspects of this disease remain poorly understood. Better understanding is needed of the epidemiological role of animal hosts, potential vectors, mechanisms of maintenance in the different ecosystems, and routes of transmission of the disease.
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22
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Rossow H, Sissonen S, Koskela KA, Kinnunen PM, Hemmilä H, Niemimaa J, Huitu O, Kuusi M, Vapalahti O, Henttonen H, Nikkari S. Detection of Francisella tularensis in voles in Finland. Vector Borne Zoonotic Dis 2014; 14:193-8. [PMID: 24575824 DOI: 10.1089/vbz.2012.1255] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Francisella tularensis is a highly virulent intracellular bacterium causing the zoonotic disease tularemia. It recurrently causes human and animal outbreaks in northern Europe, including Finland. Although F. tularensis infects several mammal species, only rodents and lagomorphs seem to have importance in its ecology. Peak densities of rodent populations may trigger tularemia outbreaks in humans; however, it is still unclear to which extent rodents or other small mammals maintain F. tularensis in nature. The main objective of this study was to obtain information about the occurrence of F. tularensis in small mammals in Finland. We snap-trapped 547 wild small mammals representing 11 species at 14 locations around Finland during 6 years and screened them for the presence of F. tularensis DNA using PCR analysis. High copy number of F. tularensis-specific DNA was detected in tissue samples of five field voles (Microtus agrestis) originating from one location and 2 years. According to DNA sequences of the bacterial 23S ribosomal RNA gene amplified from F. tularensis-infected voles, the infecting agent belongs to the subspecies holarctica. To find out the optimal tissue for tularemia screening in voles, we compared the amounts of F. tularensis DNA in lungs, liver, spleen, and kidney of the infected animals. F. tularensis DNA was detectable in high levels in all four organs except for one animal, whose kidney was F. tularensis DNA-negative. Thus, at least liver, lung, and spleen seem suitable for F. tularensis screening in voles. Thus, liver, lung, and spleen all seem suitable for F. tularensis screening in voles. In conclusion, field voles can be heavily infected with F. tularensis subsp. holarctica and thus potentially serve as the source of infection in humans and other mammals.
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Affiliation(s)
- Heidi Rossow
- 1 Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki , Helsinki, Finland
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23
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Tobudic S, Nedomansky K, Poeppl W, Müller M, Faas A, Mooseder G, Allerberger F, Stanek G, Burgmann H. Seroprevalence for Coxiella burnetii, Francisella tularensis, Brucella abortus and Brucella melitensis in Austrian adults: a cross-sectional survey among military personnel and civilians. Ticks Tick Borne Dis 2014; 5:315-7. [PMID: 24572607 DOI: 10.1016/j.ttbdis.2013.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/15/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
The prevalence of Coxiella burnetii, Francisella tularensis, Brucella abortus, and Brucella melitensis infections in Austria and the exposure risk of military personnel were assessed in an exploratory nationwide cross-sectional seroprevalence survey in 526 healthy adult individuals, 222 of which were soldiers and 304 were civilians. Screening for IgA/IgG antibodies to C. burnetii (Phase I) and IgG/IgM antibodies to C. burnetii (Phase II), and to F. tularensis was done with commercial enzyme-linked immunosorbent assays. To detect antibodies against B. abortus and B. melitensis, an in-house complement fixation test was used. Overall, 11 individuals (2.0%) showed antibodies to C. burnetii, 3 individuals (0.5%) were seropositive for F. tularensis, and one (0.3%) individual was borderline positive. All individuals positive or borderline for F. tularensis tested negative for antibodies against C. burnetii. All individuals tested negative for antibodies against B. melitensis/B. abortus. There were no significant differences between the seroprevalence of C. burnetii and F. tularensis among military personnel and civilians. Our data demonstrate serological evidence of a low rate of exposure to C. burnetii and F. tularensis among the Austrian adult population and military personnel.
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Affiliation(s)
- Selma Tobudic
- Department of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Klara Nedomansky
- Fachhochschule Campus Wien, University of Applied Sciences, Vienna, Austria
| | - Wolfgang Poeppl
- Department of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria; Department of Dermatology and Tropical Medicine, Military Hospital Vienna, Vienna, Austria
| | - Maria Müller
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Angelus Faas
- Institute for Medical Support, Military Hospital Vienna, Vienna, Austria
| | - Gerhard Mooseder
- Department of Dermatology and Tropical Medicine, Military Hospital Vienna, Vienna, Austria
| | | | - Gerold Stanek
- Institute for Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Department of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
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Otto P, Chaignat V, Klimpel D, Diller R, Melzer F, Müller W, Tomaso H. Serological investigation of wild boars (Sus scrofa) and red foxes (Vulpes vulpes) as indicator animals for circulation of Francisella tularensis in Germany. Vector Borne Zoonotic Dis 2013; 14:46-51. [PMID: 24359418 DOI: 10.1089/vbz.2013.1321] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tularemia outbreaks in humans have recently been reported in many European countries, but data on the occurrence in the animal population are scarce. In North America, seroconversion of omnivores and carnivores was used as indicator for the presence of tularemia, for the European fauna, however, data are barely available. Therefore, the suitability of wild boars (Sus scrofa) and red foxes (Vulpes vulpes) as indicators for the circulation of F. tularensis in Germany was evaluated. Serum samples from 566 wild boars and 457 red foxes were collected between 1995 and 2012 in three federal states in Central Germany (Hesse, Saxony-Anhalt, and Thuringia). The overall rate of seropositive animals was 1.1% in wild boars and 7.4% in red foxes. In conclusion, serological examination of red foxes is recommended, because they can be reliably used as indicator animals for the presence of F. tularensis in the environment.
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Affiliation(s)
- Peter Otto
- Institute of Bacterial Infections and Zoonoses (IBIZ), Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health , Jena, Germany
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Rijks JM, Kik M, Koene MG, Engelsma MY, van Tulden P, Montizaan MG, Oomen T, Spierenburg MA, Ijzer J, van der Giessen JW, Gröne A, Roest HJ. Tularaemia in a brown hare (Lepus europaeus) in 2013: first case in the Netherlands in 60 years. ACTA ACUST UNITED AC 2013; 18. [PMID: 24330941 DOI: 10.2807/1560-7917.es2013.18.49.20655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tularaemia has not been reported in Dutch wildlife since 1953. To enhance detection, as of July 2011, brown hares (Lepus europaeus) submitted for postmortem examination in the context of non-targeted wildlife disease surveillance, were routinely tested for tularaemia by polymerase chain reaction (PCR). Francisella tularensis subspecies holarctica infection was confirmed in a hare submitted in May 2013. The case occurred in Limburg, near the site of the 1953 case. Further surveillance should clarify the significance of this finding.
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Affiliation(s)
- J M Rijks
- Dutch Wildlife Health Centre, Utrecht University, Utrecht, the Netherlands
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Risk factors for pneumonic and ulceroglandular tularaemia in Finland: a population-based case-control study. Epidemiol Infect 2013; 142:2207-16. [PMID: 24289963 DOI: 10.1017/s0950268813002999] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Few population-based data are available on factors associated with pneumonic and ulceroglandular type B tularaemia. We conducted a case-control study during a large epidemic in 2000. Laboratory-confirmed case patients were identified through active surveillance and matched control subjects (age, sex, residency) from the national population information system. Data were collected using a self-administered questionnaire. A conditional logistic regression model addressing missing data with Bayesian full-likelihood modelling included 227 case patients and 415 control subjects; reported mosquito bites [adjusted odds ratio (aOR) 9·2, 95% confidence interval (CI) 4·4-22, population-attributable risk (PAR) 82%] and farming activities (aOR 4·3, 95% CI 2·5-7·2, PAR 32%) were independently associated with ulceroglandular tularaemia, whereas exposure to hay dust (aOR 6·6, 95% CI 1·9-25·4, PAR 48%) was associated with pneumonic tularaemia. Although the bulk of tularaemia type B disease burden is attributable to mosquito bites, risk factors for ulceroglandular and pneumonic forms of tularaemia are different, enabling targeting of prevention efforts accordingly.
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Sutor A, Schwarz S, Conraths FJ. The biological potential of the raccoon dog ( Nyctereutes procyonoides, Gray 1834) as an invasive species in Europe-new risks for disease spread? ACTA THERIOLOGICA 2013; 59:49-59. [PMID: 32226062 PMCID: PMC7097217 DOI: 10.1007/s13364-013-0138-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/21/2013] [Indexed: 12/28/2022]
Abstract
Invasive wildlife species have the potential to act as additional host and vector species for infectious diseases. The raccoon dog (Nyctereutes procyonides), a carnivore species that has its origin in Asia, was taken as an example to demonstrate biological and ecological prerequisites which enables an invasive species to occupy a new habitat permanently. Studies conducted during the last 20 years identified a total of 35 species of endoparasites, five ectoparasites, six bacterial or protozoan species, and five viruses found in the subspecies Nyctereutes procyonoides ussuriensis in its original and newly occupied habitat or in Nyctereutes procyonoides koreensis in its original habitat, respectively. With reference to raccoon dogs impact as vector species and the relevance for human and animal health, we selected Trichinella spp., Echinococcus multilocularis, Francisella tularensis, rabies virus, and canine distemper virus for detailed description. Results of studies from Finland and Germany furthermore showed that biological characteristics of the raccoon dog make this carnivore an ideal host and vector for a variety of pathogens. This may result in a growing importance of this invasive species concerning the epidemiology of some transmissible diseases in Europe, including the hazard that the existence of autochthonous wildlife, particularly small populations, is endangered. Potential adverse effects on human and animal health in the livestock sector must also be taken into account. Especially with regard to its potential as a reservoir for zoonotic diseases, the raccoon dog should receive more attention in disease prevention and eradication strategies.
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Affiliation(s)
- Astrid Sutor
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Seestr. 55, 16868 Wusterhausen, Germany
| | - Sabine Schwarz
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Seestr. 55, 16868 Wusterhausen, Germany
| | - Franz Josef Conraths
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Seestr. 55, 16868 Wusterhausen, Germany
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Gehringer H, Schacht E, Maylaender N, Zeman E, Kaysser P, Oehme R, Pluta S, Splettstoesser WD. Presence of an emerging subclone of Francisella tularensis holarctica in Ixodes ricinus ticks from south-western Germany. Ticks Tick Borne Dis 2012; 4:93-100. [PMID: 23141103 DOI: 10.1016/j.ttbdis.2012.09.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 11/25/2022]
Abstract
The zoonotic disease tularaemia is caused by the bacterial pathogen Francisella tularensis. Although the causative agent is known for 100 years, knowledge of its enzootic cycles is still rudimentary. Apart from tabanids and mosquitoes, hard ticks have been described as important vectors and potential reservoirs for F. tularensis. Available data on the incidence of human tularaemia indicate an increase in cases in the federal state of Baden-Wuerttemberg. To determine whether ticks are involved in the reported increase in F. tularensis infections in humans and wildlife in this south-western part of Germany, 916 Ixodes ricinus and 211 adult Dermacentor marginatus and D. reticulatus ticks were collected in two different locations. Screening for the presence of F. tularensis was performed by real-time PCR of the 16S rRNA gene. Of the 95 pools of I. ricinus ticks (representing 916 individual ticks), 8 tick pools (8.4%) were positive in this PCR. 30-bp deletion PCR confirmed that the F. tularensis subspecies holarctica was present. FtM24 VNTR analysis revealed that they belong to the emerging Franco-Iberian subclone group of F. tularensis holarctica. Of the 211 ticks of the genus Dermacentor, 35 randomly chosen DNAs were subjected to 16S rRNA gene screening PCR; 20 of these (57%) gave positive signals. For cluster analysis, the lpnA gene region of all Francisella-positive I. ricinus pools and 6 Dermacentor ticks with a positive reaction in the screening PCR was amplified and sequenced. In the resulting neighbour-joining tree, all Francisella-positive I. ricinus samples clustered with sequences of F. tularensis, whilst all Dermacentor tick samples clustered with FLE (Francisella-like endosymbiont) sequences. This study shows that I. ricinus ticks may serve as vectors and/or reservoirs of F. tularensis in Germany and supports the hypothesis that the state of Baden-Wuerttemberg represents an emerging endemic focus of tularaemia.
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Clark DV, Ismailov A, Seyidova E, Hajiyeva A, Bakhishova S, Hajiyev H, Nuriyev T, Piraliyev S, Bagirov S, Aslanova A, Debes AK, Qasimov M, Hepburn MJ. Seroprevalence of Tularemia in Rural Azerbaijan. Vector Borne Zoonotic Dis 2012; 12:558-63. [DOI: 10.1089/vbz.2010.0081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Tahir Nuriyev
- Center for Hygiene and Epidemiology, Quba, Qusar, and Xachmaz, Azerbaijan
| | - Saleh Piraliyev
- Center for Hygiene and Epidemiology, Quba, Qusar, and Xachmaz, Azerbaijan
| | - Sadigulla Bagirov
- Center for Hygiene and Epidemiology, Quba, Qusar, and Xachmaz, Azerbaijan
| | - Afag Aslanova
- Raytheon Technical Services Company, Baku, Azerbaijan
| | - Amanda K. Debes
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
| | | | - Matthew J. Hepburn
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland
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Bulut OC, Dyckhoff G, Splettstoesser W, Nemeth J, Klauschen F, Penzel R, Plinkert PK, Simon C, Weichert W, Stenzinger A. Unmasked: when a clinically malignant disease turns out infectious. A rare case of tularemia. Int J Surg Pathol 2012; 21:76-81. [PMID: 22674915 DOI: 10.1177/1066896912448424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports on a 62-year-old man, who presented with cervical mass and rather nonspecific symptoms. The medical history and clinical workup initially favored a malignant disease such as a carcinoma of unknown primary as the underlying cause. Eventually, the patient was diagnosed with a granulomatous lymphadenitis caused by Francisella tularensis subsp holarctica. Tularemia is a rare disease in Western Europe and can present in multiple ways encompassing almost asymptomatic infections and fatal disease. A rapid diagnosis is often hampered by nonspecific symptoms and the generally low prevalence and incidence of this disease in endemic countries. This case report also provides a comprehensive review of the literature on cervical tularemia and discusses the differential diagnoses.
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Maurin M, Pelloux I, Brion JP, Del Bano JN, Picard A. Human Tularemia in France, 2006-2010. Clin Infect Dis 2011; 53:e133-41. [DOI: 10.1093/cid/cir612] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lundström JO, Andersson AC, Bäckman S, Schäfer ML, Forsman M, Thelaus J. Transstadial transmission of Francisella tularensis holarctica in mosquitoes, Sweden. Emerg Infect Dis 2011; 17:794-9. [PMID: 21529386 PMCID: PMC3321753 DOI: 10.3201/eid1705.100426] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Sweden, human cases of tularemia caused by Francisella tularensisholarctica are assumed to be transmitted by mosquitoes, but how mosquito vectors acquire and transmit the bacterium is not clear. To determine how transmission of this bacterium occurs, mosquito larvae were collected in an area where tularemia is endemic, brought to the laboratory, and reared to adults in their original pond water. Screening of adult mosquitoes by real-time PCR demonstrated F. tularensislpnA sequences in 14 of the 48 mosquito pools tested; lpnA sequences were demonstrated in 6 of 9 identified mosquito species. Further analysis confirmed the presence of F. tularensisholarctica–specific 30-bp deletion region sequences (FtM19inDel) in water from breeding containers and in 3 mosquito species (Aedes sticticus, Ae. vexans, and Ae. punctor) known to take blood from humans. Our results suggest that the mosquitoes that transmit F. tularensisholarctica during tularemia outbreaks acquire the bacterium already as larvae.
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Affiliation(s)
- Jan O Lundström
- Department of Ecology and Genetics, Evolutionary Biology Centre, Uppsala University, Uppsala, Sweden.
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Prevalence of Francisella tularensis in brown hare (Lepus europaeus) populations in Lower Saxony, Germany. EUR J WILDLIFE RES 2011. [DOI: 10.1007/s10344-011-0522-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fritzsch J, Splettstoesser WD. Septic pneumonic tularaemia caused by Francisella tularensis subsp. holarctica biovar II. J Med Microbiol 2010; 59:1123-1125. [PMID: 20522628 DOI: 10.1099/jmm.0.019893-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This case of pneumonic tularaemia elucidates two aspects: it is believed to be the first documented case of bacteraemia caused by Francisella tularensis subsp. holarctica biovar II; furthermore, it illustrates the remission of septic pneumonic tularaemia without appropriate anti-infective therapy. A blood culture from a patient with community-acquired pneumonia was found to be positive for F. tularensis subsp. holarctica biovar II after 10 days of cultivation. Meanwhile, the patient had been treated with ceftriaxone, followed by sultamicillin and clindamycin. The patient continued suffering from fever of up to 40.7 degrees C and rising C-reactive protein (CRP) for 4 days before the fever and CRP declined. The isolated strain was later tested and found to be resistant to the antibiotics used. The present case underlines that F. tularensis subsp. holarctica infections may cause severe symptoms but mostly have a favourable outcome.
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Affiliation(s)
- Joerg Fritzsch
- Clinic for Internal Medicine, HELIOS Klinik Zwenkau, Zwenkau, Germany
| | - Wolf D Splettstoesser
- German National Reference Laboratory for Tularaemia, Department of Immunology, Bundeswehr Institute of Microbiology, München, Germany
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Splettstoesser WD, Seibold E, Zeman E, Trebesius K, Podbielski A. Rapid differentiation of Francisella species and subspecies by fluorescent in situ hybridization targeting the 23S rRNA. BMC Microbiol 2010; 10:72. [PMID: 20205957 PMCID: PMC2844405 DOI: 10.1186/1471-2180-10-72] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 03/08/2010] [Indexed: 11/18/2022] Open
Abstract
Background Francisella (F.) tularensis is the causative agent of tularemia. Due to its low infectious dose, ease of dissemination and high case fatality rate, F. tularensis was the subject in diverse biological weapons programs and is among the top six agents with high potential if misused in bioterrorism. Microbiological diagnosis is cumbersome and time-consuming. Methods for the direct detection of the pathogen (immunofluorescence, PCR) have been developed but are restricted to reference laboratories. Results The complete 23S rRNA genes of representative strains of F. philomiragia and all subspecies of F. tularensis were sequenced. Single nucleotide polymorphisms on species and subspecies level were confirmed by partial amplification and sequencing of 24 additional strains. Fluorescent In Situ Hybridization (FISH) assays were established using species- and subspecies-specific probes. Different FISH protocols allowed the positive identification of all 4 F. philomiragia strains, and more than 40 F. tularensis strains tested. By combination of different probes, it was possible to differentiate the F. tularensis subspecies holarctica, tularensis, mediasiatica and novicida. No cross reactivity with strains of 71 clinically relevant bacterial species was observed. FISH was also successfully applied to detect different F. tularensis strains in infected cells or tissue samples. In blood culture systems spiked with F. tularensis, bacterial cells of different subspecies could be separated within single samples. Conclusion We could show that FISH targeting the 23S rRNA gene is a rapid and versatile method for the identification and differentiation of F. tularensis isolates from both laboratory cultures and clinical samples.
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Affiliation(s)
- Wolf D Splettstoesser
- Bundeswehr Institute of Microbiology, German Reference Laboratory for Tularemia, Neuherbergstr 11, 80937 Munich, Germany.
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Hauri AM, Hofstetter I, Seibold E, Kaysser P, Eckert J, Neubauer H, Splettstoesser WD. Investigating an airborne tularemia outbreak, Germany. Emerg Infect Dis 2010; 16:238-43. [PMID: 20113553 PMCID: PMC2957990 DOI: 10.3201/eid1602.081727] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2-154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.
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Meibom KL, Barel M, Charbit A. Loops and networks in control of Francisella tularensis virulence. Future Microbiol 2009; 4:713-29. [PMID: 19659427 DOI: 10.2217/fmb.09.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Francisella tularensis is a highly infectious, Gram-negative bacterium responsible for the disease tularemia in a broad variety of animals, including humans. F. tularensis intracellular multiplication occurs mainly in macrophages. However, F. tularensis is able to infect many other cell types, including other phagocytic (dendritic cells, polymorphonuclear leukocytes) and nonphagocytic (alveolar epithelial cells, hepatocytes, endothelial cells and fibroblasts) cells. The ability of professional phagocytic cells to engulf and kill microbes is an essential component of innate defense. The ability of F. tularensis to impair phagocyte function and survive in the cytosol of infected cells thus constitutes a central aspect of its virulence. The F. tularensis intracellular lifecycle relies on the tightly regulated expression of a series of genes. The unraveling secrets of the regulatory cascades governing the regulation of virulence of F. tularensis will be discussed along with future challenges yet to be solved.
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Affiliation(s)
- Karin L Meibom
- INSERM U570, Université Paris Descartes, Faculté de Médecine Necker Enfants-Malades, 75730, Paris Cedex 15, France.
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