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Rijks JM, Tulen AD, Notermans DW, Reubsaet FAG, de Vries MC, Koene MGJ, Swaan CM, Maas M. Tularemia Transmission to Humans, the Netherlands, 2011–2021. Emerg Infect Dis 2022; 28:883-885. [PMID: 35318921 PMCID: PMC8962900 DOI: 10.3201/eid2804.211913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We used national registry data on human cases of Francisella tularensis subspecies holarctica infection to assess transmission modes among all 26 autochthonous cases in the Netherlands since 2011. The results indicate predominance of terrestrial over aquatic animal transmission sources. We recommend targeting disease-risk communication toward hunters, recreationists, and outdoor professionals.
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Koene M, Rijks J, Maas M, Ruuls R, Engelsma M, van Tulden P, Kik M, IJzer J, Notermans D, de Vries M, Fanoy E, Pijnacker R, Spierenburg M, Bavelaar H, Berkhout H, Sankatsing S, Diepersloot R, Myrtennas K, Granberg M, Forsman M, Roest HJ, Gröne A. Phylogeographic Distribution of Human and Hare Francisella Tularensis Subsp. Holarctica Strains in the Netherlands and Its Pathology in European Brown Hares (Lepus Europaeus). Front Cell Infect Microbiol 2019; 9:11. [PMID: 30805312 PMCID: PMC6378916 DOI: 10.3389/fcimb.2019.00011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/15/2019] [Indexed: 01/05/2023] Open
Abstract
Sequence-based typing of Francisella tularensis has led to insights in the evolutionary developments of tularemia. In Europe, two major basal clades of F. tularensis subsp. holarctica exist, with a distinct geographical distribution. Basal clade B.6 is primarily found in Western Europe, while basal clade B.12 occurs predominantly in the central and eastern parts of Europe. There are indications that tularemia is geographically expanding and that strains from the two clades might differ in pathogenicity, with basal clade B.6 strains being potentially more virulent than basal clade B.12. This study provides information on genotypes detected in the Netherlands during 2011–2017. Data are presented for seven autochthonous human cases and for 29 European brown hares (Lepus europaeus) with laboratory confirmed tularemia. Associated disease patterns are described for 25 European brown hares which underwent post-mortem examination. The basal clades B.6 and B.12 are present both in humans and in European brown hares in the Netherlands, with a patchy geographical distribution. For both genotypes the main pathological findings in hares associated with tularemia were severe (sub)acute necrotizing hepatitis and splenitis as well as necrotizing lesions and hemorrhages in several other organs. Pneumonia was significantly more common in the B.6 than in the B.12 cases. In conclusion, the two major basal clades present in different parts in Europe are both present in the Netherlands. In hares found dead, both genotypes were associated with severe acute disease affecting multiple organs. Hepatitis and splenitis were common pathological findings in hares infected with either genotype, but pneumonia occurred significantly more frequently in hares infected with the B.6 genotype compared to hares infected with the B.12 genotype.
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Affiliation(s)
- Miriam Koene
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, Netherlands
| | - Jolianne Rijks
- Faculty of Veterinary Medicine, Dutch Wildlife Health Centre, Utrecht University, Utrecht, Netherlands
| | - Miriam Maas
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Robin Ruuls
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, Netherlands
| | - Marc Engelsma
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, Netherlands
| | - Peter van Tulden
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, Netherlands
| | - Marja Kik
- Faculty of Veterinary Medicine, Dutch Wildlife Health Centre, Utrecht University, Utrecht, Netherlands
| | - Jooske IJzer
- Faculty of Veterinary Medicine, Dutch Wildlife Health Centre, Utrecht University, Utrecht, Netherlands
| | - Daan Notermans
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Maaike de Vries
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ewout Fanoy
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,GGD Rotterdam Rijnmond, Rotterdam, Netherlands
| | - Roan Pijnacker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marcel Spierenburg
- Netherlands Food and Consumer Product Safety Authority, Utrecht, Netherlands
| | - Herjan Bavelaar
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Hanneke Berkhout
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Sanjay Sankatsing
- Department of Internal Medicine, Diakonessenhuis, Utrecht, Netherlands
| | - Rob Diepersloot
- Department of Medical Microbiology en Immunology, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | | | | | - Hendrik-Jan Roest
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Wageningen University and Research, Lelystad, Netherlands
| | - Andrea Gröne
- Faculty of Veterinary Medicine, Dutch Wildlife Health Centre, Utrecht University, Utrecht, Netherlands
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Janse I, van der Plaats RQJ, de Roda Husman AM, van Passel MWJ. Environmental Surveillance of Zoonotic Francisella tularensis in the Netherlands. Front Cell Infect Microbiol 2018; 8:140. [PMID: 29868496 PMCID: PMC5951967 DOI: 10.3389/fcimb.2018.00140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
Tularemia is an emerging zoonosis caused by the Gram-negative bacterium Francisella tularensis, which is able to infect a range of animal species and humans. Human infections occur through contact with animals, ingestion of food, insect bites or exposure to aerosols or water, and may lead to serious disease. F. tularensis may persist in aquatic reservoirs. In the Netherland, no human tularemia cases were notified for over 60 years until in 2011 an endemic patient was diagnosed, followed by 17 cases in the 6 years since. The re-emergence of tularemia could be caused by changes in reservoirs or transmission routes. We performed environmental surveillance of F. tularensis in surface waters in the Netherlands by using two approaches. Firstly, 339 samples were obtained from routine monitoring -not related to tularemia- at 127 locations that were visited between 1 and 8 times in 2015 and 2016. Secondly, sampling efforts were performed after reported tularemia cases (n = 8) among hares or humans in the period 2013–2017. F. tularensis DNA was detected at 17% of randomly selected surface water locations from different parts of the country. At most of these positive locations, DNA was not detected at each time point and levels were very low, but at two locations contamination was clearly higher. From 7 out of the 8 investigated tularemia cases, F. tularensis DNA was detected in at least one surface water sample collected after the case. By using a protocol tailored for amplification of low amounts of environmental DNA, 10 gene targets were sequenced. Presence of F. tularensis subspecies holarctica was confirmed in 4 samples, and in 2 of these, clades B.12 and B.6 were identified. This study shows that for tularemia, information regarding the spatial and temporal distribution of its causative agent could be derived from environmental surveillance of surface waters. Tracking a particular strain in the environment as source of infection is feasible and could be substantiated by genotyping, which was achieved in water samples with only low levels of F. tularemia present. These techniques allow the establishment of a link between tularemia cases and environmental samples without the need for cultivation.
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Affiliation(s)
- Ingmar Janse
- Zoonoses and Environmental Microbiology, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Rozemarijn Q J van der Plaats
- Zoonoses and Environmental Microbiology, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Ana Maria de Roda Husman
- Zoonoses and Environmental Microbiology, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Mark W J van Passel
- Zoonoses and Environmental Microbiology, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Janse I, Maas M, Rijks JM, Koene M, van der Plaats RQ, Engelsma M, van der Tas P, Braks M, Stroo A, Notermans DW, de Vries MC, Reubsaet F, Fanoy E, Swaan C, Kik MJ, IJzer J, Jaarsma RI, van Wieren S, de Roda-Husman AM, van Passel M, Roest HJ, van der Giessen J. Environmental surveillance during an outbreak of tularaemia in hares, the Netherlands, 2015. ACTA ACUST UNITED AC 2018; 22:30607. [PMID: 28877846 PMCID: PMC5587900 DOI: 10.2807/1560-7917.es.2017.22.35.30607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/09/2017] [Indexed: 01/01/2023]
Abstract
Tularaemia, a disease caused by the bacterium Francisella tularensis, is a re-emerging zoonosis in the Netherlands. After sporadic human and hare cases occurred in the period 2011 to 2014, a cluster of F. tularensis-infected hares was recognised in a region in the north of the Netherlands from February to May 2015. No human cases were identified, including after active case finding. Presence of F. tularensis was investigated in potential reservoirs and transmission routes, including common voles, arthropod vectors and surface waters. F. tularensis was not detected in common voles, mosquito larvae or adults, tabanids or ticks. However, the bacterium was detected in water and sediment samples collected in a limited geographical area where infected hares had also been found. These results demonstrate that water monitoring could provide valuable information regarding F. tularensis spread and persistence, and should be used in addition to disease surveillance in wildlife.
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Affiliation(s)
- Ingmar Janse
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,These authors share first authorship
| | - Miriam Maas
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,These authors share first authorship
| | - Jolianne M Rijks
- Dutch Wildlife Health Centre, Utrecht University, Utrecht, the Netherlands
| | - Miriam Koene
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research (WBVR), Lelystad, the Netherlands
| | - Rozemarijn Qj van der Plaats
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Marc Engelsma
- Department of Diagnostics and Crisis Organisation, Wageningen Bioveterinary Research (WBVR), Lelystad, the Netherlands
| | - Peter van der Tas
- GGD Fryslân, Regional Public Health Service of Friesland, Leeuwarden, the Netherlands
| | - Marieta Braks
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Arjan Stroo
- Netherlands Food and Consumer Product Safety Authority, Wageningen, the Netherlands
| | - Daan W Notermans
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Maaike C de Vries
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Frans Reubsaet
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ewout Fanoy
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,GGD Utrecht, Regional Public Health Service of Utrecht, Zeist, the Netherlands
| | - Corien Swaan
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Marja Jl Kik
- Dutch Wildlife Health Centre, Utrecht University, Utrecht, the Netherlands
| | - Jooske IJzer
- Dutch Wildlife Health Centre, Utrecht University, Utrecht, the Netherlands
| | - Ryanne I Jaarsma
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sip van Wieren
- Resource Ecology Group, Department of Environmental Science, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Ana Maria de Roda-Husman
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Mark van Passel
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Hendrik-Jan Roest
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research (WBVR), Lelystad, the Netherlands
| | - Joke van der Giessen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research (WBVR), Lelystad, the Netherlands
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Kreizinger Z, Erdélyi K, Felde O, Fabbi M, Sulyok KM, Magyar T, Gyuranecz M. Comparison of virulence of Francisella tularensis ssp. holarctica genotypes B.12 and B.FTNF002-00. BMC Vet Res 2017; 13:46. [PMID: 28183313 PMCID: PMC5301346 DOI: 10.1186/s12917-017-0968-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Two main genetic groups (B.12 and B.FTNF002-00) of Francisella tularensis ssp. holarctica are endemic in Europe. The B.FTNF002-00 group proved to be dominant in Western European countries, while strains of the B.12 group were isolated mainly in Northern, Central and Eastern Europe. The clinical course of tularemia in the European brown hare (Lepus europaeus) also shows distinct patterns according to the geographical area. Acute course of the disease is observed in hares in Western European countries, while signs of sub-acute or chronic infection are more frequently detected in the eastern part of the continent. The aim of the present study was to examine whether there is any difference in the virulence of the strains belonging to the B.FTNF002-00 and B.12 genetic clades. Results Experimental infection of Fischer 344 rats was performed by intra-peritoneal injection of three dilutions of a Hungarian (B.12 genotype) and an Italian (B.FTNF002-00 genotype) F. tularensis ssp. holarctica strain. Moderate difference was observed in the virulence of the two genotypes. Significant differences were observed in total weight loss values and scores of clinical signs between the two genotypes with more rats succumbing to tularemia in groups infected with the B.FTNF002-00 genotype. Conclusions Results of the experimental infection are consistent with previous clinical observations and pathological studies suggesting that F. tularensis ssp. holarctica genotype B.FTNF002-00 has higher pathogenic potential than the B.12 genotype. Electronic supplementary material The online version of this article (doi:10.1186/s12917-017-0968-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zsuzsa Kreizinger
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Hungária körút 21, H-1143, Budapest, Hungary
| | - Károly Erdélyi
- Veterinary Diagnostic Directorate, National Food Chain Safety Office, P.O. Box 21581, Budapest, Hungary
| | - Orsolya Felde
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Hungária körút 21, H-1143, Budapest, Hungary
| | - Massimo Fabbi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna Bruno Ubertini, National Reference Laboratory for Tularemia, Pavia, 27100, Italy
| | - Kinga M Sulyok
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Hungária körút 21, H-1143, Budapest, Hungary
| | - Tibor Magyar
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Hungária körút 21, H-1143, Budapest, Hungary
| | - Miklós Gyuranecz
- Institute for Veterinary Medical Research, Centre for Agricultural Research, Hungarian Academy of Sciences, Hungária körút 21, H-1143, Budapest, Hungary.
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Towards Development of Improved Serodiagnostics for Tularemia by Use of Francisella tularensis Proteome Microarrays. J Clin Microbiol 2016; 54:1755-1765. [PMID: 27098957 DOI: 10.1128/jcm.02784-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/11/2016] [Indexed: 12/13/2022] Open
Abstract
Tularemia in humans is caused mainly by two subspecies of the Gram-negative facultative anaerobe Francisella tularensis: F. tularensis subsp. tularensis (type A) and F. tularensis subsp. holarctica (type B). The current serological test for tularemia is based on agglutination of whole organisms, and the reactive antigens are not well understood. Previously, we profiled the antibody responses in type A and B tularemia cases in the United States using a proteome microarray of 1,741 different proteins derived from the type A strain Schu S4. Fifteen dominant antigens able to detect antibodies to both types of infection were identified, although these were not validated in a different immunoassay format. Since type A and B subspecies are closely related, we hypothesized that Schu S4 antigens would also have utility for diagnosing type B tularemia caused by strains from other geographic locations. To test this, we probed the Schu S4 array with sera from 241 type B tularemia cases in Spain. Despite there being no type A strains in Spain, we confirmed the responses against some of the same potential serodiagnostic antigens reported previously, as well as determined the responses against additional potential serodiagnostic antigens. Five potential serodiagnostic antigens were evaluated on immunostrips, and two of these (FTT1696/GroEL and FTT0975/conserved hypothetical protein) discriminated between the Spanish tularemia cases and healthy controls. We conclude that antigens from the type A strain Schu S4 are suitable for detection of antibodies from patients with type B F. tularensis infections and that these can be used for the diagnosis of tularemia in a deployable format, such as the immunostrip.
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