Outbreaks of tularemia in Turkey.

Tularemia, casued by Francisella tularensis, is a zoonotic disease presenting various clinical forms. In the present study, three outbreaks of tularemia occurred from January to March and September in 2004 (first and second) and January to March in 2005 (third) are reported from the north-eastern part of Turkey. All cases originated from the same geographical location. In total, 56 patients having complaints of fever, malaise, chills and shivering, painful sore throat with swollen tonsils and enlarged cervical lymph nodes were affected and the patients were different in all cases. Forty-four, 7 and 5 people were affected in the first, second and third outbreak, respectively. The sera from all patients were analysed for the presence of F. tularensis antibodies using a microagglutination assay. Overall, of the 56 sera analysed, 39 (33, 3 and 3 were from the first, second and third outbreak, respectively) showed antibody titres of 1/160 and/or more against F. tularensis. The current report suggests that tularemia exists in north-eastern part of Turkey. The clinical manifestation of the current cases were similar to those of oropharyngeal form of tularemia. It is considered that this region should be accepted as an endemic area for tularemia and kept under control for a long period.