The First Tularemia Outbreak in the Sivas Province: A Review of 29 Cases

Objective: Several tularemia epidemics have been reported from many provinces in our country in recent years. We report the first tularemia epidemic occurring in Sivas, and some features of the cases. Methods: Twenty-nine patients admitted to the Infectious Diseases and Clinical Microbiology Clinic of Cumhuriyet University Hospital, between January 2009 and June 2010 were retrospectively investigated. Microagglutination method was used for serological diagnosis. Patients were reviewed and recorded for demographic, clinical and laboratory features.Results: 15 of the patients were male and 14 were female. The mean age was 41.8 years. The mean time between the onset of the symptoms and diagnosis was 38 days. Francisella tularensis was detected by polymerase chain reaction in lymph node aspirate from two patients. This epidemic was thought to be waterborne. In most of the cases (75.9%), the disease presented itself in the oropharyngeal form. The majority of the patients (93.1%) had cervical lymphadenopathy. Prior to diagnosis of tularemia, several antibiotic regimens ineffective for tularemia were given to 72.4% of the patients. Streptomycin and doxycycline combination was given to most of the patients (44.8%) for treatment. No mortality or sequela except for scar was observed. Conclusions: Clinicians should be careful for tularemia, even in non-endemic regions. Tularemia should be considered in the differential diagnosis of patients with tonsillopharyngitis and/or cervical lymphadenopathy.