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J Med Microbiol 58 (2009), 112-116; DOI: 10.1099/jmm.0.002279-0
© 2009 Society for General Microbiology
ISSN 0022-2615

An outbreak of oropharyngeal tularaemia linked to natural spring water

A. Willke1, M. Meric1, R. Grunow2, M. Sayan3, E. J. Finke4, W. Splettstößer4, E. Seibold4, S. Erdogan5, O. Ergonul6, Z. Yumuk7 and S. Gedikoglu8

1 Kocaeli University, Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, Kocaeli, Turkey

2 Robert Koch Institute, Centre for Biological Safety, Berlin, Germany

3 Kocaeli University, Medical Faculty, Clinical Laboratory, PCR Unit, Kocaeli, Turkey

4 Bundeswehr Institute of Microbiology, Munich, Germany

5 Istanbul University, Cerrahpasa Medical Faculty, Department of Public Health, Istanbul, Turkey

6 Marmara University, Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey

7 Kocaeli University, Medical Faculty, Department of Microbiology, Kocaeli, Turkey

8 Uludag University, Medical Faculty, Department of Microbiology, Bursa, Turkey

Correspondence
M. Meric
drmelihameric{at}gmail.com

Received March 30, 2008
Accepted September 8, 2008

A tularaemia outbreak was investigated involving 188 suspected cases in the Kocaeli region of Turkey between December 2004 and April 2005. A case–control study comprising 135 laboratory-confirmed cases and 55 controls was undertaken to identify risk factors for the development of the outbreak and to evaluate laboratory diagnostic methods. Tularaemia was confirmed by a microagglutination test (MAT) titre of ≥1 : 160 in 90 of the patients. In MAT-negative sera, 23/44 (52 %) were positive by ELISA with Francisella tularensis LPS and 1/9 (11 %) by Western blotting with this antigen. A species-specific PCR was positive in 16/25 (64 %) throat swabs and 8/13 (62 %) lymph node aspirates. Multivariate analysis showed that drinking natural spring water was the leading risk factor for the development of tularaemia (P=0.0001, odds ratio 0.165, 95 % CI 0.790–0.346). The outbreak ceased after abandonment of the suspected natural water springs.

Abbreviations: MAT, microagglutination test.






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