Tularemi: Yeniden ortaya çıkan bir hastalık

Abstract

Tularemi bakteriyel zoonotik bir hastalıktır. Etyolojik ajan son derece düşük enfektif doza sahip, gram negatif, kokobasil olan Francisella tularensis’tir. Bakteri; memeliler, kuşlar, balıklar, karada ve suda yaşayan hayvanları da içeren birçok omurgalıda bildirilmiştir. Sadece kuzey yarımkürede yaşayanlarda, daha çok İskandinav ülkeleri, Kuzey Amerika, Japonya’da ve Rusya’da görülmektedir. Ayrıca son yıllarda Türkiye’nin bazı bölgelerinde salgınlar şeklinde ortaya çıkmaktadır. Enfeksiyon insanlara böcek ısırıkları (kene, sinek, sivrisinek), enfekte hayvanlara doğrudan temas, enfekte hayvanların dokuları veya vücut sıvılarına temas, kirli su ve yiyeceklerin yenmesi ve enfekte aerozollerin solunması yoluyla bulaşmaktadır. Klinik formları ülseroglandüler veya glandüler, oküloglandüler, orofaringeal, solunum ve tifoidal formlardır. Tanı için Francisella tularensis’in izolasyonu ve/veya pozitif seroloji esas alınmaktadır. Tedavide ilk seçenek aminoglikozidlerdir (gentamisin veya streptomisin), alternatifler ise siprofloksasin veya doksisiklindir. Tedavi süresi 10-14 gündür. Sadece eski Sovyetler Birliği’nin bazı bölgelerinde kullanılan bir zayıflatılmış canlı aşısı kullanılmasına rağmen lisanslı aşısı bulunmamaktadır

Keywords

• Francisella tularensis, ülseroglandüler, orofaringeal, streptomisin

Tularemia: A re-emerging disease

Abstract

Tularemia is a bacterial zoonotic disease. The etiologic agent is Francisella tularensis which is a gram negative coccobacillus and has an exceedingly low infectious dose. Natural infections with F. tularensis have been reported in a range of vertebrates including mammals, birds, amphibians and fish. Tularemia occurs in humans only in the northern hemisphere and most frequently in Scandinavian countries, northern America, Japan and Russia. It is also an epidemic disease in some part of Turkey. The infection is transmitted to humans by arthropod bites (ticks, flies, mosquitoes), by direct contact with infected animals, by contact with infected tissues or fluids of infectious animals, by ingestion of contaminated water or food or by inhalation of infective aerosols. Clinical forms are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory and typhoidal forms. The diagnosis is based on the isolation of F.tularensis and/or positive serology. In the therapy, the first choice is an aminoglycosides (streptomycin or gentamicin) and alternative choice is ciprofloxacin or doxycycline. Duration of therapy is suggested as 10-14 days. A live attenuated vaccine is only in use some parts of the former Soviet Union but no licensed vaccine available

Keywords

• Francisella tularensis, ulceroglandular, oropharyngeal, streptomycin

References

1. Akalin H, Helvaci S, Gedikoğlu S (2009): Re-emergence of tularemia in Turkey. Int J Infect Dis, 13, 547-551.
2. Anonymous (2007): WHO Guidelines on Tularaemia, World Health Organization. http://www.who.int/csr/ resources/publications/WHO_CDS_EPR_2007_7.pdf. Erişim Tarihi: 28.01.2013.
3. Anonymous (2009): Biosafety in Microbiological and Biomedical Laboratories. 5th Edition. Centers of Disease and Control (CDC). http://www.cdc.gov/biosafety/ publications/bmbl5/BMBL5_sect_VIII_a.pdf. Erişim Tarihi: 28.01.2013.
4. Byington CL, Bender JM, Ampofo K, Pavia AT, Korgenski K, Daly J, Christenson JC, Adderson E (2008): Tularemia with vesicular skin lesions may be mistaken for infection with herpes viruses. Clin Infect Dis, 47, e4-6.
5. Celebi G, Baruönü F, Ayoğlu F, Cinar F, Karadenizli A, Uğur MB, Gedikoğlu S (2006): Tularemia, a reemerging disease in Northwest Turkey: epidemiological investigation and evaluation of treatment responses. Jpn J Infect Dis, 59, 229-234.
6. Clemens DL, Lee BY, Horwitz MA (2004): Virulent and avirulent strains of Francisella tularensis prevent acidification and maturation of their phagosomes and escape into the cytoplasm in human macrophages. Infect Immun, 72, 3204-3217.
7. Ellis J, Oyston PCF, Gren M, Titball RW (2002): Tularemia. Clin Microbiol Rev, 15, 631-46.
8. Gil H, Benach JL, Thanassi DG (2004): Presence of pili on the surface of Francisella tularensis. Infect Immun, 72, 3042-3047.

9. Gil H, Platz GJ, Forestal CA, Monfett M, Bakshi CS, Sellati TJ, Furie MB, Benach JL, Thanassi DG (2006): Deletion of TolC orthologs in Francisella tularensis identifies role s in multidrug resistance and virulence. Proc Natl Acad Sci USA, 103, 12897-12902.
10. Gurcan S, Otkun MT, Otkun M, Arikan OK, Ozer B (2004): An outbreak of tularemia in Western Black Sea region of Turkey. Yonsei Med J, 45, 17-22.
11. Helvaci S, Gedikoglu S, Akalin H, Oral HB (2000): Tularemia in Bursa, Turkey: 205 cases in ten years. Eur J Epidemiol, 16, 271-276.
12. Hopla CE (1974): The ecology of tularemia. Adv Vet Sci Comp Med, 18, 25-53.
13. Karadenizli A, Gurcan S, Kolayli F, Vahaboglu H (2005): Outbreak of tularemia in Golcuk, Turkey in 2005: report of 5 cases and an overview of the literature from Turkey. Scand J Infect Dis, 37, 712-716.
14. Kilic S (2010): Francisella tularensis ve Türkiye’de tularemi epidemiyolojisine genel bir bakış. Flora, 15, 37-58.
15. Kilic S, Yesilyurt M (2011): Tularemia: A General Overview on Current Treatment Options. Klimik Journ, 24, 2-10.
16. Mörner T (1992): The ecology of tularemia. Rev Sci Tech Off Int Epiz, 11, 1123-1130.
17. Oyston PC, Sjostedt A, Titball RW (2004). Tularaemia: bioterrorism defence renews interest in Francisella tularensis. Nat Rev Microbiol, 2, 967-978.
18. Oyston PC (2008): Francisella tularensis: unravelling the secrets of an intracellular pathogen. J Med Microbiol, 57, 921-930.
19. Pechous RD, McCarthy TR, Zahrt TC (2009): Working toward the future: Insights into Francisella tularensis pathogenesis and vaccine development. Microbiol Mol Biol Rev, 73, 684-711.
20. Penn RL (2010): Francisella tularensis (Tularemia). 2927-2937. In: Mandell GL, Bennett JE, Dolin R (Eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA, Churchill Livingstone.
21. Petersen JM, Schriefer ME (2005): Tularemia: emergence/re-emergence. Vet Res, 36, 455-467. 22. Petersen JM, Mead PS, Schriefer ME (2009): Francisella tularensis: an arthropod-borne pathogen. Vet Res, 40, 7.
22. Rhyan JC, Gahagan T, Fales WH (1990): Tularemia in a cat. J Vet Diagn Invest, 2, 239-241.
23. Tärnvik A, Berglund L (2003): Tularaemia. Eur Respir J, 21, 361-373.
24. Ulu Kilic A, Cicek Senturk G, Tutuncu EE, Kilic S, Altay FA, Gurbuz Y, Sencan I (2010): Two Tularemia Cases with Atypical Presentation. Klimik Journ, 23, 120-123.
25. Ulu Kilic A, Kilic S, Sencan I, EE, Celebi G, Gurbuz O, Ergonul O (2011): A water-borne tularemia outbreak caused by Francisella tularensis subspecies holarctica in Central Anatolia region. Mikrobiyol Bul, 45, 234-247.
26. Ulu Kilic A, Gulen G, Sezen F, Kilic S, Sencan I (2012): Tularemia in Central Anatolia. Infection, (Epub ahead of print).
27. Ulu Kilic A, Kilic S, Celebi B, Sencan I (2013): Tigesiklinin Francisella tularensis alttip holarctica’ya in vitro etkinliği; doksisiklin, siprofloksasin ve aminogliko- zidlerle karşılaştırılması. Mikrobiyol Bul, 47, 189-191. 29. Van de Beek D, Steckelberg
28. Kijpittayarit S, Wijdicks EF (2007): Tularemia with brain abscesses. Neurology, 68, 531. WF,
29. Willke A, Meric M, Grunow R, Sayan M, Finke EJ, Splettstösser W, Seibold E, Erdogan S, Ergonul O, Yumuk Z, Gedikoglu S (2009): An outbreak of oropharyngeal tularaemia linked to natural spring water. J Med Microbiol, 58, 112-116.