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1.
Br J Ophthalmol ; 91(9): 1206-8, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17475710

ABSTRACT

AIM: The authors describe a diagnostic approach that proved to be particularly valuable in rare cases of ocular tularemia registered during the tularemia outbreak in 1997-2005 in Bulgaria. The authors describe the laboratory findings and diagnosis of four cases with an oculoglandular form of infection. METHODS: Several different specimens from each patient were analysed. Oculoglandular tularemia was diagnosed in four patients either by culture, immunofluorescent antibody analysis (IFA), serology or by a polymerase chain reaction (PCR) assay. RESULTS AND DISCUSSION: Three F tularensis strains were isolated and characterised. One of these was isolated from a conjuctival swab specimen obtained from a seronegative patient. The authors report for the first time a successful application of diagnostic PCR performed directly on conjuctival swab specimen. From all analysed specimens IFA was diagnostically effective only in the case of lymph node aspirates and was not sensitive enough for conjuctival swabs or blood samples. The authors also describe the histological picture of a conjunctival granuloma in course of infection. All patients were successfully treated with ciprofloxacin. CONCLUSIONS: Some of the proposed laboratory diagnostic strategies (swab PCR) are not invasive and could represent a new approach for resolving rare and hard-to-diagnose cases of oculoglandular tularemia.


Subject(s)
Eye Infections, Bacterial/diagnosis , Tularemia/diagnosis , Conjunctiva/microbiology , DNA, Bacterial/analysis , Francisella tularensis/genetics , Francisella tularensis/isolation & purification , Humans , Ocular Motility Disorders/microbiology , Polymerase Chain Reaction/methods , Tularemia/complications
2.
J Infect Dev Ctries ; 4(11): 689-94, 2010 Nov 24.
Article in English | MEDLINE | ID: mdl-21252445

ABSTRACT

INTRODUCTION: Tularemia is an uncommon but potentially fatal zoonosis. А second outbreak of tularemia in Bulgaria, about 40 years after the first, occurred in 1997 in two western regions, near the Serbian border. In 2003 tularemia reemerged in the same foci. This retrospective study aimed to evaluate the clinical characteristics and the efficacy of antibiotic therapy in a tularemia resurgence in the Slivnitza region in 2003-2004. METHODOLOGY: A total of 26 cases were evaluated. Using medical records, the following data were collected for all patients: symptoms, physical signs, and microbiology results of agglutination tests, cultures and PCR assays. RESULTS: Twenty-four of 26 suspected tularemia patients were laboratory confirmed by agglutination test and/or culture. Fifteen (57.7%) patients had clinical presentation compatible with oropharyngeal, 8 (30.8%) with glandular, and 3 (11.5%) with oculoglandular tularemia. The most frequent symptoms were swollen neck (84.6%) and sore throat (76.9%). Lymphadenopathy (100%) was the most common finding. Francisella tularensis (F. tularensis) was detected by PCR, providing a definitive diagnosis in 82.3% of the cases. All the patients were treated with antibiotics considered effective against F. tularensis; however, therapeutic failure was observed in 23.1% of the cases, which was related to a delay in the initiation of antibiotics. CONCLUSION: The tularemia outbreak in west Bulgaria near the Serbian border was probably food-borne, associated with a surge in the rodent population. The oropharyngeal form was the most common. Although the disease runs a benign course, late initiation of antimicrobial therapy might delay complete recovery.


Subject(s)
Disease Outbreaks , Francisella tularensis/isolation & purification , Tularemia/epidemiology , Tularemia/pathology , Adolescent , Adult , Aged , Agglutination Tests , Animals , Anti-Bacterial Agents/therapeutic use , Bulgaria/epidemiology , Child , Female , Francisella tularensis/genetics , Francisella tularensis/pathogenicity , Humans , Lymphatic Diseases/microbiology , Lymphatic Diseases/pathology , Male , Middle Aged , Oropharynx/microbiology , Oropharynx/pathology , Pharyngitis/microbiology , Pharyngitis/pathology , Polymerase Chain Reaction , Rodentia/physiology , Tonsillitis/microbiology , Tonsillitis/pathology , Treatment Failure , Treatment Outcome , Tularemia/drug therapy , Tularemia/microbiology , Young Adult , Zoonoses/epidemiology
3.
Emerg Infect Dis ; 12(4): 678-80, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16704820

ABSTRACT

The 1997-2005 tularemia outbreak in Bulgaria affected 285 people. Ten strains were isolated from humans, a tick, a hare, and water. Amplified fragment length polymorphism typing of the present isolates and of the strain isolated in 1962 suggests that a new genetic variant caused the outbreak.


Subject(s)
Disease Outbreaks/statistics & numerical data , Francisella tularensis/genetics , Francisella tularensis/isolation & purification , Tularemia/epidemiology , Tularemia/microbiology , Animals , Bulgaria/epidemiology , Francisella tularensis/classification , Humans , Incidence , Phylogeny , Rabbits , Ticks/microbiology , Time Factors , Water Microbiology
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