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Mosquitoes (Diptera: Culicidae), in contrast to ticks (Acari: Ixodidae), do not carry Francisella tularensis in a natural focus of tularemia in the Czech Republic.

In total, 9,167 mosquitoes (Aedes spp.) and 1,987 ixodid ticks--1,423 Dermacentor reticulatus (F.), 504 Ixodes ricinus (L.), and 60 Haemaphysalis concinna Koch--were examined in an active enzootic focus (floodplain forest-meadow ecosystem) of tularemia in South Moravia. Czech Republic. Although no F. tularensis was detected in mosquitoes or H. concinna, 30 isolates were recovered from D. reticulatus (infection rate, 2.1%) and 1 isolate from I. ricinus (infection rate, 0.2%). Ixodid ticks, especially D. reticulatus, but not mosquitoes serve as vectors (and perhaps reservoirs) of F. tularensis at this natural focus.

Aedes↗

Protein synthesis in zinc deficient rats during tularemia.

The effect of zinc deficiency on protein synthesis in rats during tularemia was studied. Five weeks prior to infection with the live vaccine strain of Francisella tularensis, rats had been assigned to one of three dietary groups: zinc deficient (-Zn), pair-fed (PF) or ad libitum (AL). Within 4 weeks, zinc deficiency manifested itself by diminished growth rate, decreased serum and liver zinc concentrations and alopecia. By 18 hour post infection, rats of all groups were febrile and exhibited an increased hepatic uptake of zinc. Despite initially lower concentrations of seromucoid in the PF and -Zn groups, infection elicited an increase in seromucoid concentration as well as enhanced incorporation of 3H-leucine into this fraction of comparable degree in all dietary groups. The same held true for ceruloplasmin. Alpha 2-macrofetoprotein also increased to the same extent in all dietary groups. Infection was associated with a decrease in extractable albumin in ad libitum and pair fed control groups. Only the -Zn group showed a significant decrease in specific activity suggestive of diminished albumin synthesis. Zinc deficiency of itself did not cause a decrement in radiolabel in muscle protein. Thus, despite documented zinc deficiency, rats subjected to the stress of infection respond by synthesizing increased amounts of acute phase globulins apparently at the expense of serum albumin and muscle protein synthesis.

Alopecia↗

Tularemia complicated by acute renal failure.

Acute renal failure has been a rare, uniformly fatal complication of infection with Francisella tularensis. The literature suggests that either acute tubular necrosis, interstitial nephritis, or glomerulonephritis may be responsible for this syndrome. We have described a patient with tularemia who had nonoliguric acute renal failure probably due to interstitial nephritis and who recovered slowly but spontaneously during antimicrobial therapy with doxycycline.

Acute Kidney Injury↗

Epidemiology and clinical characteristics of tularemia in Oklahoma, 1979 to 1985.

We studied the clinical and epidemiologic characteristics of tularemia in 165 Oklahomans from 1979 to 1985. The ulceroglandular form of the disease was most common (60%), followed by typhoidal (18%), glandular (15%), oropharyngeal (7%), and oculoglandular (1%) forms. The male-female ratio was 3.7:1, and the highest rates of disease were found in the age groups 5 to 14, 35 to 44, and 55 to 74. Ticks were most frequently implicated as the source of infection (84/154 [55%]), followed by rabbits, (58/154 [38%]). Seventy percent of the patients were hospitalized, and four (2.5%) died. The annual number of patients who reported that rabbits were their probable source of exposure to Francisella tularensis and the estimated number of rabbits harvested (ie, killed by hunters) for the year correlated closely with the total number of cases reported from year to year.

Adolescent↗

Field investigations of tularemia in Norway.

In Norway, tularemia is a common disease in small rodent and hare populations, where large outbreaks can be observed. In humans, the yearly number of cases is low, usually less than ten, with peaks up to 44 recorded in recent years. Serological investigations on hunters and healthy school children nevertheless indicate, with up to 4.7% positivity in the latter group, that Francisella tularensis low-grade infection is widespread. F. tularensis in co-culture with amoebae, e.g. Achantamoeba castellanii, may grow after internalization and kill the amoeba. As with Legionella, Francisella virulence may be enhanced after protozoan ingestion. This suggests a mechanism that can explain the pattern of dissemination and infection in our region.

Adolescent↗

Outer membranes of a lipopolysaccharide-protein complex (LPS-17 kDa protein) as chemical tularemia vaccines.

Immunisation with outer membranes of Francisella tularensis induced an efficient protection in guinea pigs against challenge with the virulent strains 503 or 144/713 (type B biovar holarctica), both clinical isolates, and prevented the development of typical signs of infection in hamadryads (baboons), challenged with the virulent strain Schu (type A, biovar tularensis) of F. tularensis. Immunisation with a lipopolysaccharide protein complex isolated from the outer membranes afforded protection in CBA mice against challenge with strain 503. Another LPS-protein complex obtained by the simple mixture of LPS preparations from strain 503 and a 17-kDa membrane protein from the avirulent R-variant of the vaccine strain 15 also demonstrated protective properties against experimental tularemia in mice.

Animals↗

Intranasal vaccination with a defined attenuated Francisella novicida strain induces gamma interferon-dependent antibody-mediated protection against tularemia.

Francisella tularensis is an intracellular gram-negative bacterium that is the causative agent of tularemia and a potential bioweapon. We have characterized the efficacy of a defined F. novicida mutant (DeltaiglC) as a live attenuated vaccine against subsequent intranasal challenge with the wild-type organism. Animals primed with the F. novicida DeltaiglC (KKF24) mutant induced robust splenic gamma interferon (IFN-gamma) and interleukin-12 (IL-12) recall responses with negligible IL-4 production as well as the production of antigen-specific serum immunoglobulin G1 (IgG1) and IgG2a antibodies. BALB/c mice vaccinated intranasally (i.n.) with KKF24 and subsequently challenged with wild-type F. novicida (100 and 1,000 50% lethal doses) were highly protected (83% and 50% survival, respectively) from the lethal challenges. The protection conferred by KKF24 vaccination was shown to be highly dependent on endogenous IFN-gamma production and also was mediated by antibodies that could be adoptively transferred to naive B-cell-deficient mice by inoculation of immune sera. Collectively, the results demonstrate that i.n. vaccination with KKF24 induces a vigorous Th1-type cytokine and antibody response that is protective against subsequent i.n. challenge with the wild-type strain. This is the first report of a defined live attenuated strain providing protection against the inhalation of F. novicida.

Administration, Intranasal↗

Interleukin 2 and gamma interferon production, interleukin 2 receptor expression, and DNA synthesis induced by tularemia antigen in vitro after natural infection or vaccination.

The T-cell response induced by Francisella tularensis antigen in sensitized subjects was characterized in vitro by measuring DNA synthesis in whole-blood and mononuclear cell cultures, interleukin 2 (IL-2) and gamma interferon (IFN-gamma) production, and IL-2 receptor expression. Correlations between these variables were estimated. The strengths of the responses were compared in 21 subjects naturally infected 2 years ago, 6 subjects vaccinated 5 to 6 years ago, and 13 control subjects with no history of infection or vaccination. Subjects with a history of natural infection synthesized more DNA in both whole-blood and mononuclear cell cultures, secreted more IL-2 and IFN-gamma, and expressed more IL-2 receptors than control subjects did. All these responses differed highly significantly (P less than 0.001) from those of the control subjects. The vaccinees exhibited somewhat lower responses than the naturally immunized subjects did, but the vaccinees could be distinguished from the control subjects by their DNA synthesis, receptor expression, and IFN-gamma production (P less than 0.01 to 0.001). The vaccinees showed a lower response, in terms of DNA synthesis and IL-2 secretion (P less than 0.05), than the infected group did but responded in a manner similar to that of this group, with respect to receptor positivity and IFN-gamma secretion (P greater than 0.10). The correlations between all the T-cell functions were good, with highly significant correlations (P less than 0.001) between whole-blood DNA synthesis and IL-2 and IFN-gamma secretion and between the two lymphokines (P less than 0.001). The results not only increase our knowledge of the T-cell response to tularemia antigen but also give an alternative approach to DNA synthesis measurement for the quantitation of T-cell responses. The results for the low-responding sensitized subjects seem to indicate that the parameters were comparable in sensitivity.

Adult↗

Tularemia in Denmark: identification of a Francisella tularensis subsp. holarctica strain by real-time PCR and high-resolution typing by multiple-locus variable-number tandem repeat analysis.

We report ulceroglandular tularemia affecting an 8-year-old boy and the first recovery of Francisella tularensis in Denmark. A novel real-time PCR assay was used to identify the strain as F. tularensis subsp. holarctica (type B). Multiple-locus variable-number tandem repeat analysis demonstrated a close genetic relationship to strains from Norway.

Bacterial Typing Techniques↗

Tick-borne tularemia presenting as ulcerative lymphadenitis.

In a patient with suppurative lymphadenitis who fails to respond to antibiotics routinely used for pyogenic adenitis, the diagnosis of tularemia should be considered if there is good evidence for recent tick or other insect exposure. A trial of streptomycin therapy may be indicated, pending culture and serology results, in any patient whose signs and symptoms strongly suggest this diagnosis.

Arachnid Vectors↗

An outbreak of tularemia in the northern part of central Sweden.

An extensive epidemic of tularemia with 529 cases, 400 of which were confirmed by laboratory tests, occurred in the northern part of central Sweden during the summer of 1981. The outbreak was of short duration and was restricted to certain communities within a narrow geographical area. It began in the middle of July and progressed during that month and August, with only sporadic cases in September and October. During the 2 years preceding the outbreak only 3 and 7 cases were reported in Sweden. The infection was mainly transmitted by mosquitoes and most cases were ulceroglandular. The later cases in September and October were infected by contact with hares or rodents. All age groups were affected, with a slight predominance of women and the 30-60 yr age groups.

Adult↗

Tularemia outbreak, Bulgaria, 1997-2005.

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.

Animals↗

Raccoons and skunks as sentinels for enzootic tularemia.

We analyzed sera from diverse mammals of Martha's Vineyard, Massachusetts, for evidence of Francisella tularensis exposure. Skunks and raccoons were frequently seroreactive, whereas white-footed mice, cottontail rabbits, deer, rats, and dogs were not. Tularemia surveillance may be facilitated by focusing on skunks and raccoons.

Agglutination Tests↗

Tularemia in a dog.

A 13-month-old German shepherd dog was presented with acute onset of anorexia, pyrexia, lymphadenopathy, and tonsillitis. Tularemia was diagnosed based on a greater-than-fourfold increase in antiFrancisella tularensis antibody titers over a three-week period. The disease was self-limiting, and clinical signs resolved within five days with only supportive therapy.

Animals↗

Tularemia in a mule deer.

A case of tularemia was confirmed in a 51-year-old man who acquired the disease from a mule deer, Odocoileus hemionus. Francisella tularensis was isolated from bone marrow of the deer carcass.

Animals↗

Survey for rabies, leptospirosis, toxoplasmosis and tularemia in striped skunks (Mephitis mephitis) from three public use areas in northwestern Arkansas.

During a skunk eradication program in late August, 1979, 53 striped skunks (Mephitis mephitis) were removed from three public use areas on Beaver Lake, Benton and Carroll counties in northwestern Arkansas. None of the 53 animals were positive for rabies (fluorescent antibody technique) and only one of 45 (2.2%) was positive for rabies antibodies. Twenty-one of 45 animals (46.6%) tested were positive for leptospirosis; 10 of 45 (22.2%) were positive for toxoplasmosis; and none were positive for tularemia. High populations of striped skunks in public use areas could be a potentially important reservoir for several diseases affecting both humans and other animals.

Animals↗