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Complex study demonstrated high susceptibility and infectious sensitivity of Dicrostonyx torquatus Pall. to the causative agent of tularemia, and its reference to the 1-st group of mammals (according to Olsufiev).
One sporadic case of tularemia induced by direct contact with an infected hare is described. Human epidemiological data of the last ten years in Tuscany, emphasize that this infection, although at low incidence, shows the presence and persistence of Francisella tularensis in the animals and the ensuing transmission to humans so that it continues to be responsible for significant morbididy in "at risk" territories. Difficulties in the differential diagnosis, above all for glandular and pharyngeal forms, are reviewed.
A randomized investigation of the immediate (wound healing) and end-results (relapse and metastasis frequency, recurrence-free period, 2-, 3- or 5-year survival, lethality rate and mean lifespan) of combined (surgery + distant gamma-therapy) treatment of two groups of patients with endometrial carcinoma was carried out. The study group was operated on days 15-20 after immunization with tularemia live vaccine (TLV) while the controls were had no preliminary immunization. It was shown that all indices of the immediate and end-results of treatment were significantly better in the study group for all stages. It is concluded that TLV immunization given 15-20 days before surgery is followed by a lower frequency of postoperative complications and better end-results.
A study was made of a possibility of detection of the causative agent of tularemia in the organism of albino mice at early stages of development of the infection after subcutaneous infection with 1, 10 and 100 microbial cells of strains No. 503/834 (Holarctic race) and Schu (nearctic race). The following examinations were made: cultivation on nutrient media, immunofluorescent study, the antibody neutralization test and the passive hemagglutination test with erythrocytic diagnostic agents. The microbe could be regularly revealed three days after the infection. Detection of the causative agent was possible in individual cases at the earlier dates by seeding and by the fluorescent antibody method. Although by cultivation it is possible to reveal individual microbes, but the growth appears on the 3rd--5th day and later. The most rapid response (1.5--2 hours) results (on the presence of the microbe) can be obtained with the aid of the fluorescent antibody method. Application of the mentioned tests with the erythrocytic diagnostic agents permits to obtain data not only on the presence of the causative agent, but also on its quantity of the causative agent in the organism of the infected animal. The mentioned methods provide the most complete characteristics of the dynamics of the accumulation of the microbe in the animal organism.
For the first time in the Krasnoyarsk region the population Haemaphysalis concinna ticks were found to be infected with the causative agents of three natural focal tick-borne infections--tick-borne encephalitis, tick-borne rickettsiosis and tularemia. The existence of the combined natural focus of these three infections has been confirmed by epidemiological data. Ticks Dermacentor nuttalli also play a similar role in combined foci of tick-borne encephalitis and tick-borne rickettsiosis in these focal territories.
Everyday contact of the workers of Białowieza sanctuary with animals may create a risk of infection by microorganisms attacking animals. The reported study was undertaken for carrying out an epidemiological analysis of tularemia and toxocarosis in this group of workers. Tularaemia infection was not found in then. In 12% of these workers antibodies to Toxocara canis were found, and fire workers had articular borreliosis. Antibodies to taxocara were disclosed in 10% of the Białowieza population not employed in the sanctuary and 30% of the population of the village Kruklanka in the Pisz Forests. The workers of the Białowieza Sanctuary are not exposed to Toxocara canis infection more than the remaining population of Białowieza and the population in the Kruklanka village in a region far from Białowieza.
In an episode of tularemia in a Canadian zoologic garden, three black and red tamarins (Sanguinus nigricollis) and one talapoin (Cercopithecus talapoin) died. A second talapoin developed abscesses in the tongue and submandibular area; this animal recovered with treatment. Francisella tularensis was isolated from lung, liver, and spleen from each dead monkey and from pus collected from the tongue abscess of the sick talapoin. The attending veterinarian contracted the disease from a tamarin bite. The source of the disease was identified as wild ground squirrels, and the causative organism was recovered from the liver and spleen of one squirrel and from fleas found on it.
Tularemia has been identified recently as the cause of a die-off in captured wild prairie dogs (Cynomys ludovicianus) (Figure) at a commercial exotic animal distributor in Texas. The Texas Department of Health and CDC immediately notified all state health departments and are investigating the outbreak.
This paper addresses the issue of using airborne tularemia as a potential biological weapon of terrorists. Because of its extreme infectivity, easy dissemination and substantial pathogenic ability, it may become a dangerous biological agent. An outbreak of acute febrile illness with pneumonia, pleuritis and hilar lymphadenitis in urban healthy populations, regardless of age and gender, should suggest an action of terrorism. The presumptive diagnosis should be based on epidemiological and clinical findings as the final microbiological confirmation may take several weeks. The treatment with aminoglicosides or alternatively doxycycline and ciprofloxacin administered parenterally is recommended. In a mass casualty situation, oral doxycycline and ciprofloxacin are the preferred drugs. Vaccination is recommended only in the laboratory personnel working routinely with Francisella tularensis. Isolation and special precautions are not necessary because the illness is not transmitted from one person to another.
Strains of the causative agent of tularemia were for the first time isolated by the authors from the objects of the external environment in the tundra zone of Eastern Taimir; this indicates a possibility of preservation of the microbe under conditions of the extreme north.
Primary F. tularensis infection in mice induces the production of macrophage activating factors (MAFs) by spleen cells. The stimulation of macrophage cytolytic activity (MAF-c) and hydrogen peroxide production (MAF-H2O2) dominates between days 7 and 10 in the course of tularemia. Three various pools of active fractions (10-11, 14-15, 25-28) were fractionated by two-step chromatography. Typical for 10-11 and 14-15 is MAF-c activity whereas in 25-28 prevails MAF-H2O2. Initial concentrated supernatant (day 7 of infection) and individual fractions have been used to raise antibodies KI (anti 10-11) and KII (anti 14-15). Neutralization reactions with specific antibodies indicate the presence of tumor necrosis factor alpha (TNF alpha) in 14-15 (44% inhibitable), interferon gamma (IFN gamma) and interleukin 2 (IL 2) in 25-28 (65% and 30% neutralization, respectively). Utilizing KI and KII, 99% and 90% inhibition of cytolytic activity is reached in 10-11 and 14-15, respectively, in spite of non-specific cross reaction. Western blot analysis of proteins in supernatant on day 7 detects, besides TNF alpha, further protein bands (13, 15.5, 52 and 72 kDa) that seem to be associated with macrophage activation. Significant protective effect against in vivo multiplication of tularemic microbes indicates a certain role of TNF alpha, however, cooperation of other molecules is worth to be taken into consideration.
Combined action of doxycycline and mytilan, a natural polysaccharide, on the primary immune response to the antigen of the tularemia vaccinal strain in CBA mice was studied. The polysaccharide was used to compensate the immunosuppressive effect of doxycycline high doses on the humoral immune response. The maximum stimulation of the antibody titers as compared to the controls (more than 250 per cent) was observed when mytilan was administered simultaneously with or prophylactically 3 days prior to the antibiotic in doses of 2.5 and 25 mg/kg. The use of mytilan in combination with doxycycline high doses made it possible to compensate the antibiotic-induced decrease of DTH and even to stimulate it as compared to the controls. The highest levels of DTH (150 per cent against the control) were observed when mytilan was administered prophylactically in doses of 2.5 and 11.25 mg/kg 3 days prior to immunization. Mytilan had the highest stimulating effect on antibody production. The combined use of doxycycline and mytilan was characterized by significant stimulation of antibody production and DTH when the dose/time regimens were rational.
This case report details the clinical manifestation and course of glandular tularemia, an uncommon but significant cause of cervical lymphadenopathy in children. We discuss the unique attributes of this disease along with appropriate steps that lead to early identification of the organism and effective treatment. The potential use of the organism as a bioterrorism agent is another interesting aspect of this entity.
The typing of F. tularensis strains by four variable number of tandem repeats (VNTR) loci has been carried out. Among the strains isolated in the Stavropol and Krasnodar Territories seven genotypes have been detected and their spread in different natural foci has been analyzed. The data thus obtained suggest that the VNTR analysis may become an important instrument for studying the structure of the natural foci of tularemia and evolutionary relationships between individual areas of these foci.
The matrix for obtaining silica-based diagnosticum was selected, its activation with surfactant was optimized and its immobilization with tularemia immunoglobulins was carried out. In the glass suspension agglutination test (SAT) the sensitivity of the diagnosticum was 3.125 x 10(6) to 6.25 x 10(6) microbial cells per ml; the duration of SAT, including the evaluation of its results, was 1-5 minutes.
BACKGROUND: A growing incidence of tick borne encephalitis and Lyme borreliosis in north-eastern Poland as well as an increasing number of Ixodes ricinus ticks in wooded areas and meadows have prompted the authors to evaluate the presence of antibodies against Francisella tularensis in serum of forest workers. MATERIALS AND METHODS: Sera of 820 persons, including 765 healthy forest workers (group I) and 55 patients with lymphadenopathy (group II) admitted to the Department of Infectious and Neuroinfectious Diseases, Medical Academy, Białystok, were diagnosed for antibodies against F. tularensis. Agglutination test at 37 degrees C, with suspensed F. tularensis (Biomed, Kraków, Poland) were used. Simultaneously all sera were tested for the presence of antibodies against B. burgdorferi, using ELISA test, Borrelia IgM and Borrelia IgG recombinant (Biomedica, Austria). RESULTS: Of the 765 forest workers (group I), 20 (2.06%), persons showed positive (1:20) result of agglutination test, including 8 persons with antibodies against B. burgdorferi in IgG, of these 1 in IgM and IgG. Twenty persons with positive agglutination test had no signs of present or past tularemia in physical examination. Nine persons with prior diagnosis of arthritic form of Lyme boreliosis had undergone repeated antibiotic therapy (two 30-days therapy courses with cefotaksym or doxycycline). In group II, sera of 55 patients were negative in the agglutination test with F. tularensis. CONCLUSIONS: The results of our study show that in North-Eastern Poland, Ixodes ricinus is not essential in Francisella tularensis transmission in this region.
The usefulness of the ELISA using as antigen prepared in our laboratory supernatant obtained after centrifugation of sonicated F. tularensis cell suspension was compared with the tube agglutination test with commercial available antigen. Paired serum specimens obtained from 6 patients with ulceroglandular syndrome of tularemia were tested in both tests. The cut-off limit of serum antibodies was set at mean antibody titre determined in the sera of 115 blood donors exceeded by three standard deviations. Antibodies to F. tularensis in diagnostically significant titre were detected in all 12 serum samples by both tests. However the titres obtained in ELISA were several times higher than in tube agglutination test. In the second serum sample the level of IgA and IgM was lower but the level of IgG higher than in the first sample. We could not observe any difference in the level of antibodies between paired serum specimens in tube agglutination test.
Acute Francisella tularensis infection in 3 domestic cats was presumptively diagnosed on the basis of clinical signs and lesions and confirmed by culturing or immunofluorescent demonstration of the organism. Clinical findings include marked signs of depression, oral/lingual ulceration, regional or generalized lymphadenomegaly, hepatosplenomegaly, panleukopenia with severe toxic change of neutrophils, and hyperbilirubinemia with bilirubinuria. Lesions found at necropsy included icterus, oropharyngeal and lingual ulceration, multiple foci of necrosis in lymph nodes, spleen, liver, and lung, and severe segmental or diffuse enterocolitis. Results of serologic testing for F tularensis was positive in only 1 of the 3 cats. The organism was cultured aerobically from several tissues, including aspirated bone marrow obtained before death in 1 cat. Results of an indirect fluorescent antibody test, performed on fresh and formalin-fixed tissues of all cats, were positive. Because of the severe clinical course, opportunity to evaluate therapeutic regimens was not possible. Until now, confirmed diagnosis of feline tularemia only has been made retrospectively, in instances when cats were suspected to have transmitted infection to human beings in whom the primary diagnosis was made. The findings in this report provide a basis for presumptive diagnosis that will help to minimize public health risk associated with this potentially fatal zoonotic disease.