一起与天然泉水相关的口咽型兔热病暴发。

An outbreak of oropharyngeal tularaemia linked to natural spring water.

作者信息

Willke A, Meric M, Grunow R, Sayan M, Finke E J, Splettstößer W, Seibold E, Erdoğan S, Ergonul O, Yumuk Z, Gedikoglu S

机构信息

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

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

出版信息

J Med Microbiol. 2009 Jan;58(Pt 1):112-116. doi: 10.1099/jmm.0.002279-0.

DOI:10.1099/jmm.0.002279-0

PMID:19074661

Abstract

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 >or=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.

摘要

对2004年12月至2005年4月期间土耳其科贾埃利地区发生的一起涉及188例疑似病例的兔热病疫情进行了调查。开展了一项病例对照研究，纳入135例实验室确诊病例和55例对照，以确定疫情暴发的危险因素并评估实验室诊断方法。90例患者通过微量凝集试验（MAT）滴度≥1:160确诊为兔热病。在MAT阴性血清中，23/44（52%）通过土拉弗朗西斯菌脂多糖（LPS）ELISA检测呈阳性，1/9（11%）通过该抗原的蛋白质印迹法检测呈阳性。种特异性PCR在16/25（64%）份咽拭子和8/13（62%）份淋巴结穿刺液中呈阳性。多因素分析显示，饮用天然泉水是兔热病发生的主要危险因素（P=0.0001，比值比0.165，95%可信区间0.790-0.346）。在停用疑似天然泉水后，疫情得到控制。