Objective: Tularemia is a zoonotic disease. Sporadic cases and outbreaks occur in humans. Here, we report a waterborne outbreak, its clinical presentation, and the results of treatment. Material and Methods: An increase in the frequency of patients presenting with lymphadenopathy from the same region was detected. Patients with serological diagnosis of tularemia were included in the study between December 2018 and April 2019. This case series were evaluated as an outbreak, clinical and laboratory parameters, demographic characteristics, clinical forms of tularemia and laboratory findings such as immunoglobulin M antibody titer for F. tularemia, inflammatory markers (C-reactive protein, leukocytosis, erythrocyte sedimentation rate), choice of first antibiotic treatment, total duration of treatment, initial clinical/laboratory response day, relapse and reinfection ratios have been investigated. The bacteria was investigated from drinking water fountains by polymerase chain reaction (PCR) (16sRNA Nanobiz® F. tularemia). Results: Tularemia was diagnosed serologically in 35 patients. Distribution of clinical forms was glandular (21 cases-60%); ulceroglandular (11 cases-31.4%); oropharyngeal (2 cases-5.7%) and oculoglandular (1 case-2.8%), respectively. First serologic test positivity was 80%. Inflammatory markers such as C-reactive protein, leukocytes, erythrocyte sedimentation rate were high. Antibiotic choice for treatment was streptomycin in 19 cases (54.3%), ciprofloxacin in nine cases (25.7%), gentamicin in four cases (11.4%); doxycycline in three cases (8.6%) respectively. The common suspicious contact was the use of drinking water from street fountains. F.tularemia PCR (16sRNA) was positive in 35 of these fountains (35/80, 43.75%). Conclusion: Tularemia should always be considered in head and neck lymphandenopathies that do not heal or show late recovery. We should keep in mind tularemia in a water-borne outbreak, were high it is rare.
Keywords: Tularemia; lymphadenopathy; outbreak