Characteristics of Tularemia in Kosovo during the period 2006-2011

Abstract

Aim: First cases of tularemia in Kosovo were confirmed in 2000. During the 2000-2002 epidemic outbreak over 600 cases occurred whereas in 2010 over 320 tularemia caseswere reported. Our aim was to present the epidemiological, clinical and diagnostic characteristics and treatment of patients with tularemia treated in the Clinic for Infectious Disease at University Clinical Center of Kosovo, during 2006-2011. Methods: A total of 100 patients were examined. Medical records data including anamnesis, clinical examinations, laboratory tests and treatment were analyzed. Results: Mean age of patients was 23.7 years. The average hospital stay was 15.7 days/patient. All patients were from rural areas and 66% of them had access only to well water. The predominant manifestation of the disease was the glandular form whereas 19%and 17%of cases presented pharyngeal and pulmonary forms too, respectively. High Erythrocyte Sedimentation rate was recorded in 95% of pat ients. 51% of cases had slight anemia and 47% had leukocytosis. Agglutination test in all cases was positive. The Polymerase Chain Reaction test was positive in all taken samples and Francisella tularensis subspecies holartica was isolated as putative agent. Besides Gentamycin (88%) and Streptomycin (12%), incision and drainage of lymph nodes as accessory therapy was applied in 51%of patients. Conclusion: Tularemia still represents a public health problem in Kosovo. The glandular form of the disease predominates. Incision and drainage of inflamed glands as accessory therapy has shown to be a good method of treatment for severe forms of disease in combination with antimicrobial therapy.