Characteristics of Tularemia in Kosovo 2010

Beckground: Francisella tularensis is a gram-negative zoonotic pathogen primarily of animals and occasionally of humans. The disease is now recognized as tularemia in most parts of the world, but it has been called rabbit fever, deer-fly fever, and market men’s disease in the United States; wild hare disease (yato-byo) and Ohara’s disease in Japan; and water-rat trappers’ disease in Russia. Tularemia continues to be responsible for significant morbidity and mortality, despite the availability of numerous antibiotics active against the organism. The first cases of tularaemia in Kosovo are reported in the south-western part of Kosovo, in the region of Gjakova in April 2000 in the village of Brovina - 22 patients who were infected through contaminated well water. In the meantime disease is spread in villages of Skivjan, Korenica, Batusha and later throughout Kosovo. Aim: The aim of this study is presentation of characteristics of Tularemia in Kosovo in 2010 and analyzes of the epidemiological, clinical and treatment features of Tularaemia in Kosovo. Methods: We analyzed 53 cases of tularaemia (from 320 patients with tularaemia in Kosovo in 2010) that were from 12 municipalities of Kosovo. The largest number of patients were from Municipality of Vushtria (11 patients) and municipality of Skenderaj (9 patients). All these cases were from rural areas; this confirms that social and epidemiological conditions are very important for appearance of this disease. We have analyzed the data from their medical histories, which includes their medical anamnesis, clinical examination, laboratory tests and their treatment. Results: The mean age of patients was 22 years, 13 patients were children under the age of 10 years. Patients were hospitalized an average of 14.7 days, while incubation time of the disease was an averaging of 28 days. Social and epidemiologic conditions were important factors in the appearance of the disease; 29 patients were water supplied only from wells. All patients were from rural areas. Clinical manifestations were temperature, neck pain, neck and axillary lymphadenopathy, and apathy. Clinically, glandular form has dominated. From laboratory tests, 51 of patients had high erythrocyte sedimentation rate, 13 cases had a slight anemia, and 34 patients had leukocytosis. Other laboratory tests were in normal values. Agglutination test in all cases was positive. All cases were treated with antibiotics; 31 patient were treated with gentamicin, 8 patients were treated with streptomycin and 14 patient were treated with other antibiotic. Incision and drainage of the gland as adjuvant therapy was applied in 27 patient. Conclusions: In this late decade in our country, tularemia continues to be a disease that represents a healthcare problem. Glandular forms of tularemia dominate in Kosovo. Treatment with gentamicin has had good effects. Incision and drainage of the inflamed glands has shown to be a good method in accelerating the recovery of patient. Prophylaxis has to be applied for prevention of the disease