Wilke, AyşeMeriç, MelihaGrunow, RolandSayan, MuratFinke, Ernst-JurgenSplettstoesser, W.Seibold, ErikErdoğan, SarperErgönül, ÖnderYumuk, Zeki2022-04-212022-04-212009-01Wilke, A. vd. (2009). "An outbreak of oropharyngeal tularaemia linked to natural spring water". Journal of Medical Microbiology, 58(1), 112-116.0022-2615https://doi.org/10.1099/jmm.0.002279-0https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.002279-0http://hdl.handle.net/11452/25973A 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 >= 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 (111 %) 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.eninfo:eu-repo/semantics/openAccessMATMicroagglutination testTurkeyMicrobiologyAdultAnti-bacterial agentsCase-control studiesDisease outbreaksFemaleHumansMaleMiddle agedOropharynxTularemiaTurkeyWater microbiologyArticle0002623144000142-s2.0-5814952261411211658119074661MicrobiologyFrancisella Tularensis; Tularemia; AnimalsAntigenCeftriaxoneDrinking waterLipopolysaccharideMacrolidePenicillin GAdultAgglutination testAntibody titerArticleCase control studyConfidence intervalControlled studyDifferential diagnosisDisease courseEnzyme linked immunosorbent assayEpidemicFemaleFrancisella tularensisHumanInfection riskLaboratory diagnosisLymph node biopsyLymphadenitisMajor clinical studyMaleMultivariate analysisOropharyngeal tularemiaPolymerase chain reactionPriority journalSpecies differenceSpringStatistical significanceThroat cultureTonsillitisTularemiaTurkey (republic)Water analysisWestern blotting