Date: Sun 1 Oct 2017
Source: Outbreak News Today [edited]
An outbreak of the zoonotic bacterial infection, tularemia, has been reported in Armenia according to a Haqqin.az report (computer translated). According to the report, at least 20 people in the village of Artsvaberd in Tavush province were affected by the outbreak. The report does not state how the villagers were infected.
Tularemia can be transmitted to people, such as hunters, who have handled infected animals. Infection can also arise from the bite of infected insects (most commonly ticks and deer flies); by exposure to contaminated food, water, or soil; by eating, drinking, putting hands to eyes, nose, or mouth before washing after outdoor activities; by direct contact with breaks in the skin; or by inhaling particles carrying the bacteria (through mowing or blowing vegetation and excavating soil).
Typical signs of infection in humans may include fever, chills, headache, swollen and painful lymph glands, and fatigue. If tularemia is caused by the bite of an infected insect or from bacteria entering a cut or scratch, it usually causes a skin ulcer or pustule and swollen glands. Eating or drinking food or water containing the bacteria may produce a throat infection, mouth ulcers, stomach pain, diarrhoea and vomiting. Inhaling the bacterium may cause an infection of the lungs with chest pain and coughing.
Tularemia can be effectively treated with antimicrobials. Untreated tularemia can lead to hospitalization and may be fatal if not diagnosed and treated appropriately. [Byline: Robert Herriman]
[Tularemia is typically found in animals, especially small mammals such as voles, mice, rodents, rabbits, and hares. _Francisella tularensis_ is found in a wide range of animal hosts and is capable of surviving for weeks at low temperatures in water, moist soil, or decaying plant and animal matter. Although hundreds of differing vertebrates and invertebrates can be infected with the tularemia bacillus, no more than a dozen or so are important in its ecology. Humans become infected through a variety of mechanisms including bites of infected arthropods (mosquitoes, ticks, deerflies), handling infected or dead animals, ingesting contaminated food or water, and inhaling aerosols of bacteria. The type of exposure will dictate the form of the disease manifestation, with cutaneous exposures usually resulting in the glandular or ulceroglandular forms.
The report does not give information about the clinical manifestations of tularemia in these cases, the mode of transmission or the method of diagnosis (clinical, serology or culture). Additionally, the time span of the development of the cases is not given, which would help decide whether the cases may be related (occurring over a short time) as opposed to 20 cases in 2017. A cluster of 20 cases would suggest a common source exposure such as contaminated water or food. ProMED would appreciate more information in this regard.
Tavush is a province of Armenia. It is located at the northeast of Armenia and bordered by Georgia from the north and Azerbaijan from the east and its location may be seen on a map at <https://en.wikipedia.org/wiki/Tavush_Province
>. - ProMED Mod.LL]
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