Epidemiol Health.  2015;37:e2015011. 10.4178/epih/e2015011.

Tularemia, a re-emerging infectious disease in Iran and neighboring countries

• Zargar A
• Maurin M
• Mostafavi

• KMID: 2380648
• DOI: http://doi.org/10.4178/epih/e2015011

Abstract

OBJECTIVES
Tularemia is a zoonotic disease transmitted by direct contact with infected animals and through arthropod bites, inhalation of contaminated aerosols, ingestion of contaminated meat or water, and skin contact with any infected material. It is widespread throughout the northern hemisphere, including Iran and its neighbors to the north, northeast, and northwest.
METHODS
In this paper, the epidemiology of tularemia as a re-emerging infectious disease in the world with a focus on Iran and the neighboring countries is reviewed.
RESULTS
In Iran, positive serological tests were first reported in 1973, in wildlife and domestic livestock in the northwestern and southeastern parts of the country. The first human case was reported in 1980 in the southwest of Iran, and recent studies conducted among at-risk populations in the western, southeastern, and southwestern parts of Iran revealed seroprevalences of 14.4, 6.52, and 6%, respectively.
CONCLUSIONS
Several factors may explain the absence of reported tularemia cases in Iran since 1980. Tularemia may be underdiagnosed in Iran because Francisella tularensis subspecies holarctica is likely to be the major etiological agent and usually causes mild to moderately severe disease. Furthermore, tularemia is not a disease extensively studied in the medical educational system in Iran, and empirical therapy may be effective in many cases. Finally, it should be noted that laboratories capable of diagnosing tularemia have only been established in the last few years. Since both recent and older studies have consistently found tularemia antibodies in humans and animals, the surveillance of this disease should receive more attention. In particular, it would be worthwhile for clinical researchers to confirm tularemia cases more often by isolating F. tularensis from infected humans and animals.

Keyword

Tularemia; Francisella tularensis; Bacterial infections; Rodentia

MeSH Terms

Aerosols
Animals
Antibodies
Arthropods
Bacterial Infections
Communicable Diseases, Emerging*
Eating
Epidemiology
Francisella tularensis
Humans
Inhalation
Iran*
Livestock
Meat
Rodentia
Seroepidemiologic Studies
Serologic Tests
Skin
Tularemia*
Water
Zoonoses
Aerosols
Antibodies
Water