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DOI: 10.1055/s-0034-1370117
Die Tularämie in Deutschland
Tularemia in GermanyPublication History
11 November 2013
31 January 2014
Publication Date:
17 June 2014 (online)
Zusammenfassung
Das Bakterium Francisella tularensis ist inzwischen seit mehr als 100 Jahren als Verursacher der Tularämie, einer in der gesamten nördlichen Hemisphäre verbreiteten Zoonose, bekannt. Die Prävalenz der Tularämie zeigt große geographische Schwankungen, wobei die Erkrankung in Deutschland vergleichsweise selten vorkommt. Die klinischen Manifestationsformen der Tularämie sind vielfältig und umfassen ulzeroglanduläre, glanduläre, oropharyngeale, okuloglanduläre, respiratorische sowie typhoide Verläufe. Aufgrund der niedrigen Prävalenz und der unspezifischen Symptomatik gelingen eine rasche Diagnosestellung sowie der frühe Beginn einer wirksamen Therapie eher selten. Daher fassen wir in diesem Artikel wesentliche Aspekte zu Ätiologie, Ökologie und Infektionswegen, aktueller epidemiologischer Situation, klinischem Bild, Diagnostik sowie Therapie der Tularämie zusammen mit Schwerpunkt auf der Situation in Deutschland.
Abstract
The bacterium Francisella tularensis is known for more than 100 years by now as the etiological agent of the disease tularemia, a zoonotic infection with a worldwide distribution in the Northern Hemisphere. The prevalence of tularemia shows a wide geographic variation, being comparably infrequent in Germany. Tularemia can present itself with multiple clinical manifestations including ulceroglandular, glandular, oropharyngeal, oculoglandular, respiratory and typhoidal forms. Due to the low prevalence and the unspecific symptomatology, a rapid diagnosis and early start of an effective therapy are rarely obtained. Thus, in this article we summarize important aspects concerning etiology, ecology and routes of transmission, recent epidemiologic situation, clinical picture, diagnostics and treatment of tularemia, focusing on the situation in Germany.
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Literatur
- 1 Allue M, Sopena CR, Gallardo MT et al. Tularaemia outbreak in Castilla y Leon, Spain, 2007: an update. Euro Surveill 2008; 13
- 2 Bulut OC, Dyckhoff G, Splettstoesser W et al. Unmasked: when a clinically malignant disease turns out infectious. A rare case of tularemia. Int J Surg Pathol 2013; 21: 76-81
- 3 Capka E, Roch M, Ritter M et al. [A 23-year-old patient with sore throat and cervical lymph node enlargement: a rare presentation of tularemia]. Internist (Berl) 2010; 51: 784-787
- 4 Chocarro A, Gonzalez A, Garcia I. Treatment of tularemia with ciprofloxacin. Clin Infect Dis 2000; 31: 623
- 5 Christova I, Velinov T, Kantardjiev T et al. Tularaemia outbreak in Bulgaria. Scand J Infect Dis 2004; 36: 785-789
- 6 Dlugaiczyk J, Harrer T, Zwerina J et al. Oropharyngeal tularemia--a differential diagnosis of tonsillopharyngitis and cervical lymphadenitis. Wien Klin Wochenschr 2010; 122: 110-114
- 7 Eliasson H, Back E. Tularaemia in an emergent area in Sweden: an analysis of 234 cases in five years. Scand J Infect Dis 2007; 39: 880-889
- 8 Ellis J, Oyston PC, Green M et al. Tularemia. Clin Microbiol Rev 2002; 15: 631-646
- 9 European Centre for Disease Prevention and Control. Annual epidemiological report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. Stockholm: 2013
- 10 Franke J, Fritzsch J, Tomaso H et al. Coexistence of pathogens in host-seeking and feeding ticks within a single natural habitat in Central Germany. Appl Environ Microbiol 2010; 76: 6829-6836
- 11 Fritzsch J, Splettstoesser WD. Septic pneumonic tularaemia caused by Francisella tularensis subsp. holarctica biovar II. J Med Microbiol 2010; 59: 1123-1125
- 12 Gehringer H, Schacht E, Maylaender N et al. Presence of an emerging subclone of Francisella tularensis holarctica in Ixodes ricinus ticks from south-western Germany. Ticks Tick Borne Dis 2013; 4: 93-100
- 13 Georgi E, Schacht E, Scholz HC et al. Standardized broth microdilution antimicrobial susceptibility testing of Francisella tularensis subsp. holarctica strains from Europe and rare Francisella species. J Antimicrob Chemother 2012; 67: 2429-2433
- 14 Grunow R, Splettstosser W, Hirsch FW et al. Differentialdiagnose der Tularämie. Dtsch Med Wochenschr 2001; 126: 408-413
- 15 Grunow R, Kalaveshi A, Kuhn A et al. Surveillance of tularaemia in Kosovo, 2001 to 2010. Euro Surveill 2012; 17
- 16 Gurkov R, Kisser U, Splettstosser W et al. Tularaemia of middle ear with suppurative lymphadenopathy and retropharyngeal abscess. J Laryngol Otol 2009; 123: 1252-1257
- 17 Hanke CA, Otten JE, Berner R et al. Ulceroglandular tularemia in a toddler in Germany after a mosquito bite. Eur J Pediatr 2009; 168: 937-940
- 18 Hauri AM, Hofstetter I, Seibold E et al. Investigating an airborne tularemia outbreak, Germany. Emerg Infect Dis 2010; 16: 238-243
- 19 Hofstetter I, Eckert J, Splettstoesser W et al. Tularaemia outbreak in hare hunters in the Darmstadt-Dieburg district, Germany. Euro Surveill 2006; 11: E060119 060113
- 20 Jenzora A, Jansen A, Ranisch H et al. Seroprevalence study of Francisella tularensis among hunters in Germany. FEMS Immunol Med Microbiol 2008; 53: 183-189
- 21 Johansson A, Berglund L, Sjostedt A et al. Ciprofloxacin for treatment of tularemia. Clin Infect Dis 2001; 33: 267-268
- 22 Kaysser P, Seibold E, Matz-Rensing K et al. Re-emergence of tularemia in Germany: presence of Francisella tularensis in different rodent species in endemic areas. BMC Infect Dis 2008; 8: 157
- 23 Kohlmann R, Wolf PJ, Gatermann SG. Pleuropulmonale Tularämie bei einem 63-jährigen Jäger in Deutschland. Dtsch Med Wochenschr 2014; 139: 534-537
- 24 Kuehn A, Schulze C, Kutzer P et al. Tularaemia seroprevalence of captured and wild animals in Germany: the fox (Vulpes vulpes) as a biological indicator. Epidemiol Infect 2013; 141: 833-840
- 25 Larssen KW, Afset JE, Heier BT et al. Outbreak of tularaemia in central Norway, January to March 2011. Euro Surveill 2011; 16
- 26 Lubbert C, Taege C, Seufferlein T et al. Prolongierter Verlauf einer durch Zeckenstich übertragenen ulzeroglandulären Tularämie bei einer 20-jährigen Patientin. Dtsch Med Wochenschr 2009; 134: 1405-1410
- 27 Matyas BT, Nieder HS, Telford SR et al. Pneumonic tularemia on Martha's Vineyard: clinical, epidemiologic, and ecological characteristics. Ann N Y Acad Sci 2007; 1105: 351-377
- 28 Maurin M, Pelloux I, Brion JP et al. Human tularemia in France, 2006-2010. Clin Infect Dis 2011; 53: e133-141
- 29 Meric M, Willke A, Finke EJ et al. Evaluation of clinical, laboratory, and therapeutic features of 145 tularemia cases: the role of quinolones in oropharyngeal tularemia. APMIS 2008; 116: 66-73
- 30 Muller W, Hotzel H, Otto P et al. German Francisella tularensis isolates from European brown hares (Lepus europaeus) reveal genetic and phenotypic diversity. BMC Microbiol 2013; 13: 61
- 31 Otto P, Chaignat V, Klimpel D et al. Serological Investigation of Wild Boars (Sus scrofa) and Red Foxes (Vulpes vulpes) As Indicator Animals for Circulation of Francisella tularensis in Germany. Vector Borne Zoonotic Dis 2014; 14: 46-51
- 32 Oyston PC, Sjostedt A, Titball RW. Tularaemia: bioterrorism defence renews interest in Francisella tularensis. Nat Rev Microbiol 2004; 2: 967-978
- 33 Perez-Castrillon JL, Bachiller-Luque P, Martin-Luquero M et al. Tularemia epidemic in northwestern Spain: clinical description and therapeutic response. Clin Infect Dis 2001; 33: 573-576
- 34 Porsch-Ozcurumez M, Kischel N, Priebe H et al. Comparison of enzyme-linked immunosorbent assay, Western blotting, microagglutination, indirect immunofluorescence assay, and flow cytometry for serological diagnosis of tularemia. Clin Diagn Lab Immunol 2004; 11: 1008-1015
- 35 Potz-Biedermann C, Schwendemann L, Schroppel K et al. Ulceroglandular tularemia. J Dtsch Dermatol Ges 2011; 9: 806-808
- 36 RFI. Tularämie – Zum Vorkommen in Deutschland. Epid Bull 2007; 7: 51-56
- 37 Schatzle W, Schwenk R. Three cases of tularaemia in southern Baden-Wuerttemberg, Germany, November 2007. Euro Surveill 2008; 13
- 38 Schubert A, Splettstoesser W, Batzing-Feigenbaum J. Tularaemia in Berlin – two independent cases in travellers returning from central Anatolia, Turkey, February 2011. Euro Surveill 2011; 16
- 39 Siret V, Barataud D, Prat M et al. An outbreak of airborne tularaemia in France, August 2004. Euro Surveill 2006; 11: 58-60
- 40 Sjostedt A. Tularemia: history, epidemiology, pathogen physiology, and clinical manifestations. Ann N Y Acad Sci 2007; 1105: 1-29
- 41 Splettstoesser WD, Piechotowski I, Buckendahl A et al. Tularemia in Germany: the tip of the iceberg?. Epidemiol Infect 2009; 137: 736-743
- 42 Staples JE, Kubota KA, Chalcraft LG et al. Epidemiologic and molecular analysis of human tularemia, United States, 1964-2004. Emerg Infect Dis 2006; 12: 1113-1118
- 43 Sutera V, Levert M, Burmeister WP et al. Evolution toward high-level fluoroquinolone resistance in Francisella species. J Antimicrob Chemother 2014; 69: 101-110
- 44 Tarnvik A, Berglund L. Tularaemia. Eur Respir J 2003; 21: 361-373
- 45 Tarnvik A, Chu MC. New approaches to diagnosis and therapy of tularemia. Ann N Y Acad Sci 2007; 1105: 378-404
- 46 Thomas LD, Schaffner W. Tularemia pneumonia. Infect Dis Clin North Am 2010; 24: 43-55
- 47 Ulu-Kilic A, Gulen G, Sezen F et al. Tularemia in central anatolia. Infection 2013; 41: 391-399
- 48 Weber IB, Turabelidze G, Patrick S et al. Clinical recognition and management of tularemia in Missouri: a retrospective records review of 121 cases. Clin Infect Dis 2012; 55: 1283-1290
- 49 Weile J, Seibold E, Knabbe C et al. Treatment of tularemia in patient with chronic graft-versus-host disease. Emerg Infect Dis 2013; 19: 771-773