Prevalence of ticks infected withFrancisella tularensis in natural foci of tularemia in western Slovakia

The prevalence of ticks infected withF. tularensis was followed during a systematic surveillance in endemic area of tularemia in western Slovakia over the years 1984–93. Ticks were collected from vegetation in localities of Podunajské Biskupice, in the vicinity of the capital of Slovakia, Bratislava, near the river Danube. In total 6033 ticks, mostly adults ofDermacentor reticulatus andIxodes ricinus (4994 and 1004, respectively) and 35 nymphs ofHaemaphysalis concinna, were examined for the presence ofF. tularensis. Out of 4542 starving ticks, 34F. tularensis strains were isolated predominantly fromD. reticulatus (30), and to a smaller extent also fromI. ricinus (3) andH. concinna (1). Natural infection withF. tularensis was further proved from 1491 adults ofD. reticulatus fed on laboratory animals, rabbits and white mice, together in 27 cases. From that, 21 times it was by positive isolation either from suspensions of partly or fully engorged ticks and their feaces, or from spleens of animals dead after the feeding of ticks. In addition, solely the development of antibodies against the agent was confirmed in 6 rabbit hosts. The presence ofF. tularensis in all the above mentioned tick species and namely the relatively high and permanent infestation ofD. reticulatus adults, ranging between 0.5–2% during the followed time period, demonstrated the maintenance of active natural focus of tularemia in the area under study. The present paper also emphasizes the epidemiologic consequence of various species of ticks in endemic foci of tularemia and the aspect of possible ways of transmission of the agent to humans.     

Landscape Epidemiology of Tularemia Outbreaks in Sweden

Summer outbreaks of tularemia that occurred from 1995 through 2005 in 2 locations in Sweden affected 441 persons. We performed an epidemiologic investigation of these outbreaks using a novel strategy, involving high-resolution genotyping of Francisella tularensis isolates obtained from 136 patients (using 18 genetic markers developed from 6 F. tularensis genome sequences) and interviews with the patients. Strong spatial associations were found between F. tularensis subpopulations and the places of disease transmission; infection by some subpopulations occurred within areas as small as 2 km², indicating unidentified environmental point sources of tularemia. In both locations, disease clusters were associated with recreational areas beside water, and genetic subpopulations were present throughout the tularemia season and persisted over years. High-resolution genotyping in combination with patients’ statements about geographic places of disease transmission provided valuable indications of likely sources of infection and the causal genotypes during these tularemia outbreaks.     

Changes of the epidemiology and the clinical picture of tularemia in Southern Moravia (the Czech Republic) during the period 1936-1999

The author has processed data on early occurrence of tularemia in Southern Moravia collected from literature, materials of epidemical ward of the Regional Hygienic Station (RHS), Brno, and clinical documentation of patients treated for tularemia at the Clinic of infectious diseases, Brno. Tularemia has been appearing in Southern Moravia since autumn 1936. At that time, 290 people contracted the external (mainly ulceroglandular) form of this disease by handling tularemic hares. During the 60s, large severe epidemics of professionally-acquired pulmonary forms of tularemia, mainly in workers in 'cold divisions' of sugar factories, were occurring. The 25-year period of low occurrence of disease, which followed, was interrupted in 1978 with the curious epidemic of tularemia contracted through the alimentary tract in an old people's home. The transmission medium of the infectious agent was juice which had been made from fallen apples infected by little mouse rodents. In autumn 1994, the number of tularemia cases rose again and, during the season of 1998–1999, 115 cases of tularemia contracted mainly by handling tularemic hares were recorded. The author demonstrated the relationship among sources and modes of transmission of Francisella tularensis and clinical form of the disease using the group of patients treated at the Clinic of infectious diseases in Brno.     

Identification of Francisella tularensis Cluster in Central and Western Europe

We conducted a molecular analysis of Francisella tularensis strains isolated in Switzerland and identified a specific subpopulation belonging to a cluster of F. tularensis subsp. holarctica that is widely dispersed in central and western continental Europe. This subpopulation was present before the tularemia epidemics on the Iberian Peninsula.     

Francisella tularensis infection: variable clinical aspects with persistent pulmonary nodules presentation,a case series of human tularemia in Franche-Comté, France

Tularemia is a zoonotic infectious disease caused by the facultative intracellular Gram-negative bacterium Francisella tularensis. Depending on the transmission route of this agent tularemia can present itself as a local infection or a systemic disease. We describe herein three cases of confirmed tularemia in immunocompetent patients during the summer of 2019; two patients with unusual respiratory presentation and pulmonary nodules on imaging, following exposure to aerosols. The third patient was a hunter presenting with a classical ulceroglandular form occurring 4 days after a tick bite in Bourgogne Franche-Comté. All patients were diagnosed from the results of positive F. tularensis PCR (or universal PCR targeting the 16S ribosomal ribonucleic acid gene) and/or seroconversion. The patient with ulceroglandular form received antibiotics, with a complete recovery. The two patients with pneumonic tularemia recovered without antibiotic treatment.  However, pulmonary nodules persisted on follow-up CT months later, despite overall clinical recovery.     

A waterborne tularemia outbreak

A waterborne tularemia outbreak is described. Forty nine cases were identified in Sansepolcro, a small Medioeval town in the province of Arezzo, Tuscany, Italy. All cases had laterocervical or sub-mandibular adenitis, and occurred within a period of three weeks during March and April 1982.The study showed association between cases and the consumption of water from an unchlorinated water system. Francisella tularensis type 1 was isolated from wild hares captured in the area.     

Vaccination with a defined Francisella tularensis subsp. novicida pathogenicity island mutant (ΔiglB) induces protective immunity against homotypic and heterotypic challenge

Francisella tularensis, an intracellular Gram-negative bacterium, is the causative agent of tularemia and a potential bioweapon. Currently, there is no licensed vaccine against this organism. We have characterized the efficacy of a defined F. tularensis subsp. novicida mutant (ΔiglB) as a live attenuated vaccine against pneumonic tularemia. Replication of the iglB mutant (KKF235) in murine macrophages was significantly lower than the wild type novicida strain U112, and exhibited an LD₅₀ greater than 10⁶-fold (>10⁷ CFU vs <10 CFU) in an intranasal challenge model. Mice immunized with KKF235 intranasally or orally induced robust antigen-specific splenic IFN-γ recall responses, as well as the production of systemic and mucosal antibodies. Intranasal vaccination with KKF235 protected mice from subsequent homotypic challenge with U112 as well as heterotypic challenge with F. tularensis subsp. holarctica (LVS). Moreover, protected animals also exhibited minimal pathological changes compared with mock-vaccinated and challenged animals. The protection conferred by KKF235 vaccination was shown to be highly dependent on endogenous IFN-γ production. Most significantly, oral immunization with KKF235 protected mice from a highly lethal subsp. tularensis (SCHU S4) pulmonary challenge. Collectively, these results further suggest the feasibility of using defined pathogenicity island mutants as live vaccine candidates against pneumonic tularemia.     

Multiple Francisella tularensis Subspecies and Clades, Tularemia Outbreak, Utah

In July 2007, a deer fly–associated outbreak of tularemia occurred in Utah. Human infections were caused by 2 clades (A1 and A2) of Francisella tularensis subsp. tularensis. Lagomorph carcasses from the area yielded evidence of infection with A1 and A2, as well as F. tularensis subsp. holarctica. These findings indicate that multiple subspecies and clades can cause disease in a localized outbreak of tularemia.     

A family outbreak of tularemia

A family cluster of tularemia is described. In a family of three members different clinical type of the disease occurred after having been exposed to a sick wild hare. From the hare kidney Francisella tularensis type 1 was isolated. Pneumonic, typhoid-like tularemia occurred in the father who inhaled hare skin hairs and an ulceroglandular form in the mother and in the child who had direct contact with the animal.Corresponding author.     

Quantum of infection of Francisella tularensis tularensis in host-seeking Dermacentor variabilis

The American dog tick, Dermacentor variabilis, is fundamental to the perpetuation of Francisella tularensis tularensis on Martha's Vineyard, Massachusetts, U.S.A. Although infected ticks are relatively common on the island, human cases deriving from tick bite are rare. It may be that the quantum of bacteria within these naturally infected ticks is frequently too small to cause disease. Accordingly, we quantified the amount of F.t. tularensis bacteria in host-seeking ticks from the island. Contrary to our expectations, the majority of the ticks harbor large numbers of bacteria (median 3.3×10⁸ genome equivalents/tick). Such a large quantum of infection might suggest that aerosolization of the ticks themselves might comprise the proximal determinant of risk for the inhalational tularemia that is common on Martha's Vineyard. However, the paradox of fewer ulceroglandular tularemia cases than would be expected given the abundance of potentially highly infectious ticks remains to be solved.     

中国土拉弗朗西斯菌holarctica亚种的遗传多样性

目的 研究国内外土拉弗朗西斯菌的遗传进化关系。方法 选择17个单核苷酸多态性、4个插入/缺失和12个可变数目串联重复,采用单核苷酸多态性和插入/缺失、多位点可变数目串联重复分析方法单独和组合起来对39株土拉菌(10株中国土拉菌和29株已公布测序的土拉菌)进行系统进化分析。结果 组合分析显示,3株中国土拉菌和日本的FSC022被分配到B5;剩余3株中国土拉菌和瑞典的FSC200被分配到B1;3株和美国的OSU18被分配到B2;1株和法国的FTNF002-00、德国的F92与美国的OR96246一起被分配到B4。10株中国土拉菌分为4种亚型,研究表明中国土拉菌具有广泛的遗传多样性。结论 本研究针对土拉菌B型建立了一套简易高效的分型方法,并以此为基础得出土拉菌B型的起源可能是亚洲地区。     

Investigating an Airborne Tularemia Outbreak, Germany

In November 2005, an outbreak of tularemia occurred among 39 participants in a hare hunt in Hesse, Germany. Previously reported tularemia outbreaks in Germany dated back to the 1950s. We conducted a retrospective cohort study among participants and investigated the environment to identify risk factors for infection. Ten participants had serologic evidence of acute Francisella tularensis infection; 1 other participant died before laboratory confirmation was obtained. Presence within 5 meters of the place where disemboweled hares were rinsed with a water hose was the risk factor most strongly associated with infection (risk ratio 22.1; 95% confidence interval 13.2–154.3). Swabs taken at the game chamber and water samples were PCR negative for F. tularensis. Eleven of 14 hare parts showed low-level concentrations of F. tularensis, compatible with cross-contamination. More than half of case-patients may have acquired infection through inhalation of aerosolized droplets containing F. tularensis generated during rinsing of infected hares.     

Recombinant attenuated Listeria monocytogenes vaccine expressing Francisella tularensis IglC induces protection in mice against aerosolized Type A F. tularensis

Fransicella tularensis, the causative agent of tularemia, is in the top category (Category A) of potential agents of bioterrorism. To develop a safer vaccine against aerosolized F. tularensis, we have employed an attenuated Listeria monocytogenes, which shares with F. tularensis an intracellular and extraphagosomal lifestyle, as a delivery vehicle for F. tularensis antigens. We constructed recombinant L. monocytogenes (rLm) vaccines stably expressing seven F. tularensis proteins including IglC (rLm/iglC), and tested their immunogenicity and protective efficacy against lethal F. tularensis challenge in mice. Mice immunized intradermally with rLm/iglC developed significant cellular immune responses to F. tularensis IglC as evidenced by lymphocyte proliferation and CD4+ and CD8+ T-cell intracellular expression of interferon gamma. Moreover, mice immunized with rLm/iglC were protected against lethal challenge with F. tularensis LVS administered by the intranasal route, a route chosen to mimic airborne infection, and, most importantly, against aerosol challenge with the highly virulent Type A F. tularensis SchuS4 strain.     

Protection of vaccinated mice against pneumonic tularemia is associated with an early memory sentinel-response in the lung

Francisella tularensis is the intracellular bacterial pathogen causing the respiratory life-threatening disease tularemia. Development of tularemia vaccines has been hampered by an incomplete understanding of the correlates of immunity. Moreover, the importance of lung cellular immunity in vaccine-mediated protection against tularemia is a controversial matter. Live attenuated vaccine strains of F. tularensis such as LVS (Live Vaccine Strain), elicit an immune response protecting mice against subsequent challenge with the virulent SchuS4 strain, yet the protective immunity against pulmonary challenge is limited in its efficacy and longevity. We established a murine intra-nasal immunization model which distinguishes between animals fully protected, challenged at 4 weeks post double-vaccination (200 inhalation Lethal Dose 50%, LD₅₀, of SchuS4), and those which do not survive the lethal SchuS4 infection, challenged at 8 weeks post double vaccination. Early in the recall immune response in the lung (before day 3), disease progression and bacterial dissemination differed considerably between protected and non-protected immunized mice. Pre-challenge analysis, revealed that protected mice, exhibited significantly higher numbers of lung Ft-specific memory T cells compared to non-protected mice. Quantitative PCR analysis established that a higher magnitude, lung T cells response was activated in the lungs of the protected mice already at 24 h post-challenge. The data imply that an early memory response within the lung is strongly associated with protection against the lethal SchuS4 bacteria presumably by restricting the dissemination of the bacteria to internal organs. Thus, future prophylactic strategies to countermeasure F. tularensis infection may require modulation of the immune response within the lung.     

Characterization of rationally attenuated Francisella tularensis vaccine strains that harbor deletions in the guaA and guaB genes

Francisella tularensis, the etiologic agent of tularemia, can cause severe and fatal infection after inhalation of as few as 10–100 CFU. F. tularensis is a potential bioterrorism agent and, therefore, a priority for countermeasure development. Vaccination with the live vaccine strain (LVS), developed from a Type B strain, confers partial protection against aerosal exposure to the more virulent Type A strains and provides proof of principle that a live attenuated vaccine strain may be efficacious. However LVS suffers from several notable drawbacks that have prevented its licensure and widespread use. To address the specific deficiencies that render LVS a sub-optimal tularemia vaccine, we engineered F. tularensis LVS strains with targeted deletions in the guaA or guaB genes that encode critical enzymes in the guanine nucleotide biosynthetic pathway. F. tularensis LVSΔguaA and LVSΔguaB mutants were guanine auxotrophs and were highly attenuated in a mouse model of infection. While the mutants failed to replicate in macrophages, a robust proinflammatory cytokine response, equivalent to that of the parental LVS, was elicited. Mice vaccinated with a single dose of the F. tularensis LVSΔguaA or LVSΔguaB mutant were fully protected against subsequent lethal challenge with the LVS parental strain. These findings suggest the specific deletion of these target genes could generate a safe and efficacious live attenuated vaccine.     

Epitope-based vaccination against pneumonic tularemia

Francisella tularensis, the etiological agent of tularemia, is one of the most infectious bacterial pathogens known. No vaccine is currently approved for public use. Previously, we identified epitopes recognized specifically by T cells obtained from individuals following infection with F. tularensis. Here, we report that a subunit vaccine constructed based upon these epitopes elicited protective immunity in “humanized” HLA class II (DRB1*0401) transgenic mice. Vaccinated mice challenged intratracheally with a lethal dose of F. tularensis (Live Vaccine Strain) exhibited a rapid increase in pro-inflammatory cytokine production and diminished number of organisms in the lungs, and a concurrent increased rate of survival. These results demonstrate the efficacy of an epitope-based tularemia vaccine and suggest that such an approach might be widely applicable to the development of vaccines specific for intracellular bacterial pathogens.     

Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review

Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.     

Identification of Francisella tularensis outer membrane protein A (FopA) as a protective antigen for tularemia

Francisella tularensis is a highly pathogenic gram negative bacterium that infects multiple sites in a host, including the skin and the respiratory tract, which can lead to the onset of a deadly disease with a 50% mortality rate. The live vaccine strain (LVS) of F. tularensis, while attenuated in humans but still virulent in mice, is not an option for vaccine use in the United States due to safety concerns, and currently no FDA approved vaccine exists. The purpose of the present work was to assess the ability of recombinant Francisella outer membrane protein A (FopA) to induce a protective response in mice. The gene encoding FopA from F. tularensis LVS was cloned and expressed in Escherichia coli. The resulting recombinant protein was affinity-purified from the E. coli outer membrane, incorporated into liposomes and administered to mice via multiple routes. FopA-immunized mice produced FopA-specific antibodies and were protected against both lethal intradermal and intranasal challenges with F. tularensis LVS. The vaccinated mice had reduced bacterial numbers in their lungs, livers and spleens during infection, and complete bacterial clearance was observed by day 28 post infection. Passive transfer of FopA-immune serum protected naïve mice against lethal F. tularensis LVS challenge, showing that humoral immunity played an important role in vaccine efficacy. FopA-immunization was unable to protect against challenge with the fully virulent SchuS4 strain of F. tularensis; however, the findings demonstrate proof of principle that an immune response generated against a component of a subunit vaccine is protective against lethal respiratory and intradermal tularemia.     

Water as Source of Francisella tularensis Infection in Humans,Turkey

Francisella tularensis DNA extractions and isolates from the environment and humans were genetically characterized to elucidate environmental sources that cause human tularemia in Turkey. Extensive genetic diversity consistent with genotypes from human outbreaks was identified in environmental samples and confirmed water as a source of human tularemia in Turkey.     

Vaccination of Fischer 344 rats against pulmonary infections by Francisella tularensis type A strains

Pneumonic tularemia caused by inhalation of the type A strains of Francisella tularensis is associated with high morbidity and mortality in humans. The only vaccine known to protect humans against this disease is the attenuated live vaccine strain (LVS), but it is not currently registered for human use. To develop a new generation of vaccines, multiple animal models are needed that reproduce the human response to F. tularensis infection and vaccination. We examined the potential use of Fischer 344 rat as such a model. Fischer 344 rats were very sensitive to intratracheal infection with the virulent type A strain SCHU S4 and generally succumbed less than 2 weeks after infection. Similar to humans and non-human primates, Fischer 344 rats vaccinated with LVS by subcutaneous or intradermal routes were protected against a greater range of respiratory SCHU S4 challenge doses than has been reported for LVS vaccinated mice. Intratracheal LVS vaccination also induced effective immunity, but it was less protective when the challenge dose exceeded 10⁵ SCHU S4. LVS vaccination did not prevent SCHU S4 infection but rather controlled bacterial growth and pathology, leading to the eventual clearance of the bacteria. Our results suggest that the Fischer 344 rat may be a good model for studying pneumonic tularemia and evaluating potential vaccine candidates.