Molecular detection and identification of fatal infectious agent, isolated from patients in an outbreak occurred in Sistan & Balochistan province of Iran

An outbreak of tularemia or plague like syndrome occurred in the province of Sistan and Balochistan of Iran, from May to June 2007. Tularemia and plague had not been reported in this region for last 100 years and before. Thirteen eight cases were identified with ulcer glandular syndrome dominant to all cases with age from children to elderly ages. With fatality rate of 26% and death of 8 patient that have been reported by villagers very late, all other patients and new cases recovered after antibiotic therapy and other heath measures to prevent the spread of diseases. Targeted chemoprophylaxis, sanitation, and vector control played a crucial role in controlling the outbreak. Coco bacillus like agents was isolated from the blood samples of the patients. Epidemiologic, microbiological and molecular analysis of samples findings suggested the possible existence of a local animal reservoir, food or water contamination during this period, but its origin could not be determined. This sudden and unexpected reemergence of tularemia or plague like disease in this province with no background history of rodents or other animal death from the disease or any human cases is important for molecular epidemiology and root finding.