The epidemics of noduli mulgentium in Europe and the largest one in Croatia

The first part of the paper describes all extensive epidemics of milker's nodules (noduli mulgentium) in Europe until 1967, also presenting the then state-of-the-art on the disease. This is followed by description of the largest recorded epidemic that occurred in Rijeka hinterland from August to November 1967 involving 136 individuals, mostly women. The epidemiological, clinical, immunologic and genetic aspects of the epidemic are analyzed. Epidemiologically, direct disease transmission from one human to another one, with at least minimal skin lesion preceding the infection, was demonstrated in three cases. The pattern of dissemination to 18 different locations suggested the infection in animals to have also been mediated by some insect species. Clinically, the recorded complications of the disease included pyoderma and secondary exanthema (30% and 15% of cases), the latter being accompanied by eosinophilia in 10% to 19% of cases. Both complications regularly disappeared before the clearance of primary efflorescence. Three pregnant women were affected in the first trimester when the fetal effect of the virus is most risky. However, no teratogenic effect on the fetus could be proved in these children at birth or at the age of two years. The prevalence of the disease has been on a decrease worldwide owing to the very successful and inexpensive preventive measures in humans (wearing rubber gloves on milking affected cows). As the disease, still burdened with some obscurities, belongs to the group of zoonoses that are interesting not only to dermatologists but also to veterinarians, epidemiologists, microbiologists and others, it appears worthy to present this shortened version of a thesis entitled "Tubercula mulgentium s.s. according to Berger" (then the accepted term for the disease in human and veterinary medicine), defended at School of Medicine, University of Ljubljana, in Ljubljana, Slovenia.