Journal Article

Outbreak of <i>Francisella novicida</i> Bacteremia Among Inmates at a Louisiana Correctional Facility

Meghan E. Brett, Laurel B. Respicio-Kingry, Stephanie Yendell, Raoult Ratard, Julie Hand, Gary Balsamo, Christine Scott-Waldron, Catherine O'Neal, Donna Kidwell, Brook Yockey, Preety Singh, Joseph Carpenter, Vincent Hill, Jeannine M. Petersen and Paul Mead

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 59, issue 6, pages 826-833
Published in print September 2014 | ISSN: 1058-4838
Published online June 2014 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/ciu430
Outbreak of Francisella novicida Bacteremia Among Inmates at a Louisiana Correctional Facility

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Background.Francisella novicida is a rare cause of human illness despite its close genetic relationship to Francisella tularensis, the agent of tularemia. During April–July 2011, 3 inmates at a Louisiana correctional facility developed F. novicida bacteremia; 1 inmate died acutely.

Methods. We interviewed surviving inmates; reviewed laboratory, medical, and housing records; and conducted an environmental investigation. Clinical and environmental samples were tested by culture, real-time polymerase chain reaction (PCR), and multigene sequencing. Isolates were typed by pulsed-field gel electrophoresis (PFGE).

Results. Clinical isolates were identified as F. novicida based on sequence analyses of the 16S ribosomal RNA, pgm, and pdpD genes. PmeI PFGE patterns for the clinical isolates were indistinguishable. Source patients were aged 40–56 years, male, and African American, and all were immunocompromised. Two patients presented with signs of bacterial peritonitis; the third had pyomyositis of the thigh. The 3 inmates had no contact with one another; their only shared exposures were consumption of municipal water and of ice that was mass-produced at the prison in an unenclosed building. Swabs from one set of ice machines and associated ice scoops yielded evidence of F. novicida by PCR and sequencing. All other environmental specimens tested negative.

Conclusions. To our knowledge, this is the first reported common-source outbreak of F. novicida infections in humans. Epidemiological and laboratory evidence implicate contaminated ice as the likely vehicle of transmission; liver disease may be a predisposing factor. Clinicians, laboratorians, and public health officials should be aware of the potential for misidentification of F. novicida as F. tularensis.

Keywords: Francisella novicida; ice; outbreak; prison

Journal Article.  4207 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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