Outbreak of Francisella novicida bacteremia among inmates at a louisiana correctional facility.

[pyomyositis]

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 .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 ).Clinical isolates were identified as F . novicida based on sequence analyses of the 16 S 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 .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 .

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pyomyositis

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