Outbreak of Francisella novicida Bacteremia Among Inmates at a Louisiana Correctional Facility
Outbreak of Francisella novicida Bacteremia Among Inmates at a Louisiana Correctional Facility
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DOI：
10.1093/cid/ciu430
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发表时间：
2014-09-15
影响因子：
11.8
通讯作者：
Mead, Paul
中科院分区：
文献类型：
--
作者：
Brett, Meghan E.;Respicio-Kingry, Laurel B.;Mead, Paul
背景新杀弗朗西斯菌是一种罕见的人类疾病的原因，尽管其密切的遗传关系，土拉热弗朗西斯菌，土拉菌病的代理。在2011年4月至7月期间，路易斯安那州一所教养所的3名囚犯患上了F。1例急性死亡。我们采访了幸存的囚犯;审查了实验室，医疗和住房记录;并进行了环境调查。临床和环境样本进行了测试，培养，实时聚合酶链反应（PCR）和多基因测序。用脉冲场凝胶电泳（PFGE）对分离株进行分型。临床分离株经鉴定为F.基于16 S核糖体RNA、pgm和pdpD基因的序列分析，临床分离株的PmeI PFGE模式难以区分。来源患者年龄为40-56岁，男性，非洲裔美国人，均为免疫功能低下。两名患者出现细菌性腹膜炎体征;第三名患者出现大腿化脓性肌炎。这3名囚犯彼此之间没有联系;他们唯一的共同接触是饮用市政水和在监狱一个不封闭的建筑物内大量生产的冰。从一台制冰机和相关的冰勺上取下的拭子显示F。通过PCR和测序鉴定杀线虫活性。所有其他环境标本检测均为阴性。据我们所知，这是第一次报道的F。在人类中的novicida感染。流行病学和实验室证据表明，受污染的冰可能是传播媒介;肝脏疾病可能是一个诱发因素。临床医生、实验室工作者和公共卫生官员应该意识到F. novicida as F.土拉热。
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.