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

Autor:	Brett ME; Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Bacterial Diseases Branch., Respicio-Kingry LB; Bacterial Diseases Branch., Yendell S; Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Arboviral Diseases Branch, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado., Ratard R; Louisiana Office of Public Health, New Orleans., Hand J; Louisiana Office of Public Health, New Orleans., Balsamo G; Louisiana Office of Public Health, New Orleans., Scott-Waldron C; Louisiana Office of Public Health, New Orleans., O'Neal C; Infectious Diseases, Louisiana State University Medical Center, Baton Rouge., Kidwell D; Louisiana Office of Public Health, Shreveport Regional Laboratory, Shreveport., Yockey B; Bacterial Diseases Branch., Singh P; Louisiana Department of Corrections, Baton Rouge., Carpenter J; Division of Healthcare Quality Promotion., Hill V; Waterborne Disease Prevention Branch, CDC, Atlanta, Georgia., Petersen JM; Bacterial Diseases Branch., Mead P; Bacterial Diseases Branch.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2014 Sep 15; Vol. 59 (6), pp. 826-33. Date of Electronic Publication: 2014 Jun 18.
DOI:	10.1093/cid/ciu430
Abstrakt:	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. (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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