title: Outbreak of Francisella novicida bacteremia among inmates at a louisiana correctional facility.
abstract: 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.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Bacterial Diseases Branch.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Brett
authors.affiliation: Bacterial Diseases Branch.
authors.forename: Laurel B
authors.initials: LB
authors.lastname: Respicio-Kingry
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia Arboviral Diseases Branch, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Yendell
authors.affiliation: Louisiana Office of Public Health, New Orleans.
authors.forename: Raoult
authors.initials: R
authors.lastname: Ratard
authors.affiliation: Louisiana Office of Public Health, New Orleans.
authors.forename: Julie
authors.initials: J
authors.lastname: Hand
authors.affiliation: Louisiana Office of Public Health, New Orleans.
authors.forename: Gary
authors.initials: G
authors.lastname: Balsamo
authors.affiliation: Louisiana Office of Public Health, New Orleans.
authors.forename: Christine
authors.initials: C
authors.lastname: Scott-Waldron
authors.affiliation: Infectious Diseases, Louisiana State University Medical Center, Baton Rouge.
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Neal
authors.affiliation: Louisiana Office of Public Health, Shreveport Regional Laboratory, Shreveport.
authors.forename: Donna
authors.initials: D
authors.lastname: Kidwell
authors.affiliation: Bacterial Diseases Branch.
authors.forename: Brook
authors.initials: B
authors.lastname: Yockey
authors.affiliation: Louisiana Department of Corrections, Baton Rouge.
authors.forename: Preety
authors.initials: P
authors.lastname: Singh
authors.affiliation: Division of Healthcare Quality Promotion.
authors.forename: Joseph
authors.initials: J
authors.lastname: Carpenter
authors.affiliation: Waterborne Disease Prevention Branch, CDC, Atlanta, Georgia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Hill
authors.affiliation: Bacterial Diseases Branch.
authors.forename: Jeannine M
authors.initials: JM
authors.lastname: Petersen
authors.affiliation: Bacterial Diseases Branch.
authors.forename: Paul
authors.initials: P
authors.lastname: Mead
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia; D015897:Comorbidity; D003428:Cross Infection; D004269:DNA, Bacterial; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D017809:Fatal Outcome; D005603:Francisella / Q000145:classification* / Q000235:genetics*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D006268:Health Facilities; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012336:RNA, Ribosomal, 16S; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S
keywords: Francisella novicida; ice; outbreak; prison