Abstract
Francisella philomiragia is a rare and opportunistic pathogen capable of producing invasive infection in patients with compromised neutrophil function and in patients that have survived a near-drowning. A case of F philomiragia adenitis and lung nodules, refractory to cephalosporin therapy, is reported in a 10-year-old boy with chronic granulomatous disease following a facial abrasion from a saltwater crab. To the authors' knowledge, this is the first Canadian clinical isolate to be reported. Genus and species identification was confirmed via 16S ribosomal RNA sequence analysis. A literature review revealed three groups at risk of F philomiragia infection: young patients with chronic granulomatous disease; adults with hematogenous malignancy; and near-drowning patients. Pneumonia, fever without an apparent source and sepsis are the main clinical presentations. Invasive procedures may be required to isolate this organism and ensure appropriate antimicrobial therapy. Limited awareness of F philomiragia has led to delayed identification, patient death and misidentification as Francisella tularensis - a biosafety level three pathogen and potential bioterrorism agent.
Highlights
Francisella philomiragia is a rare and opportunistic pathogen capable of producing invasive infection in patients with compromised neutrophil function and in patients that have survived a near-drowning
The present article describes the first case of Francisella philomiragia infection reported in Canada, which manifested as adenitis and pulmonary infection in a patient with chronic granulomatous disease (CGD)
As noted by Wenger et al [1], patients fell into three main categories: CGD patients; patients that experienced near-drownings in saltwater; and adults with hematological malignancy
Summary
A case of F philomiragia adenitis and lung nodules, refractory to cephalosporin therapy, is reported in a 10-year-old boy with chronic granulomatous disease following a facial abrasion from a saltwater crab. Unlike its more virulent relative Francisella tularensis, F philomiragia is an opportunist, causing pneumonia and systemic infection almost exclusively in immunocompromised patients or following near-drowning. Limited awareness of this organism has led to delayed diagnosis, therapeutic failures and poor outcomes. CASE PRESENTATION A 10-year-old boy with CGD and on long-term itraconazole and trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis presented with a two-week history of fatigue and intermittent fever, followed by the appearance of tender, left-sided submandibular swelling He subsequently developed a nonproductive cough and was brought to his physician for assessment. Examination of a follow-up chest x-ray revealed a small effusion at the right lung base
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