Francisella novicida infection in a patient with pulmonary infection and pancreatitis in Italy
Sara Rigamonti,
Emanuela Olivieri,
Nadia Vicari,
Erika Scaltriti,
Moira Bazzucchi,
Claudio Marco Lodola,
Arianna Torri,
Vittorio Sambri,
Carlo Biagetti,
Paola Prati
Affiliations
Sara Rigamonti
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy
Emanuela Olivieri
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy; Corresponding author.
Nadia Vicari
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy
Erika Scaltriti
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. dei Mercati, 13a, Parma, PR 43126, Italy
Moira Bazzucchi
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy
Claudio Marco Lodola
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy
Arianna Torri
Unit of Microbiology, Greater Romagna Hub Laboratory, Piazza della Liberazione, 60, Pievesestina Forlì-Cesena 47522, Italy
Vittorio Sambri
Unit of Microbiology, Greater Romagna Hub Laboratory, Piazza della Liberazione, 60, Pievesestina Forlì-Cesena 47522, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Via Irnerio 49, Bologna 40126, Italy
Carlo Biagetti
Division of Infectious diseases, Infermi Hospital, AUSL Romagna, Viale Luigi Settembrini,2, Rimini 47923, Italy
Paola Prati
Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna (IZSLER), Str. Privata Campeggi, 59, Pavia 27100, Italy
Tularemia is a rare but potentially life threatening zoonotic disease caused by Francisella tularensis. F. novicida, previously considered a subspecies of F. tularensis, is currently considered a separate species. Human infections related to F. novicida are exceedingly rare but can cause morbidity and mortality in debilitated or immunocompromised individuals.A 42-year-old male presented at the hospital with vomiting, dehydration, constipation and pain in the right iliac fossa. He was first diagnosed with pancreatitis and admitted for further analysis. Chest computerized tomography scan showed the presence of parenchymal consolidation in the left upper and lower lobes of the lung with pleural effusion. Blood cultures isolated a Gram-negative coccobacillus, that was at first identified by MALDI-TOF as Francisella tularensis. Serological analysis for the detection of total antibodies against F. tularensis and Real-Time PCR targeting the gene coding for 23 kDa, resulting negative. Subsequently, PCR targeting helicases and tul4 genes, and the Regions of Difference RD1 and RD6 were performed allowing the identification of F. novicida. The isolate was further genetically characterized by whole genome sequencing (WGS).This is the first reported case of human infection caused by F. novicida in Italy.Given the rarity of human cases and the lack of specific symptoms, this pathogen is difficult to identify and the diagnosis can be extremely challenging. In this case report, despite the lack of amplification of the gene encoding for 23 kDa protein, the identification of Francisella species was achieved with the amplification of different genes and characterized by WGS.
