IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
Can J Infect Dis Med Microbiol. 2005 Jul;16(4):245-8. doi: 10.1155/2005/486417.
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.
嗜肺军团菌是一种罕见的机会性病原体，能够在中性粒细胞功能受损的患者和经历近乎溺水的患者中引起侵袭性感染。本文报告了一例嗜肺军团菌腺病和肺结节病例，患者为 10 岁慢性肉芽肿病男孩，面部被咸水蟹擦伤。据作者所知，这是加拿大首例临床分离株。通过 16S 核糖体 RNA 序列分析确认了属和种的鉴定。文献复习显示，嗜肺军团菌感染的高危人群有三组：患有慢性肉芽肿病的年轻患者；患有血液恶性肿瘤的成年人；以及经历近乎溺水的患者。肺炎、无明显病因的发热和败血症是主要的临床表现。为了分离该病原体并确保适当的抗菌治疗，可能需要进行侵入性操作。对嗜肺军团菌的认识有限导致了诊断延迟、患者死亡和错误鉴定为弗朗西斯菌——一种生物安全三级病原体和潜在的生物恐怖主义剂。
