We report isolation of Francisella novicida-causing bacteremia in a woman from Thailand who was receiving chemotherapy for ovarian cancer. The organism was isolated from blood cultures and identifi ed by 16S rDNA and PPIase gene analyses. Diagnosis and treatment were delayed due to unawareness of the disease in this region.F rancisella novicida, a rare human pathogen, has recently been considered to be a subspecies of F. tularensis on the basis of DNA similarity (1,2). The reservoir and transmission route of F. novicida were not clearly defi ned. Since the fi rst isolation of F. novicida, to our knowledge, only 5 patients with suspected infection have been reported (3-5). F. novicida, however, has neither been isolated nor associated with human disease in Thailand. We report a case of F. novicida infection in a Thai patient who was undergoing chemotherapy. The StudyIn October 2007, a 37-year-old woman from Thailand sought treatment at Siriraj Hospital (a 2,400-bed university hospital in Bangkok, Thailand) with a history of fever for 1 week. She was a hairdresser residing in a suburban area of Prachuap Khiri Khan, a southern province of Thailand. She denied history of blood transfusion, animal contact, and travel abroad. She had not been aware of being bitten by insects recently. There was no incidence of unusual animal death in the area in which she resided. Five months before seeking treatment, she received a diagnosis of advanced stage clear cell adenocarcinoma of the ovary with metastasis to peritoneum, spleen, uterus, and multiple abdominal lymph nodes. Chemotherapy was planned. Initial laboratory screening showed increased liver enzyme levels and abnormal hepatitis markers confi rming chronic active hepatitis B virus infection. Chemotherapy was delayed while she was treated with lamivudine. A follow-up visit in early September showed that her liver function biochemistry results had returned to within normal limits. Chemotherapy with carboplastin and paclitaxel was then initiated.At the time of admission, 25 days after the start of chemotherapy, the patient had fever (39 o C), blood pressure 90/60 mm Hg, and pulse rate 75 beats/min. She also had an episode of gastrointestinal hemorrhage with melena. It was believed that fever and gastrointestinal bleeding were complications from chemotherapy; thus, microbiologic investigation was not promptly initiated. Abnormal laboratory fi ndings included anemia (hemoglobin 80 g/L) and leukocytosis with marked neutrophilia (Figure). Urine and stool cultures showed insignifi cant growth.Two samples of blood cultures from peripheral lines were obtained using BacT/Alert FA bottles (bioMérieux, Durham, NC, USA) on day 10 of hospital admission and incubated in the continuous monitoring BacT/Alert 3D system (bioMérieux). Both blood culture bottles grew small pleomorphic gram-negative coccobacillus after incubation for 2 days. Samples from positive bottles were subcultured onto 5% (vol/vol) sheep blood agar, MacConkey agar, and chocolate agar. A slow-growing bacterium was recove...
Background Only three other cases of rat bite fever caused by Streptobacillus notomytis in humans have been reported since this species was identified in 2015. Data specific to the differences in clinical features and geographic distribution between S. notomytis infection and S. moniliformis infection are scarce. All previous cases of human S. notomytis infection were reported from Japan. This is the first case of S. notomytis infection reported from outside of Japan. Case presentation A 72-year-old Thai woman was admitted to Siriraj Hospital (Bangkok, Thailand)—Thailand’s largest university-based national tertiary referral center—in August 2020 with fever, myalgia, and polyarthralgia for 3 days, and gradually decreased consciousness for the past 1 day. Physical examination and laboratory investigations revealed septic arthritis of both knee joints, meningitis, and hepatitis. She was initially misdiagnosed as rheumatoid arthritis in the elderly since the initial investigations were unable to detect a causative pathogen. However, S. notomytis infection was later confirmed by polymerase chain reaction amplification of a part of the 16S rRNA gene and sequencing from synovial fluid. Her clinical course was also complicated by spondylodiscitis and epidural abscess caused by S. notomytis, which was detected from tissue biopsy. Therefore, rat bite fever in this patient manifested as meningitis, septic polyarthritis, hepatitis, and spondylodiscitis. The patient was treated with intravenous ceftriaxone then switched to oral amoxicillin with complete recovery. Conclusions The clinical manifestations of S. notomytis infection are similar to those demonstrated in S. moniliformis infection. This case also showed that arthritis caused by S. notomytis mimics rheumatoid arthritis, and that meningitis and spondylodiscitis are potential coexisting complications that can be found in S. notomytis infection.
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