Francisella philomiragiaAdenitis and Pulmonary Nodules in a Child with Chronic Granulomatous Disease

Abstract

Francisella philomiragiais 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 ofF philomiragiaadenitis 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 ofF philomiragiainfection: 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 ofF philomiragiahas led to delayed identification, patient death and misidentification asFrancisella tularensis- a biosafety level three pathogen and potential bioterrorism agent.