Abstract: SA-PO1143
Francisella novicida: An Exceedingly Rare Cause of Pneumonia in a Kidney Transplant Recipient
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Acosta, Enrique, Methodist Dallas Medical Center, Dallas, Texas, United States
- Castillo-Lugo, Jose A., Dallas Nephrology Associates, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Dallas Nephrology Associates, Dallas, Texas, United States
- Dominguez, Edward A., Methodist Transplant Physicians, Dallas, Texas, United States
Introduction
Francisella novicida is a gram negative coccobacilli that very rarely causes human illness. Its close relative F. tularensisis is well known for causing tularemia. Unlike F. tularensis, there have been no documented cases of F. novicida transmission to humans by through arthropod bites. All documented cases are associated with patients who are immunocompromised. Common clinical symptoms include fever, myalgias, lymphadenopathy, and pneumonia. F. novicida infection in humans is exceedingly rare and therefore often difficult to diagnose accurately. Only 11 cases of infection in humans have been documented.
Case Description
A 63-year-old AA woman with history of hypothyroidism and End Stage Kidney Disease on hemodialysis secondary to hypertension was admitted to the hospital for an elective kidney transplant. She underwent an en blocpediatric kidney transplant and received thymoglobulin induction due to the presence of a high cPRA of 91%. On post-op day 3 she developed hypoxemia with increased oxygen requirements and high-grade fever on post-op day 5. Chest CT showed diffuse bilateral patchy pulmonary infiltrates. Initial suspicion was volume overload or capillary leak syndrome due to thymoglobulin. However, oxygen requirements did not improve with ultrafiltration. Bronchoscopy with broncho alveolar lavage (BAL) was performed on post-op day 7. Initial blood cultures revealed gram negative coccobacilli. She was started on empiric meropenem, micafungin, and vancomycin which did not improve clinical status and Infectious Disease service added empiric fluoroquinolones. Francisella novicida was isolated in 2 sets of blood cultures and in BAL specimens. Final identification was performed at Centers for Disease Control and Prevention in Fort Collins, Colorado. The patient completed 14 days of fluoroquinolones and symptoms subsided. Kidney function improved and she is no longer on dialysis.
Discussion
Per our literature review, this is the first time that this bacteria has been isolated in a specimen other than blood or lymph node. Notably, there was an outbreak of F. novicida in a correctional facility in the patient’s hometown in 2011. This case illustrates the value of a thorough history, the importance of interdisciplinary management, and the crucial role of early recognition of sepsis in solid organ transplant patients.