Produces poisonous
H2S gas and necrotizing infections

Exposure of Laboratory Workers to Francisella tularensis despite a Bioterrorism Procedure

A rapidly fatal case of pulmonary tularemia in a 43-year-old man who was transferred to a tertiary care facility is presented. The
microbiology laboratory and autopsy services were not notified of the clinical suspicion of tularemia by the service caring for the
patient. Despite having a laboratory bioterrorism procedure in place and adhering to established laboratory protocol, 12
microbiology laboratory employees were exposed to Francisella tularensis and the identification of the organism was delayed due
to lack of notification of the laboratory of the clinical suspicion of tularemia. A total of 11 microbiology employees and two persons
involved in performing the patient's autopsy received prophylactic doxycycline due to concerns of transmission. None of them
developed signs or symptoms of tularemia. One microbiology laboratory employee was pregnant and declined prophylactic
antibiotics. As a result of this event, the microbiology laboratory has incorporated flow charts directly into the bench procedures for
several highly infectious agents that may be agents of bioterrorism. This should permit more rapid recognition of an isolate for
referral to a Level B laboratory for definitive identification and should improve laboratory safety.

At the autopsy, the findings included bilateral hemorrhagic necrotizing pneumonia with lobar consolidation.
Microabscesses were found in the spleen and liver, and bilateral acute tubular necrosis of both kidneys was present.
J Clin Microbiol. 2002 June; 40(6): 2278–2281.

The Francisella tularensis sequencing project is part of the NIAID funded Microbial Sequencing Center at
the Broad Institute.

Francisella tularensis is the causative agent of tularemia, a zoonotic disease that has gained special interest of late
due in part to its very high infectivity that enables airborne transmission and a very low infection dose. As few as ten
bacteria by the respiratory route can cause disease in humans (1). For this reason, F. tularensis is considered a
potential bioterrorism agent and it is one of only three bacterial pathogens included in the NIAID category A list of
select agents. Although the more common form of the disease (ulceroglandular tularemia) is contracted from the bite
of ticks or other arthopods that have fed on infected animals (rabbits, ground squirrels, and other rodents), the
disease can also be transmitted by airborne route. Pneumonic tularemia is contracted through aerosol generated by
farming activities in areas populated by infected animals. The severity of the disease is variable and depends both on
the route of infection and the virulence of the organism. Interestingly, tularemia has been known to occur only in the
Northern Hemisphere, although recently, a case has been reported in Australia and a Francisella novicida-like strain
has been implicated (2).

Treatment of murine pneumonic Francisella tularensis infection with gatifloxacin, moxifloxacin or

The efficacies of gatifloxacin and moxifloxacin were assessed in a BALB/c mouse model of pneumonic tularemia and
compared with the efficacy of ciprofloxacin. The rate of relapse following dexamethasone treatment was also
investigated. Mice were given 100 mg/kg of the antibiotic by oral administration twice daily for 14 days following an
aerosol challenge. All three fluoroquinolones prevented disease during the treatment period, but significant failure
rates occurred after the cessation of therapy. Both gatifloxacin and moxifloxacin were more effective than ciprofloxacin
at reducing late mortality. Fluoroquinolones may therefore be considered useful candidates for the treatment of
pneumonic tularemia.
International Journal of Antimicrobial Agents, Volume 27, Issue 5, May 2006, Pages 439-443

Tularemia: emergence/re-emergence

Abstract -
Francisella tularensis is a gram-negative coccobacillus and the etiologic agent of the zoonotic disease tularemia. First
described in 1911 in Tulare County, California, it has since been reported throughout the Northern Hemisphere, with
natural infections reported among an unusually wide range of vertebrates and invertebrates. In recent years,
tularemia has emerged in new geographic locations, populations, and settings. This review will serve to highlight
mechanisms contributing to the recent emergence of tularemia as well as a repertoire of diagnostic tools useful for
detecting and diagnosing disease.

Vet. Res. 36 (2005) 455-467

Problems in Identification of Francisella philomiragia Associated with Fatal Bacteremia in a Patient with
Chronic Granulomatous Disease

Francisella philomiragia is a rare gram-negative, halophilic coccobacillus with bizarre spherical forms on primary
isolation. A case of F. philomiragia bacteremia in a 24-year-old patient with chronic granulomatous disease is
reported. Identification of F. philomiragia was problematic with conventional tests but was done correctly and rapidly
by kit 16S ribosomal DNA sequencing.
J Clin Microbiol. 2004 April; 42(4): 1840–1842

Francisella tularensis peritonitis in stomach cancer patient.

Tularemia with peritonitis developed in a 50-year-old man soon after diagnosis of stomach cancer with metastasis.
The asciteschyliform ascites , chylous ascites the presence of chyle in the peritoneal cavity owing to anomalies,
injuries, or obstruction of the thoracic duct.
Francisella philomiragia adenitis and pulmonary nodules in a child with chronic granulomatous disease

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
gramilomatous 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.
Canadian Journal of Infectious Diseases & Medical Microbiology, 2005 (Vol. 16) (No. 4) 245-248