The stealth Francisella: The first fatality caused by Francisella novicida bacteraemia in Malaysia.

Francisella novicida is a rare opportunistic pathogen that is closely related to Francisella tularensis subspecies tularensis and subspecies holartica. However, it does not cause tularaemia and is not transmitted to humans through arthropod bites. This case is the first time this bacterium has been isolated from a patient in Malaysia. The patient was a 69-year-old woman with hypertension and dyslipidaemia, who unfortunately passed away due to the infection. She presented with infective gastroenteritis and deteriorated into full blown Gram-negative bacteraemia. Despite treatment with meropenem, she succumbed to the infection. Identification attempts using conventional and mass spectrometry method failed. The microbiological confirmation relied on next generation sequencing. This case highlights the challenges faced on bacterial identification, possible empirical treatment options for unidentified gram-negative bacteraemia and implication of rare bacterial infection.