Fusobacterium infection is rare, but possibly life-threatening infection characterized by sepsis and thrombophlebitis of the internal jugular veins, also known as termed Lemièrre's syndrome. A range of other clinical manifestations exist and various complications may arise. The diagnosis cannot be made without high clinical suspicion and proper microbiological studies.
Fusobacterium spp. (F. necrophorum and F. nucleatum) are gram-negative anaerobic bacterial microorganisms that normally reside in the human oropharynx as commensal flora  . For still unknown reasons, the infection can develop in young and healthy adults (F. necrophorum) and in the elderly population with various risk factors, most important being dialysis of neoplastic disease (F. nucleatum)  . Fusobacterium infection is most commonly encountered in the form of Lemièrre's syndrome - initial infection of the oropharynx (angina and/or tonsillitis) is followed by thrombophlebitis of the internal jugular vein and septic dissemination of the bacteria through this venous vessel   . Fusobacteria is able to reach the internal jugular vein through the lateral pharyngeal space, triggering the formation of platelet aggregates and an intense inflammatory reaction . Approximately 7 days pass from throat infection to the formation of septic emboli, which travel to the lungs and the larger joints in most cases  . Patients complain of a sore throat, pain in the neck, fever, lethargy, and poor general condition  . The infection is known to be life-threatening in the absence of early antibiotic therapy     . In addition to Lemièrre's syndrome, other infections of the head and neck (mastoiditis, sinusitis, abscess formation, and otitis, commonly seen in in the pediatric population), as well as meningitis are possible manifestations of fusobacterium infection, and organ-related signs and symptoms are noted  .
Entire Body System
- Foul Smelling Discharge
A foul-smelling discharge is pathognomonic although its absence does not exclude a diagnosis. Several anaerobic culture systems are available. Normal blood agar plates can be used. [virology-online.com]
Major Clues to Anaerobic Infection Foul-smelling discharge Infection in proximity to a mucosal surface Tissue necrosis, gangrene Gas in tissues or discharges Infection associated with malignancy Infections secondary to human or animal bite Infection related [antimicrobe.org]
The diagnosis of fusobacterium infection is difficult to make without a thorough clinical investigation that might lead the physician toward this pathogen as the underlying cause. A detailed patient history is perhaps a pivotal step, as the initial signs and symptoms of a sore throat and subsequent deterioration can be indicative of fusobacterium infection. After a complete physical examination, imaging and microbiological studies should be employed to solidify the diagnosis. Computed tomography (CT) is recommended, as it is able to detect multiple septic emboli and confirm inflammatory lesions in the sinuses, the mastoid processes and in other organs  . Conversely, microbiological examination, principally in the form of blood cultures, is advised, but because several weeks are necessary for fusobacterium growth, more advanced methods are necessary  . For this reason, polymerase chain reaction (PCR), a procedure that detects bacterial deoxyribonucleic acid (DNA) in patient samples, should be performed whenever possible, as it carries a very good rate of diagnosis in a much faster manner than blood cultures    . Its price and the need for advanced laboratory requirement, however, limits the use of this procedure in many parts of the world in daily practice  . In spite of the challenges faced in confirming fusobacterium infection, reports have emphasized the perhaps critical role of the physician's awareness of this bacterial microorganism in the differential diagnosis, suggesting that clinical findings seen in these patients must include fusobacterium as a possible cause  .
Proper treatment requires recognition of the oropharyngeal source of the septicemia and its differentiation from endocarditis. Antibiotic therapy should be prolonged, and metastatic abscesses drained. [utsouthwestern.influuent.utsystem.edu]
Empiric antibiotic treatment was started with ceftazidime. [onlinelibrary.wiley.com]
Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre's syndrome is presented. [unboundmedicine.com]
Proper treatment requires recognition of the oropharyngeal source of the septicemia and its differentiation from endocarditis. Antibiotic therapy should be prolonged, and metastatic abscesses drained. (JAMA 1982;248:1348-1350) [jamanetwork.com]
Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med. 2006;119:993e7–10. CrossRef Google Scholar 17. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. [link.springer.com]
In general, prognosis for full recovery is good if prompt and appropriate treatment is given. A mortality rate of 4–18% has been recorded in the past [6, 16]. [hindawi.com]
Immunocompromised patients, the elderly, diabetics, patients with renal insufficiency, or patients with congestive heart failure are at increased risk for developing FB, and carry a worse prognosis [1, 4]. [cambridge.org]
【論文名】 Human microbiome Fusobacterium nucleatum in esophageal cancer tissue is associated with prognosis 【著者名・所属】 Kensuke Yamamura, 1 Yoshifumi Baba, 1 Shigeki Nakagawa, 1 Kosuke Mima, 1 Keisuke Miyake, 1 Kenichi Nakamura, 1 Hiroshi Sawayama, 1 Koichi [kumamoto-u.ac.jp]
The prognosis for Lemierre’s syndrome is good. Fewer than 5 percent of all people diagnosed with Lemierre’s syndrome die from complications due to the infection. [healthline.com]
A recent systematic review of 102 studies (114 patients) of Lemierre’s syndrome reported the incidence, etiology, management, and prognosis of the rare syndrome. 5 This review reported that most cases (51%) present in the second decade of life, most [healio.com]
It remains unknown whether there is any etiological link between microorganisms and colorectal carcinoma. Any such link could provide a potential mode of intervention in the prevention of colonic cancer. Fusobacterium necrophorum Gram stain [anaerobicinfections.blogspot.com]
In this case, routine sections stained with hematoxylin and eosin (H&E) provided strong evidence against a neoplastic etiology and indicated an infectious/inflammatory process. [karger.com]
Fusobacterium necrophorum is the usual etiologic agent. There is little data on its epidemiology, though one Danish study reported an incidence of 0.8/1,000,000. [path.upmc.edu]
Pyogenic liver abscess: Recent trends in etiology and prognosis. Clin Infect Dis 2007;44:1194-1201. 4. Mohsen AH, Green ST, Read RC, et al. Liver abscess in adults: Ten years experience in a UK centre. QJM 2002;95:797. 5. [bcmj.org]
Studies on local and invasive infections with Fusobacterium necrophorum, involving national epidemiology of bacteremia and Lemierrè's syndrome, anticoagulant therapy of associated septic thromboflebitis, prospective coagulation studies on patients with [portal.research.lu.se]
Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. [cambridge.org]
Goldberg EA, Venkat-Ramani T, Hewit M, Bonilla HF: Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia. Epidemiol Infect. 2012, 141: 325-329. 4. [bmcinfectdis.biomedcentral.com]
There is little data on its epidemiology, though one Danish study reported an incidence of 0.8/1,000,000. LS was first described by the French physician Lemierre in a Lancet article published in 1936. [path.upmc.edu]
Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia. Epidemiol Infect. 2013 Feb;141(2):325-9. DOI: 10.1017/S0950268812000660 11. Pett E, Saeed K, Dryden M. [egms.de]
S.aureus) PATHOPHYSIOLOGY Primary infection is followed by local invasion of the lateral pharyngeal space then septic thrombophlebitis of the IJ vein primary source of infection is commonly the palatine tonsils and peritonsillar tissue other sources include [lifeinthefastlane.com]
In an effort to find a prophylactic preventive method against the detrimental birth outcome induced by F. nucleatum placental infection, omega-3 fatty acids were tested for their anti-inflammatory properties. [academiccommons.columbia.edu]
Any such link could provide a potential mode of intervention in the prevention of colonic cancer. Fusobacterium necrophorum Gram stain [anaerobicinfections.blogspot.com]
There is furthermore no proof that treatment of fusobacterium will hasten symptom improvement or, more importantly, prevent Lemierre’s. [blogs.jwatch.org]
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- Aliyu SH, Marriott RK, Curran MD, et al. Real-time PCR investigation into the importance of Fusobacterium necrophorum as a cause of acute pharyngitis in general practice. J Med Microbiol. 2004;53(Pt 10):1029–1035.