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Fusobacterium Infection

Fusobacterium Infections

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.


Presentation

Fusobacterium spp. (F. necrophorum and F. nucleatum) are gram-negative anaerobic bacterial microorganisms that normally reside in the human oropharynx as commensal flora [1] [2]. 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) [2] [3]. 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 [1] [2] [3]. 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 [4]. 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 [2] [4]. Patients complain of a sore throat, pain in the neck, fever, lethargy, and poor general condition [5] [6]. The infection is known to be life-threatening in the absence of early antibiotic therapy [1] [2] [4] [5] [6]. 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 [1] [5].

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]

Workup

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 [2] [5]. 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 [5] [7]. 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 [1] [2] [5] [7]. 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 [5] [7]. 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 [5] [6].

Treatment

  • 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]
  • Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre's syndrome is presented.[unboundmedicine.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]
  • […] rely on their own discretion and judgment in medical diagnosis and treatment.[redbook.solutions.aap.org]
  • There is furthermore no proof that treatment of fusobacterium will hasten symptom improvement or, more importantly, prevent Lemierre’s.[blogs.jwatch.org]

Prognosis

  • 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]
  • 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]
  • 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]

Etiology

  • 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]
  • 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]
  • 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]
  • Scand J Infect Dis 44:848–851. doi: 10.3109/00365548.2012.690161 View Article Google Scholar Crippin JS, Wang KK (1992) An unrecognized etiology for pyogenic hepatic abscesses in normal hosts: dental disease.[springerplus.springeropen.com]

Epidemiology

  • Discussion The organization of microbiology diagnostic services in the Calgary Zone of AHS provides the ability to study the epidemiology of uncommon infections in this defined population.[bmcinfectdis.biomedcentral.com]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.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 outcome of mould infections in hematopoietic stem cell transplant recipients". Clin Infect Dis.. 2002. pp. 909. Andreassen, UK, Baer, S, Nielsen, TG.[clinicaladvisor.com]
  • Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroentrol Hepatol 2004;2:1032. 3. Rahimian J, Wilson T, Oram V, et al. Pyogenic liver abscess: Recent trends in etiology and prognosis.[bcmj.org]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • 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]
  • You agree to immediately notify us in the event you determine, or have reason to believe, that an unauthorized party has gained access to the Materials and to take all reasonable steps, both to ensure that such activity ceases and to prevent any recurrence[redbook.solutions.aap.org]
  • […] the release of acetylcholine at nueromuscular junctions, which prevents contractions and causes flaccid paralysis Normal Intestinal Flora Can be nosocomial in hospitals in patients with broad spectrum antibiotics Two Toxins: 1.[quizlet.com]

References

Article

  1. Creemers-Schild D, Gronthoud F, Spanjaard L, Visser LG, Brouwer CNM, Kuijper EJ. Fusobacterium necrophorum, an emerging pathogen of otogenic and paranasal infections? New Microbes New Infect. 2014;2(3):52-57.
  2. Riordan T. Human Infection with Fusobacterium necrophorum (Necrobacillosis), with a Focus on Lemierre’s Syndrome. Clin Microbiol Rev. 2007;20(4):622-659.
  3. Afra K, Laupland K, Leal J, Lloyd T, Gregson D. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC Infect Dis. 2013;13:264
  4. Shahani L, Khardori N. Fusobacterium necrophorum – beyond Lemierres syndrome. BMJ Case Reports. 2011;2011:bcr0720114527.
  5. Arane K, Goldman RD. Fusobacterium infections in children. Can Fam Physician. 2016;62(10):813-814.
  6. Cheung WY, Bellas J. Fusobacterium: Elusive cause of life-threatening septic thromboembolism. Can Fam Physician. 2007;53(9):1451-1453.
  7. 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.

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Last updated: 2018-06-21 23:40