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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].

Wound Infection
  • Comparative in vitro activity of ertapenem and 11 other antimicrobial agents against aerobic and anaerobic pathogens isolated from skin and soft tissue animal and human bite wound infections. J Antimicrob Chemother. 2001;48:641–51.[link.springer.com]
  • infections, peritonities Bacteroides Peptostreptococcus Fusobacterium Pulmonary anaerobic infections Abscess, necrotizing pneumonia, aspiration pneumonia Peptostreptococcus Fusobacterium Actinomyces Prevotella Melaninogencia Pelvic anaerobic infections[quizlet.com]
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]
Animal Bite
  • bites Clostridium Perfringens (gas gangrene) Peptostreptococcus Bacteroides S.[quizlet.com]
Abdominal Pain
  • He complained of fever and abdominal pain, and had a liver abscess of 6 cm in diameter. Fusobacterium was isolated from abscess in both cases as a result of percutaneous transhepatic drainage.[jstage.jst.go.jp]
  • Abstract An 18-year-old male was admitted to the Accident & Emergency department with complaints of abdominal pain, vomiting and diarrhoea. He was clinically jaundiced and further CT scan suggested liver abscess.[unboundmedicine.com]
  • She had diffuse abdominal pain that had become localized to the right upper quadrant, and had progressed to being sharp and steady in nature and worse with inspiration.[bcmj.org]
  • Case Report A 65-year-old man presented to the emergency department with fever, chills, nausea and abdominal pain.[karger.com]
Neck Pain
  • Within four to five days, the symptoms progress to include: Fever and chills One-sided neck pain and swelling Trouble swallowing Chest pain Cough Shortness of breath Coughing up blood Joint pain Night sweats Yellowish eyes and skin (jaundice) Severe or[everydayhealth.com]
  • Case Report The 60-year-old male was admitted to our department with 2 weeks' history of severe neck pain and progressive spastic tetraparesis.[jsss-journal.com]
Meningism
  • 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[symptoma.com]
  • Fusobacterium necrophorum meningitis associated with cerebral vein thrombosis. Pediatr Infect Dis J 16, 330 –331. [CrossRef] [Google Scholar] 9. Soo, R., Gisbell, I., Gallo, J. & Pokorny, C. S. ( 1999 ;).[jmm.microbiologyresearch.org]
  • Regardless of the source of infection Fusobacterum spp. is a very rare cause of meningitis.[jsss-journal.com]
  • Salvado Otogenic Fusobacterium necrophorum meningitis in children Pediatr Infect Dis J, 14 (1995), pp. 627-628 [10.] B. Bader-Meunier, G. Pinto, M. Tardieu, D. Pariente, S. Bobin, J.P.[elsevier.es]
Lethargy
  • 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.[symptoma.com]
  • Acute oropharyngeal infections (starts off in pharyngitis then fever, lethargy, lateral neck tenderness and swelling) can form jugular vein thrombosis and abscess formation in lung Characteristics of Actinomyces Anaerobe, but aerotolerant gram ( ) filamentous[quizlet.com]
Stroke
  • Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review Standard Harvard APA CBE MLA Vancouver Author Bibtex @article{d0c9a9d73ab34784b372782bacb4caaf, title "Arterial Ischemic Stroke[pure.au.dk]

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

  • 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]
  • Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre's syndrome is presented.[unboundmedicine.com]
  • Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum.[dovepress.com]
  • As for treatment, current U.S. guidelines support antibiotic therapy for known group A streptococcal pharyngitis. However, no guidelines address management of non-group A streptococcal or F. necrophorum pharyngitis.[consultant360.com]
  • There is furthermore no proof that treatment of fusobacterium will hasten symptom improvement or, more importantly, prevent Lemierre’s.[blogs.jwatch.org]

Prognosis

  • 【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]
  • 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]
  • 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]
  • 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

  • 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]
  • 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]
  • Aliment Pharmacol Ther 36:467–476. doi: 10.1111/j.1365-2036.2012.05212.x View Article Google Scholar Kaplan GG, Gregson DB, Laupland KB (2004) Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess.[springerplus.springeropen.com]
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]
  • […] 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]
  • In rare and severe cases, surgery may also be performed to remove the infected blood clots from the jugular veins, or to tie off the jugular veins to prevent blood clots that carry the bacteria from traveling to other parts of the body.[everydayhealth.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: 2019-07-11 20:45