The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis.

BACKGROUND AND PURPOSE: Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography. MATERIALS AND METHODS: CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group). RESULTS: Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly). CONCLUSIONS: In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.

Pulmonary and thoracic infection by Fusobacterium nucleatum. / Infección pulmonar y torácica por Fusobacterium nucleatum.

INTRODUCTION: Fusobacterium nucleatum is an anaerobic bacillus that is part of the oral microbiota and dental pla que. This can cause local and potentially remote infections, which are exceptional in pediatrics. Ob jective: To present the case of a patient with lung injury with chest wall invasion by Fusobacterium nucleatum. CLINICAL CASE: An 11-year-old female immunocompetent patient who consulted due to a two-week history of cough, night sweats, without fever or weight loss, and increased volume at the left spleen thoracic level. There was no history of chest wall trauma or travel outside the country. Two weeks before the onset of symptoms, she was treated for dental caries. Imaging studies and CT scan showed left spleen pneumonia, which invades the pleura and the chest wall. A minimal thoracotomy was performed, releasing a thick, foul-smelling liquid. The studies for common germs and tubercu losis were negative. Hematology ruled out tumor lesions. The anaerobic study reported the develo pment of Fusobacterium nucleatum. The patient was treated with penicillin followed by amoxicillin presenting good clinical and radiological responses. The dental procedure was suspected as the cause of infection. CONCLUSIONS: Fusobacterium nucleatum can occasionally cause remote or extra-oral in fections in immunocompetent patients, such as pneumonia with chest wall invasion, therefore it is necessary to bear it in mind.

Fusobacterium nucleatum causing a pyogenic liver abscess: a rare complication of periodontal disease that occurred during the COVID-19 pandemic.

Fusobacterium nucleatum is a periodontal commensal and pathogen. In rare cases, these anaerobic gram-negative bacilli have been reported to cause pyogenic liver abscesses (PLAs). We describe a patient who developed a periodontal abscess during the COVID-19 pandemic and was unable to access the restricted General Dental Services at this time. She subsequently developed a F. nucleatum bacteraemia and liver abscess. The non-specific signs and symptoms experienced meant the patient self-isolated due to suspected COVID-19 infection and presentation to hospital was delayed. We also include the results of a literature search of other cases of PLAs attributed to F. nucleatum PLAs often develop insidiously. They require percutaneous drainage and prolonged antimicrobial therapy. Clinicians should be aware of this rare complication of a dentoalveolar infection in a patient who is systemically unwell.

A rare case of polymicrobial chronic maxillary sinusitis due to concurrent isolation of Parvimonas micra and Fusobacterium nucleatum.

Parvimonas micra and Fusobacterium nucleatum are commensal pathogens very rarely isolated simultaneously in clinical specimens. We report a case of chronic maxillary sinusitis caused by these two pathogens, presumably resulting from a co-existing dental infection.

Liver abscess due to Fusobacterium species detected on ultrasonography: a case report.

An oral infection harboring Fusobacterium species can gain entrance to the liver via hematogenous spread in the form of septic embolus, and can thereby cause abscesses. Such spread, described as Lemierre syndrome, is life threatening. We present such a case history of a man in his mid-40s, who presented with infection and Fusobacterium liver abscess with an acute fulminant disease course. The initial diagnosis was arrived at by ultrasound imaging and blood investigations. He was treated with antibiotics, ultrasound-guided liver abscess drainage, and extraction of the infected molar tooth. He was discharged 6 weeks after admission. To date, there have been no reports describing the ultrasound images of a Fusobacterium liver abscess in detail. Hence, we herein present the ultrasound images of a Fusobacterium liver abscess.

Septic internal jugular vein thrombosis caused by Fusobacterium necrophorum and mediated by a broken needle.

The injection of drugs into the neck is unusual and thrombosis of the internal jugular vein can be a rare clinical presentation with a high risk for severe complications. We report a case of a 31-year-old male intravenous drug user presenting with fever, shortness of breath and right neck oedema. Laboratory studies revealed elevated inflammation parameters. X-ray imaging revealed a broken syringe needle inside the soft tissues of the neck. Computed tomography (CT) scans of the thorax and brain were unremarkable, while cervical CT showed a fully thrombosed, right internal jugular vein. Intravenous antibiotics were initiated, and modified after identification of an anaerobic Gram-negative oropharynx-derived pathogen (Fusobacterium necrophorum). The patient was discharged after resolution of symptoms under treatment. Septic internal jugular vein thrombosis should always be included in the differential diagnosis of local neck inflammation and systemic sepsis in intravenous drug users. Prompt and aggressive antibiotic treatment is vital, whereas the role of anticoagulation therapy is not definitely known.

Lemierre syndrome: not so forgotten!

Lemierre syndrome is a rare and life-threatening illness. Often referred to as "the forgotten disease," its incidence is reported to be as low as 1 in a million. The microorganism responsible for Lemierre syndrome is typically Fusobacterium necrophorum. The bacterium starts in the pharynx and peritonsillar tissue, then disseminates through lymphatic vessels. Severe sepsis rapidly develops, as does the hallmark of this syndrome: septic thrombophlebitis of the internal jugular vein. This report describes a case of Lemierre syndrome in a previously healthy 26-year-old man with life-threatening internal jugular vein thrombophlebitis following 2 weeks of an indolent course of pharyngitis. The patient's initial presentation and extensive travel history as an Army veteran were particularly challenging aspects in establishing his diagnosis. The diagnosis of Lemierre syndrome is frequently delayed. Routine use of bedside ultrasonography may aid in rapid diagnosis of the disease.

Radiography-based score indicative for the pathogenicity of bacteria in odontogenic infections.

OBJECTIVE: To develop a new radiography-based score to assess the potential of bacteria to cause odontogenic infections derived from the occurrence of bacteria at small or large radiographical lesions. MATERIALS AND METHODS: The patients analyzed were a sub-population from a large randomized clinical trial comparing moxifloxacin and clindamycin in the treatment of inflammatory infiltrates and odontogenic abscesses. Routine radiographs were used to analyze the area of the periapical radiolucent lesions. Lesions were stratified by their radiographically measured area as large (>9 mm(2)) or small (≤9 mm(2)). A risk ratio was calculated for each species from the frequency of their occurrence in large vs in small lesions. RESULTS: Fifty-one patients, 19 with abscesses and 32 with infiltrates, were evaluated. Overall, the radiographical lesion areas ranged from 0.4-46.2 mm(2) (median = 9 mm(2)). An increased risk (risk ratio >1) to occur at large abscess lesions was observed for Prevotella (P.) oralis, P. buccae, P. oris, P. intermedia, Fusobacterium nucleatum and Streptococcus (Strep.) anginosus group. An increased risk to occur at large infiltrate lesions was found for Strep. salivarius, Strep. parasanguis, Strep. anginosus group, Capnocytophaga spp., Neisseria (N.) sicca, Neisseria spp., Staphylococcus (Staph.) aureus, P. intermedia, P. buccae, Prevotella spp. and P. melaninogenica. CONCLUSIONS: The radiography-based score suggests that certain Prevotella spp., F. nucleatum and Strep. anginosus groups play a crucial role in the pathogenesis of odontogenic abscesses, and that various streptococci, Neisseria spp., Capnocytophaga spp., Staph. aureus and Prevotella spp. are involved in the pathogenesis of odontogenic infiltrates.

Endobronchial lesion due to pulmonary Fusobacterium nucleatum infection in a child.

Clinically significant infections due to the members of the genus Fusobacterium are rare. The clinical manifestations of pulmonary Fusobacterium nucleatum infections range from simple aspiration pneumonia to severe diseases as necrotizing pneumonia, lung abscess, and empyema. Endobronchial lesions and obstructions are rarely seen in children and are often a misdiagnosed result in delay of definitive treatment. Here, we report a case of endobronchial lesion due to pulmonary F. nucleatum infection in an entirely healthy child before illness. This is the first case reported in the literature of endobronchial lesion due to pulmonary F. nucleatum infection.

Lemierre's syndrome mimicking leptospirosis.

Lemierre's syndrome is a suppurative thrombophlebitis involving the internal jugular vein, most commonly associated with Fusobacterium necrophorum, usually a complication of oropharyngeal infections. This syndrome is rare and is often overlooked. We present a case of sepsis mimicking initially severe leptospirosis (Weil's disease) due to acute febrile illness with multiorgan failure and hyperbilirubinemia. Finally, blood cultures revealed Fusobacterium necrophorum and computed tomography (CT) demonstrated bilateral pulmonary nodules and a thrombus in the right internal jugular vein. Early clinical suspicion is crucial so that appropriate diagnostic investigation and antibiotic therapy can be initiated to minimize the risk of life-threatening complications.

Lemierre syndrome: report of five new cases and literature review.

Lemierre Syndrome (LS) is relatively rare, and its clinical features are potentially confusing. Without proper therapy, LS is associated with significant morbidity and is potentially fatal. Recognition of the imaging features of LS in the chest and the neck may permit a timely diagnosis and lead to prompt institution of appropriate therapy. The emergency imaging features of LS in five cases are reviewed with emphasis on computed tomography of the chest and neck.

Advanced Lemierre syndrome requiring surgery.

A 38-year-old homeless man was admitted with a 2-week history of a sore throat, increasing shortness of breath, and high fever. Clinical examination showed enlarged and tender submandibular and anterior cervical lymph nodes and a pronounced enlargement of the left peritonsillar region (Figure 1a). CT scan of the throat and the chest showed left peritonsillar abscess formation, occlusion of the left internal jugular vein with inflammatory wall thickening and perijugular soft tissue infiltration, pulmonary abscesses, and bilateral pleural effusions (Figures 1b-e, arrowed). Anaerobe blood cultures grew Fusobacterium necrophorum, leading to the diagnosis of Lemierre's syndrome. Treatment with high-dose amoxicillin and clavulanic acid improved the oropharyngeal condition, but the patient's general status declined further, marked by dyspnea and tachypnea. Repeated CT scans showed progressive lung abscesses and bilateral pleural empyema. Bilateral tonsillectomy, ligation of the left internal jugular vein, and staged decortication of bilateral empyema were performed. Total antibiotic therapy duration was 9 weeks, including a change to peroral clindamycin. Clinical and laboratory findings had returned to normal 12 weeks after surgery.The patient's history and the clinical and radiological findings are characteristic for Lemierre's syndrome. CT scans of the neck and the chest are the diagnostic methods of choice. F. necrophorum is found in over 80% of cases of Lemierre's syndrome and confirms the diagnosis. Prolonged antibiotic therapy is usually sufficient, but in selected patients, a surgical intervention may be necessary. Reported mortality rates are high, but in surviving patients, the recovery of pulmonary function is usually good.