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Louis-Jean SF, Agrawal N, Bisht S. Fusobacterium nucleatum Pyogenic Liver Abscess and the Role of Bacterial Virulence and Gut Microbiota Dysbiosis. Cureus 2023; 15:e34548. [PMID: 36879688 PMCID: PMC9985409 DOI: 10.7759/cureus.34548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
In the United States, pyogenic liver abscesses are often due to monomicrobial infection and are rarely documented to be a consequence of Fusobacterium infection, a common cause of Lemierre's syndrome. Recent advances in gut microbial studies have identified Fusobacterium as a commensal gut flora that becomes pathogenic in the setting of dysbiosis resulting from colorectal diseases, such as diverticulitis. While the bacteria's tropism for the liver remains to be elucidated, the virulence pattern of Fusobacterium and the portal venous drainage system have allowed us to understand the bacterium's propensity for causing right hepatic abscesses. In this case report, we detail an immunocompetent man with a history of sigmoid diverticulitis who developed a right hepatic abscess due to Fusobacterium nucleatum, while delineating a review of the literature on the virulent properties of the bacterium and the impact of gut microbiota dysbiosis in its pathogenicity. A descriptive analysis was also performed to identify the characteristics of patients who are at risk in hopes of further improving the clinical diagnostic schema for this condition.
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Affiliation(s)
| | - Nirav Agrawal
- Internal Medicine, Anne Arundel Medical Center, Annapolis, USA
| | - Sushrit Bisht
- Internal Medicine, Anne Arundel Medical Center, Annapolis, USA
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Collins L, Diamond T. Fusobacterium nucleatum causing a pyogenic liver abscess: a rare complication of periodontal disease that occurred during the COVID-19 pandemic. BMJ Case Rep 2021; 14:e240080. [PMID: 33500312 PMCID: PMC7843314 DOI: 10.1136/bcr-2020-240080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
| | - Tom Diamond
- Hepatobiliary Surgery, Mater Hospital, Belfast, UK
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Lee YJ, Li KY, Wang PJ, Huang HW, Chen MJ. Alleviating chronic kidney disease progression through modulating the critical genus of gut microbiota in a cisplatin-induced Lanyu pig model. J Food Drug Anal 2019; 28:103-114. [PMID: 31883598 DOI: 10.1016/j.jfda.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023] Open
Abstract
In the present study, we investigated the effects of Probiotic mix 1 (Pm1) with Lactobacillus plantarum subsp. plantarum, Lactobacillusparacasei subsp. paracasei, and Streptococcus salivarius subsp. thermophilus on preventing renal injury using a chronic kidney disease (CKD) minipig model previously developed in our lab using cisplatin-induced CKD in Lanyu pigs. The results indicated that the high dosage Pm1 (H.Pm1) group demonstrated lower incidence of lesions, including atrophy, mononuclear inflammation, cell infiltration, and interstitial fibrosis in renal tubules in hematoxylin and eosin (H&E) and Masson's trichrome stain. We further systematically investigated the preventing effect of Pm1. The H.Pm1 group decreased inflammatory cytokines production and increased the level of superoxide dismutase activity in plasma. The pigs fed with high dosage of Pm1 group also showed reduced both creatinine and blood urea nitrogen (BUN) when compared with the cisplatin group. Microbiota results indicated that Pm1-intervention not only reduced the abundance of Gram-negative bacteria but also affected the abundance of specific genera biomarkers, Anaerovibrio, possible_genus_SK018, Holdemanella, and Lachnospiraceae_UCG_010 in gut microbiota, leading to decreased inflammation and apoptosis in the kidney and further prevention/alleviation of the symptoms of CKD.
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Affiliation(s)
- Ya-Jane Lee
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yi Li
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan
| | - Pin-Jhu Wang
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Wen Huang
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan
| | - Ming-Ju Chen
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan; Center for Biotechnology, National Taiwan University, Taipei, Taiwan.
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Lamarche C, Iliuta IA, Kitzler T. Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach. Can J Kidney Health Dis 2019; 6:2054358119839080. [PMID: 31065378 PMCID: PMC6488776 DOI: 10.1177/2054358119839080] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/25/2019] [Indexed: 01/14/2023] Open
Abstract
Purpose of review: Infections are a major contributor to morbidity and mortality in end-stage
renal disease (ESRD) patients. A better understanding of the interplay
between infectious processes and ESRD may eventually lead to the development
of targeted treatment strategies aimed at lowering overall disease morbidity
and mortality. Monogenic causes are a major contributor to the development
of adult chronic kidney disease (CKD). Recent studies identified a genetic
cause in 10% to 20% of adults with CKD. With the introduction of whole-exome
sequencing (WES) into clinical mainstay, this proportion is expected to
increase in the future. Once patients develop CKD/ESRD due to a genetic
cause, secondary changes, such as a compromised immune status, affect
overall disease progression and clinical outcomes. Stratification according
to genotype may enable us to study its effects on secondary disease
outcomes, such as infectious risk. Moreover, this knowledge will enable us
to better understand the molecular interplay between primary disease and
secondary disease outcomes. Sources of information: We conducted a literature review using search engines such as PubMed, PubMed
central, and Medline, as well as cumulative knowledge from our respective
areas of expertise. Methods: This is a transdisciplinary perspective on infectious complications in ESRD
due to monogenic causes, such as autosomal dominant polycystic kidney
disease (ADPKD), combining expertise in genomics and immunology. Key findings: In ADPKD, infection is a frequent complication manifesting primarily as lower
urinary tract infection and less frequently as renal infection. Infectious
episodes may be a direct consequence of a specific underlying structural
abnormality, for example the characteristic cysts, among others. However,
evidence suggests that infectious disease risk is also increased in ESRD due
to secondary not-well-understood disease mechanisms. These disease
mechanisms may vary depending on the underlying nature of the primary
disease. While the infectious disease risk is well documented in ADPKD,
there are currently insufficient data on the risk in other monogenic causes
of ESRD. WES in combination with novel technologies, such as RNA sequencing
and single-cell RNA sequencing, can provide insight into the molecular
mechanisms of disease progression in different monogenic causes of CKD/ESRD
and may lead to the development of novel risk-stratification profiles in the
future. Limitations: This is not a systematic review of the literature and the proposed
perspective is tainted by the authors’ point of view on the topic. Implications: WES in combination with novel technologies such as RNA sequencing may enable
us to fully unravel underlying disease mechanisms and secondary disease
outcomes in monogenic causes of CKD and better characterize individual risk
profiles. This understanding will hopefully facilitate the development of
novel targeted therapies.
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Affiliation(s)
- Caroline Lamarche
- Department of Surgery, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Ioan-Andrei Iliuta
- Department of Medicine, Division of Nephrology, University of Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Thomas Kitzler
- Department of Medicine, Division of Nephrology, Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, MA, USA
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Abstract
Background Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature. Case presentation A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords “Fusobacterium” and “Liver abscess”. Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre’s Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks. Conclusion Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.
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Affiliation(s)
- Dilip Jayasimhan
- Department of Medicine, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand.
| | - Linus Wu
- Department of General Surgery, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand
| | - Paul Huggan
- Department of Medicine, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand.
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Hong CS, Chung KM, Huang PC, Wang JJ, Yang CM, Chu CC, Chio CC, Chang FL, Chien CC. Epidemiology and mortality of liver abscess in end-stage renal disease dialysis patients: Taiwan national cohort study. PLoS One 2014; 9:e88078. [PMID: 24551077 PMCID: PMC3925100 DOI: 10.1371/journal.pone.0088078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 01/04/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis. DESIGN SETTING PARTICIPANTS & MEASUREMENTS Using Taiwan's National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models. RESULTS Of the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years). The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%. CONCLUSIONS The incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.
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Affiliation(s)
- Chon-Seng Hong
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kun-Ming Chung
- Department of General Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Po-Chang Huang
- Department of Orthopedics Medicine, Chi-Mei Medical Center, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Ming Yang
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurological Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Fu-Lin Chang
- Department of Pharmaceutical Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chih-Chiang Chien
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
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Chao CT, Lee SY, Yang WS, Chen HW, Fang CC, Yen CJ, Chiang CK, Hung KY, Huang JW. Peritoneal dialysis peritonitis by anaerobic pathogens: a retrospective case series. BMC Nephrol 2013; 14:111. [PMID: 23705895 PMCID: PMC3666898 DOI: 10.1186/1471-2369-14-111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/20/2013] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial infections account for most peritoneal dialysis (PD)-associated peritonitis episodes. However, anaerobic PD peritonitis is extremely rare and intuitively associated with intra-abdominal lesions. In this study, we examined the clinical characteristics of PD patients who developed anaerobic peritonitis. Methods We retrospectively identified all anaerobic PD peritonitis episodes from a prospectively collected PD registry at a single center between 1990 and 2010. Only patients receiving more than 3 months of PD were enrolled. We analyzed clinical features as well as outcomes of anaerobic PD peritonitis patients. Results Among 6 patients, 10 episodes of PD-associated peritonitis were caused by anaerobic pathogens (1.59% of all peritonitis episodes during study the period), in which the cultures from 5 episodes had mixed growth. Bacteroides fragilis was the most common species identified (4 isolates). Only 3 episodes were associated with gastrointestinal lesions, and 4 episodes were related to a break in sterility during exchange procedures. All anaerobic pathogens were susceptible to clindamycin and metronidazole, but penicillin resistance was noted in 4 isolates. Ampicillin/sulbactam resistance was found in 2 isolates. In 5 episodes, a primary response was achieved using the first-generation cephalosporin and ceftazidime or aminoglycoside. In 3 episodes, the first-generation cephalosporin was replaced with aminoglycosides. Tenckhoff catheter removal was necessary in 2 episodes. Only one episode ended with mortality (due to a perforated bowel). Conclusion Anaerobic PD-associated peritonitis might be predominantly caused by contamination, rather than intra-abdominal events. Half of anaerobic PD-associated peritonitis episodes had polymicrobial growth. The overall outcome of anaerobic peritonitis is fair, with a high catheter survival rate.
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Rodrigues L, Neves M, Machado S, Sá H, Macário F, Alves R, Mota A, Campos M. Uncommon cause of chest pain in a renal transplantation patient with autosomal dominant polycystic kidney disease: a case report. Transplant Proc 2013; 44:2507-9. [PMID: 23026633 DOI: 10.1016/j.transproceed.2012.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of end-stage renal disease (ESRD) and, because of its intrinsic systemic involvement, its treatment can be a medical and surgical challenge. This condition is often associated with the presence of hepatic cysts and their prevalence generally increases with age. Most patients remain asymptomatic, but some of these will develop complications associated with enlargement and infection of their cysts. Chest pain is a rare manifestation of these complications and, after exclusion of more common cardiovascular and pulmonary causes, should raise the suspicion of an infected hepatic cyst in these patients. We report the case of a 62-year-old male who underwent a kidney transplantation from a cadaveric donor in 1997 (etiology of the ESRD was ADPKD), and was admitted to the emergency department with complaints of chest pain radiating to both shoulders and the interscapular region. An echocardiogram was showed compression of the right atrium by a large liver cyst without associated ventricular dysfunction. Computer tomography-guided drainage of the cyst was performed and an Enterobacter aerogenes sensitive to carbamapenemes was isolated from respective cultures. The patient presented a favorable clinical outcome with prolonged administration of antibiotic therapy according to the antibiotic susceptibility testing. There was no need for surgical intervention.
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Affiliation(s)
- L Rodrigues
- Department of Nephrology, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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Abstract
Hydatid cyst disease is a common worldwide zoonosis. Most of the cysts are located in the liver. Abscess formation due to infection of the cyst is an important complication. M. morganii, a Gram-negative Bacillus, is a quite rare cause of liver abscess. A 77-year-old woman was admitted to hospital with complaints of fever, chills, nausea, vomiting, loss of appetite, and abdominal pain located in the right-upper quadrant. Her history was positive for hepatic hydatid cyst disease ten years ago. Physical examination revealed a painful mass filling the right-upper quadrant and extending down to umbilicus. Indirect hemagglutinin test for hydatid cyst was positive at a titer of 1/320. Giant liver abscess due to infected hydatid cyst was found in computed tomography scan. Surgeons performed cystectomy and cholecystectomy. Cefazoline, cefuroxime, and metronidazole were administered empirically, but all the three agents were replaced with intravenous ceftriaxone after M. morganii was isolated from the cultures of the abscess material. Clinical signs of the patient resolved at the second week of treatment, and she was discharged.
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Fardini Y, Wang X, Témoin S, Nithianantham S, Lee D, Shoham M, Han YW. Fusobacterium nucleatum adhesin FadA binds vascular endothelial cadherin and alters endothelial integrity. Mol Microbiol 2011; 82:1468-80. [PMID: 22040113 DOI: 10.1111/j.1365-2958.2011.07905.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fusobacterium nucleatum is a Gram-negative oral anaerobe, capable of systemic dissemination causing infections and abscesses, often in mixed-species, at different body sites. We have shown previously that F. nucleatum adheres to and invades host epithelial and endothelial cells via a novel FadA adhesin. In this study, vascular endothelial (VE)-cadherin, a member of the cadherin family and a cell-cell junction molecule, was identified as the endothelial receptor for FadA, required for F. nucleatum binding to the cells. FadA colocalized with VE-cadherin on endothelial cells, causing relocation of VE-cadherin away from the cell-cell junctions. As a result, the endothelial permeability was increased, allowing the bacteria to cross the endothelium through loosened junctions. This crossing mechanism may explain why the organism is able to disseminate systemically to colonize in different body sites and even overcome the placental and blood-brain barriers. Co-incubation of F. nucleatum and Escherichia coli enhanced penetration of the endothelial cells by the latter in the transwell assays, suggesting F. nucleatum may serve as an 'enabler' for other microorganisms to spread systemically. This may explain why F. nucleatum is often found in mixed infections. This study reveals a possible novel dissemination mechanism utilized by pathogens.
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Affiliation(s)
- Yann Fardini
- Department of Periodontics, Case Western Reserve University, Cleveland, OH 44106, USA
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Jiménez-Bonilla JF, Quirce R, Calabia ER, Banzo I, Martínez-Rodríguez I, Carril JM. Hepatorenal Polycystic Disease and Fever: Diagnostic Contribution of Gallium Citrate Ga 67 Scan and Fluorine F 18 FDG-PET/CT. Eur Urol 2011; 59:297-9. [DOI: 10.1016/j.eururo.2009.05.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Ulug M, Gedik E, Girgin S, Kemal Celen M, Ayaz C. Pyogenic liver abscess caused by community-acquired multidrug resistance Pseudomonas aeruginosa. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70046-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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