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Liu Y, Li Z, Fu H, Ruan W, Wang H, Ding Y, Zhang M. The first case report: diagnosis and management of necrotizing fusobacterium lung abscess via BALF next-generation sequencing. BMC Infect Dis 2024; 24:218. [PMID: 38373919 PMCID: PMC10875748 DOI: 10.1186/s12879-024-09087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Fusobacterium necrophorum (F. necrophorum)-induced necrotizing pneumonia is a rare but severe pulmonary infection. Insufficient microbiological detection methods can lead to diagnostic difficulties. METHODS We report a case of F. necrophorum lung abscess diagnosed by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF). RESULTS BALF-NGS detected F. necrophorum, guiding subsequent targeted antibiotic therapy. With active drainage and metronidazole treatment, the patient's condition was effectively treated. CONCLUSION BALF-NGS is a valuable tool for the rapid diagnosis of infections caused by difficult-to-culture bacteria. It played a decisive role in the early identification of F. necrophorum, enabling timely and targeted antibiotic intervention. Early diagnosis and appropriate treatment are crucial for the management of F. necrophorum pneumonia.
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Affiliation(s)
- Yang Liu
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China.
| | - Ziye Li
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Handan Fu
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Weiliang Ruan
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Hua Wang
- Special Inspection Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Yuhong Ding
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Miao Zhang
- Radiology Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
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2
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Tay RWH, Vasoo S. Fusobacterium necrophorum pharyngitis complicated by sepsis and extrapharyngeal dissemination in two young adults. Singapore Med J 2023; 64:768-769. [PMID: 35739600 PMCID: PMC10775296 DOI: 10.11622/smedj.2022084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Raphael Wei Hao Tay
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shawn Vasoo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore E-mail:
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3
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Yu J, Tycksen E, Yang W, Mariani TJ, Bhattacharya S, Falsey AR, Topham DJ, Storch GA. Use of Host Response to Refine the Diagnosis of Group A Streptococcal Pharyngitis. J Pediatric Infect Dis Soc 2022; 11:482-491. [PMID: 36153766 PMCID: PMC9720373 DOI: 10.1093/jpids/piac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/10/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Current diagnostic tests for pharyngitis do not distinguish between symptomatic group A Streptococcus (GAS) infection and asymptomatic colonization, resulting in over-diagnosis and unnecessary use of antibiotics. We assessed whether measures of host response could make this distinction. METHODS We enrolled 18 children with pharyngitis having Centor scores of 4 or 5 and 21 controls without pharyngitis or other acute infections. Both groups had throat cultures, molecular tests for GAS and respiratory viruses and IgM serology for Epstein-Barr virus. Host response was evaluated with white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and sequencing of RNA from peripheral blood leukocytes. RESULTS Of 18 cases, 11 had GAS pharyngitis, 3 had adenovirus pharyngitis and 4 had other pharyngitis. Among asymptomatic controls, 5 were positive for GAS. WBC, CRP, and PCT were higher in subjects with pharyngitis compared to asymptomatic controls including those with GAS. Transcriptional profiles from children with symptomatic GAS were clearly distinct from those of children in all other groups. The levels of two genes, CD177 and TLR5 each individually accurately distinguished between symptomatic and asymptomatic GAS. Optimal diagnostic sensitivity and specificity were achieved by the combination of CRP and PCT, and by each of the two gene markers. CONCLUSION In this exploratory study, we showed that traditional measures of inflammation and markers of host gene expression distinguish between symptomatic and asymptomatic GAS. These results point to future rapid molecular approaches for improving the diagnosis of GAS pharyngitis, that may help reduce unnecessary antibiotic use.
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Affiliation(s)
- Jinsheng Yu
- Department of Genetics, Genome Technology Access Center at the McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Eric Tycksen
- Department of Genetics, Genome Technology Access Center at the McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Wei Yang
- Department of Genetics, Genome Technology Access Center at the McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Thomas J Mariani
- Department of Pediatrics, Division of Neonatology and Pediatric Molecular and Personalized Medicine Program, University of Rochester School of Medicine, Rochester, New York 14642, USA
| | - Soumyaroop Bhattacharya
- Department of Pediatrics, Division of Neonatology and Pediatric Molecular and Personalized Medicine Program, University of Rochester School of Medicine, Rochester, New York 14642, USA
| | - Ann R Falsey
- Department of Medicine, University of Rochester School of Medicine, Rochester, New York 14642, USA
| | - David J Topham
- Department of Medicine, University of Rochester School of Medicine, Rochester, New York 14642, USA
| | - Gregory A Storch
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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4
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Affiliation(s)
- Michael J Litt
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Mary W Montgomery
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Kirstin M Small
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Amy L Miller
- From the Department of Medicine, Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital, Boston
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5
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Pallon J, Rööst M, Sundqvist M, Hedin K. The aetiology of pharyngotonsillitis in primary health care: a prospective observational study. BMC Infect Dis 2021; 21:971. [PMID: 34535115 PMCID: PMC8446737 DOI: 10.1186/s12879-021-06665-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 09/07/2021] [Indexed: 11/12/2022] Open
Abstract
Background Few studies on pharyngotonsillitis have examined the clinical presentation of different aetiologies where pathogens have been detected using molecular methods. We aimed to assess how well clinical signs and symptoms can predict (1) the presence or absence of a broad range of viruses and bacteria, and (2) reconsultations for a sore throat or a complication. Methods In this descriptive observational prospective study in primary health care 220 patients aged 15–45 with suspected pharyngotonsillitis were sampled from nose, throat and blood and screened for 20 bacteria and viruses using polymerase chain reaction (PCR), culture and serology. Odds ratios (OR) and predictive values with 95% confidence intervals (CI) were used to show association between microbiological findings and clinical signs and symptoms. Patients were followed up after 3 months by reviewing electronic medical records. Results Both cough and coryza were more common in patients with only viruses (67%) than in patients with only bacteria (21%) (p < 0.001), whereas tonsillar coating was more common in patients with only bacteria (53%) than in patients with only viruses (29%) (p = 0.006). Tonsillar coating (adjusted OR 6.0; 95% CI 2.5–14) and a lack of cough (adjusted OR 3.5; 95% CI 1.5–8.0) were significantly associated with Streptococcus pyogenes (group A streptococci; GAS) and with any bacterial finding. A Centor score of 3–4 had a positive predictive value of 49% (95% CI 42–57) for GAS and 66% (95% CI 57–74) for any bacterial findings. The use of rapid antigen detection test for GAS increased the positive predictive value for this group to 93%. Conclusions Signs and symptoms, both single and combined, were insufficient to rule in GAS or other pathogens. However, both cough and coryza were useful to rule out GAS. The results support the clinical approach of restricting rapid antigen detection testing to patients with 3–4 Centor criteria. The low carriage rate of bacteria among asymptomatic controls implied that most detections in patients represented a true infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06665-9.
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Affiliation(s)
- Jon Pallon
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden. .,Department of Clinical Sciences, Malmö, Clinical Research Centre, Box 50332, 202 13, Malmö, Sweden.
| | - Mattias Rööst
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Martin Sundqvist
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.,Futurum, Region Jönköping County, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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6
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Malmberg S, Petrén S, Gunnarsson R, Hedin K, Sundvall PD. Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis. BMJ Open 2021; 11:e042816. [PMID: 34088705 PMCID: PMC8183226 DOI: 10.1136/bmjopen-2020-042816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The main objective of this review was to describe and quantify the association between Fusobacterium necrophorum (FN) and acute sore throat in primary healthcare (PHC). METHODS In this systematic review and meta-analysis, we searched Scopus and PubMed for case-control studies reporting the prevalence of FN in patients attending primary care for an uncomplicated acute sore throat as well as in healthy controls. Only studies published in English were considered. Publications were not included if they were case studies, or if they included patients prescribed antibiotics before the throat swab, patients with a concurrent malignant disease, on immunosuppression, having an HIV infection, or patients having another acute infection in addition to a sore throat. Inclusion criteria and methods were specified in advance and published in PROSPERO. The primary outcome was positive etiologic predictive value (P-EPV), quantifying the probability for an association between acute sore throat and findings of FN in the pharynx. For comparison, our secondary outcome was the corresponding P-EPV for group A Streptococcus (GAS). RESULTS PubMed and Scopus yielded 258 and 232 studies, respectively. Removing duplicates and screening the abstracts resulted in 53 studies subsequently read in full text. For the four studies of medium to high quality included in the meta-analysis, the cumulative P-EPV regarding FN was 64% (95% CI 33% to 83%). GAS, based on data from the same publications and patients, yielded a positive EPV of 93% (95% CI 83% to 99%). CONCLUSIONS The results indicate that FN may play a role in PHC patients with an acute sore throat, but the association is much weaker compared with GAS.
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Affiliation(s)
- Stefan Malmberg
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - Susanna Petrén
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ronny Gunnarsson
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Katarina Hedin
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Region Jönköpings County, Jönköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Pär-Daniel Sundvall
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden
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7
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Centor RM, Huddle TS. Should the risk of Fusobacterium necrophorum pharyngotonsillitis influence prescribing empiric antibiotics for sore throats in adolescents and young adults? Anaerobe 2021; 71:102388. [PMID: 34089856 DOI: 10.1016/j.anaerobe.2021.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022]
Abstract
Fusobacterium necrophorum, a gram-negative anaerobe, causes pharyngotonsillitis primarily in adolescents and young adults (approximately 15-30 years old). The same age group has the highest incidence of peritonsillar abscess and the Lemierre syndrome. The same organism, F. necrophorum, is the most common cause of peritonsillar abscess in this age group and causes at least 80% of Lemierre syndrome cases. We outline the case for empiric antibiotic treatment of some patient in this age group who have a significant probability that F. necrophorum is the cause of their pharyngotonsillitis.
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Affiliation(s)
- Robert M Centor
- UAB, FOT 720, 1530 3rd Ave S, Birmingham, AL, 35294-3407, USA.
| | - Thomas S Huddle
- UAB, FOT 720, 1530 3rd Ave S, Birmingham, AL, 35294-3407, USA
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8
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Nygren D, Brorson E, Musonda M, Wasserstrom L, Johansson Å, Holm K. Geographical differences in tonsillar carriage rates of Fusobacterium necrophorum - A cross-sectional study in Sweden and Zambia. Anaerobe 2021; 69:102360. [PMID: 33757851 DOI: 10.1016/j.anaerobe.2021.102360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022]
Abstract
While Fusobacterium necrophorum historically has been considered normal tonsillar flora, recent studies from Europe and the US have suggested that carriage occur transiently in adolescence and young adulthood. However, no studies originating from Africa exist. In this cross-sectional study of tonsillar carriage of F. necrophorum, we aimed to investigate geographical differences in tonsillar carriage rates of F. necrophorum in healthy participants aged 15-25 years in Sweden and Zambia and further investigate the age distribution of tonsillar carriage in Zambia. Specimens were obtained by tonsillar swabs and analyzed with real-time PCR for F. necrophorum. In participants aged 15-25 years, tonsillar carriage was more common in Sweden 21/100 (21%) than in Zambia 6/192 (3%), p < 0.001. In Zambian participants aged above 25 years tonsillar carriage was rare 1/76 (1%). In conclusion, the high rate of tonsillar carriage in participants aged 15-25 years in Sweden has implications on the interpretation of tonsillar findings in patients with pharyngotonsillitis. Interestingly, a geographical difference was found with tonsillar carriage rarely identified in Zambia.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Ellen Brorson
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Lisa Wasserstrom
- Clinical Microbiology Laboratory, Skåne University Hospital, Lund, Sweden
| | | | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
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9
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Presence of microorganisms in children with pharyngotonsillitis and healthy controls: a prospective study in primary healthcare. Infection 2021; 49:715-724. [PMID: 33686635 PMCID: PMC7938884 DOI: 10.1007/s15010-021-01595-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
Purpose Most studies on paediatric pharyngotonsillitis focus on group A streptococci. This study, however, analyses a broad spectrum of bacteria and viruses related to paediatric pharyngotonsillitis and evaluates their associated clinical symptoms and courses. Methods This observational prospective study in primary healthcare includes 77 children aged < 15 with a sore throat and 34 asymptomatic children, all of whom were sampled from the tonsils with an E-swab® for analysis with culture and PCR for 14 bacteria and 15 viruses. Patients were evaluated clinically, and their symptoms recorded in diaries for 10 days. Participants were followed up for 3 months by reviewing medical records. Results A pathogen was detected in 86% of patients and in 71% of controls (P = 0.06). Bacteria were found in 69% of patients and 59% of controls (P = 0.3), and viruses in 36% and 26%, respectively (P = 0.3). Group A streptococci was the most common finding, with a prevalence of 49% and 32%, respectively (P = 0.1). Clinical signs were not useful for distinguishing pathogens. None of the controls and 16% of the patients reconsulted for a sore throat within 3 months. Conclusion Bacteria were more common than viruses in both study groups. The high rate of pathogens in asymptomatic children interferes with diagnoses based on aetiology. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01595-9.
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10
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Nygren D, Holm K. Invasive infections with Fusobacterium necrophorum including Lemierre's syndrome: an 8-year Swedish nationwide retrospective study. Clin Microbiol Infect 2020; 26:1089.e7-1089.e12. [DOI: 10.1016/j.cmi.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
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11
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Klasinc R, Lupyr K, Zeller I, Paula H, Makristathis A, Tuchmann F, Wrba T, Assadian O, Presterl E. Clinical characteristics of a large cohort of patients with positive culture of Fusobacterium necrophorum. GMS INFECTIOUS DISEASES 2019; 6:Doc03. [PMID: 30671334 PMCID: PMC6301733 DOI: 10.3205/id000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Fusobacterium necrophorum is a rare pathogen, mostly affecting young adults, causing infections of the head and neck, typically described as the Lemierre's syndrome. Today this symptom complex has become increasingly rare and has almost turned to a 'forgotten disease'. Methods: We performed a retrospective, descriptive study to identify the clinical features of patients with positive culture of F. necrophorum. Additionally, the antibiotic susceptibility profile of the pathogens was analysed. Results: During a period of 22 years 36 patients with at least one isolate of F. necrophorum were identified. Mostly tonsillar and peritonsillar abscesses were found, 10 patients were identified with bacteraemia, but only 4 patients presented with symptoms like sore throat, fever and swollen cervical lymph nodes, which may suggest Lemierre's. Most of the isolates (33/35) showed sensitivity to all tested antibiotics. Conclusion: Appropriate techniques are needed to detect F. necropho rum, especially from throat swabs, in the microbiological laboratory. Current clinical and microbiological practice may lead to under-diagnosis of infections caused by F. necrophorum. Further research is needed to define the colonization rate and to optimize methods for detection as well as identification of virulence.
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Affiliation(s)
- Romana Klasinc
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria.,Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Kostiantyn Lupyr
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Iris Zeller
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Helga Paula
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Athanasios Makristathis
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Felix Tuchmann
- Department of Dermatology, Medical University of Vienna, Austria
| | - Thomas Wrba
- Medical University of Vienna, IT4Science, IT-Systems & Communications, Vienna, Austria
| | - Ojan Assadian
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
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12
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The Brief Case: Retropharyngeal Abscess in a 14-Year-Old Caused by Fusobacterium necrophorum. J Clin Microbiol 2018; 56:56/12/e00487-18. [PMID: 30482869 DOI: 10.1128/jcm.00487-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Curr Probl Pediatr Adolesc Health Care 2018; 48:272-288. [PMID: 30337150 DOI: 10.1016/j.cppeds.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions.
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Affiliation(s)
- Alexandra B Yonts
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States.
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14
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Atkinson TP, Centor RM, Xiao L, Wang F, Cui X, Van Der Pol W, Morrow CD, Ratliff AE, Crabb DM, Totten AH, Estrada CA, Faircloth MB, Waites KB. Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity. PLoS One 2018; 13:e0189423. [PMID: 29351278 PMCID: PMC5774679 DOI: 10.1371/journal.pone.0189423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/24/2017] [Indexed: 12/21/2022] Open
Abstract
Fusobacterium necrophorum (Fn), a gram-negative anaerobe, is increasingly implicated as an etiologic agent in older adolescents and young adults with sore throat. Inadequately treated Fn pharyngitis may result in suppurative complications such as peritonsillar abscess and Lemierre’s syndrome. Data from the literature suggest that the incidence of life-threating complications in these age groups from Fn pharyngitis (Lemierre’s syndrome) in the United States exceeds those associated with group A beta-hemolytic streptococcal (GAS) pharyngitis (acute rheumatic fever). Using real-time PCR, we previously reported about a 10% prevalence of Fn in asymptomatic medical students and about 20% in students complaining of sore throat at a university student health clinic (p = 0.009). In this study, a comprehensive microbiome analysis of the same study samples confirms that Fn pharyngitis was more common than GAS pharyngitis. Eighteen patients were found to have Fn OTU values exceeding an arbitrary cutoff value of 0.1, i.e. greater than 10% of total sequences, with five subjects reaching values above 0.7. By contrast only 9 patients had GAS OTU values greater than 0.1 and none exceeded 0.6. When the data were analyzed using five separate assessments of alpha diversity, in each case for Fn there were statistically significant differences between Fn positive_high (OTU abundance > 0.1) vs control, Fn positive_high vs Fn negative (OTU abundance = 0), Fn positive_high vs Fn positive_low (OTU abundance > 0 and < 0.1). When the data were analyzed using three beta diversity indexes (Bray-Curtis, weighted unifrac, and unweighted unifrac), there were statistically significant differences between Fn positive_high (OTU abundance ≥ 0.1) vs control for all three. Statistically significant differences remained if we chose somewhat different OTU abundance cutoffs of 0.05 or 0.15. We conclude that Fn appears to play a dominant role in bacterial pharyngitis in the older adolescent and young adult age groups and that the development of a productive mucosal infection with Fn is linked to a significant decrease in the diversity of the associated tonsillar microbiome.
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Affiliation(s)
- T. Prescott Atkinson
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Robert M. Centor
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Li Xiao
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Fuchenchu Wang
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Xiangqin Cui
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - William Van Der Pol
- Center For Clinical & Translational Science, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Casey D. Morrow
- Department of Cell, Developmental, & Integrative Biology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amy E. Ratliff
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Donna M. Crabb
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Arthur H. Totten
- Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Carlos A. Estrada
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michael B. Faircloth
- Department of Family & Community Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ken B. Waites
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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