Meningitis due to Fusobacterium necrophorum in an adult

Primary meningitis due to Fusobacterium nucleatum successfully treated with ceftriaxone in a healthy adult male

Fusobacterium nucleatum is a rod-shaped gram-negative obligate anaerobe; this organism, and other anaerobes, are usually not a part of the culture performed for a cerebrospinal fluid (CSF) sample. To date, four cases of Fusobacterium meningitis in adults have been published. We report successful treatment of a case of primary meningitis due to Fusobacterium nucleatum in an otherwise healthy 72-year-old male.

Fusobacterium necrophorum, an emerging pathogen of otogenic and paranasal infections?

Fusobacterium necrophorum is a rare causative agent of otitis and sinusitis. Most commonly known is the classic Lemièrre's syndrome of postanginal sepsis with suppurative thrombophlebitis of the jugular vein. We report five patients diagnosed recently with a complicated infection with F. necrophorum originating from otitis or sinusitis. Two patients recovered completely, one patient died due to complications of the infection, one patient retained a slight hemiparesis and one patient had permanent hearing loss. Diagnosis and management are discussed. A possible factor in the emergence of F. necrophorum is proposed.

Rehabilitation and functional outcomes after extensive surgical debridement of a knee infected by fusobacterium necrophorum: a case report

BACKGROUND AND PURPOSE

Joint infection is a rare but serious complication after knee injury that should be part of a physical therapist's differential diagnosis. This case report presents the care of a 17 year-old female athlete with septic arthritis from a Fusobacterium infection after sustaining a right lateral meniscus tear. Joint pathology combined with the aggressive infectious agent led to arthrofibrosis of her knee joint and resultant activity limitations and participation restrictions. The purpose of this case report is to highlight a rare and unique pathology, the serious effects that a joint infection can have on musculoskeletal function, and the challenges encountered during the rehabilitation process.

CASE DESCRIPTION

The subject was a 17 year-old volleyball player who injured her right knee while playing volleyball. Within 7 days, the subject developed a severe joint infection that spread into surrounding gluteal, quadriceps, and gastrocnemius musculature. The infection was surgically debrided eight times during a 10-week inpatient hospital stay. A manipulation under anesthesia was performed to restore range of motion in her knee joint. Outpatient physical therapy was initiated 4 days later in order to restore musculoskeletal function.

OUTCOME

Over eight months of physical therapy services were utilized to address the impairments and activity limitations caused by her joint dysfunction. She met her physical therapy goals and made significant improvements on the Knee Outcome Survey and the Lower Extremity Functional Scale. Success in physical therapy and completion of additional strength training exercise allowed this subject to return to competitive softball at the club level during her freshman year of college.

DISCUSSION

Though rare after musculoskeletal injury, joint infection can lead to soft tissue damage, partial or complete degradation of articular cartilage, and arthrofibrosis causing significant disability. Physical therapists must incorporate evidence-based treatment principles including eccentric exercise, core stability, and lower extremity strength training along with sports-specific rehabilitation into the treatment plan in order to address activity limitations and meet physical therapy goals.

LEVEL OF EVIDENCE

Level 4-Single Case report.

Pott's puffy tumor: a forgotten differential diagnosis of frontal swelling of the forehead

A 14-year-old adolescent boy experienced a nonsevere infection of the upper respiratory tract. After 10 days, he developed headache, intermittent vomiting, and fever. A sudden prominent swelling of the forehead occurred, and his general condition deteriorated. Cranial computed tomography showed a subdural empyema and subperiosteal abscess owing to osteomyelitis of the frontal bone. Surgical drainage of the subdural empyema and the subperiosteal abscess was performed, and appropriate long-term antibiotic therapy was initiated. The swelling of the forehead caused by a subperiosteal abscess with osteomyelitis of the frontal bone after frontal sinusitis or trauma is known as Pott's puffy tumor. This case demonstrates that swelling of the forehead in the presence of upper respiratory tract infection should lead to prompt evaluation for complications.

Clinical characteristics, pathogens implicated and therapeutic outcomes of mixed infection in adult bacterial meningitis

We reviewed retrospectively the data for adult patients with bacterial meningitis over a period of 10.5 years in our hospital. The clinical characteristics and laboratory data of the 21 cases (52 strains) of mixed infection were analyzed. Two hundred and fifteen cases of single pathogen adult bacterial meningitis (ABM) were also included for comparison. Post-neurosurgical type of ABM was presented in 86% of the mixed infection group. Brain abscess was found in three patients. Fourteen patients survived and seven cases died. The analysis showed a statistical significance for the mixed infection group having a higher rate of nosocomially-acquired, post-neurosurgical condition, hydrocephalus, and lower level of cerebrospinal fluid white cell count, protein and lactate than the single pathogen group. Logistic regression analysis showed the independent factor of "hydrocephalus" (p = 0.002). Presence of hydrocephalus is a significant neuroimaging feature when compared with the single pathogen group. As compared with the previous study results of mixed infection in ABM, the present study showed a change of pathogens implicated of increasing Pseudomonas spp. and Acinetobacter spp. infections, and an emergence of anaerobic pathogens. All these changes deserve special attention because of the need for an appropriate choice of empirical antibiotics and choice of culture method.

Fulminant Fusobacterium necrophorum meningitis in an immunocompetent adolescent

Fusobacterium necrophorum is an anaerobic, gram-negative highly virulent bacillus, isolated from the oropharingeal cavity, the gastrointestinal tract, and the female genital tract. It is responsible of several clinical syndromes, mainly in children or adolescents, ranging from localized abscess, usually in the upper respiratory sites, to severe septicemic diseases, including meningitis. We report the fatal case of an immunocompetent male with suppurative otitis media and meningitis. Initial empiric antibiotic treatment was not effective. After the recovery of anaerobic gram-negative bacilli from blood cultures, treatment with metronidazole was started, and a rapid improvement in laboratory parameters was observed. However, the patient's clinical course was incurable because of cerebral hypertensive complications. F. necrophorum was identified as the causative agent of this metastatic and fatal infection. This case has shown the severity of infection due to F. necrophorum and, at the same time, the underestimation of anaerobic bacteria in the spectrum of etiologic agents responsible for meningitis. Only a prompt diagnosis and an adequate treatment can improve the prognosis and avoid a fatal outcome.

Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome

Human infection with Fusobacterium necrophorum usually involves F. necrophorum subsp. funduliforme rather than F. necrophorum subsp. necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests that F. necrophorum can be limited to the throat and cause persistent or recurrent tonsillitis. F. necrophorum is unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.

Comparison of broad-range bacterial PCR and culture of cerebrospinal fluid for diagnosis of community-acquired bacterial meningitis

Appropriate, rapid and reliable laboratory tests are essential for the diagnosis and optimal antibiotic therapy of acute bacterial meningitis. Broad-range bacterial PCR, combined with DNA sequencing, was compared with culture-based methods for examining cerebrospinal fluid (CSF) samples from patients with suspected meningitis. In total, 345 CSF specimens from 345 patients were analysed, with acute community-acquired bacterial meningitis being diagnosed in 74 patients. The CSF of 25 patients was positive by both PCR and culture; 26 patients had CSF specimens positive by PCR only, and 14 patients had specimens positive by culture only. The sensitivity of PCR and culture for clinically relevant meningitis was 59% (44/74) and 43% (32/74), respectively, while the specificity was 97% (264/271) and 97% (264/271), respectively. The commonest bacterial rRNA gene sequences detected by PCR only were those of Streptococcus pneumoniae and Neisseria meningitidis (n = 12). PCR failed to detect the bacterial rRNA gene in seven specimens from patients with symptoms compatible with acute bacterial meningitis. Overall, the results demonstrated that PCR in conjunction with sequencing may be a useful tool in the diagnosis of bacterial meningitis. PCR is particularly useful for analysing CSF from patients who have been treated with antibiotics before lumbar puncture.

Méningite à Fusobacterium necrophorum: complication oubliée d'une gingivite

By now Lemierre's syndrome is a seldom-described disease whose prognosis depends on the precocity of treatment.

CASE PRESENTATION

We report the case of an 11-month-old child, with a fulminant Fusobacterium necrophorum meningitis, which derived from a gingival infection, with fatal outcome.

CONCLUSION

This atypical case of Lemierre's syndrome (young age occurrence and localisation) underlines the potential severity of F. necrophorum sepsis.

Two cases of fatal meningitis due to Fusobacterium necrophorum

It is extremely important to consider Fusobacterium necrophorum as a cause of meningitis in children after otitis or other upper respiratory tract infections, because of its increasing incidence. A high index of suspicion and prompt microbiological identification are mandatory; as this organism is often penicillin-resistant, prolonged antibiotic therapy is required and invasive infection carries a high risk of fatal cerebral vessel thrombosis. This report presents two fatal cases who presented to our pediatric intensive care unit in December 2004.