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Salehi O, Chen A, Cevik J. Cryptogenic pyogenic liver abscess caused by Fusobacterium necrophorum in an immunocompetent patient. BMJ Case Rep 2023; 16:e255460. [PMID: 38097280 PMCID: PMC10729157 DOI: 10.1136/bcr-2023-255460] [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] [Indexed: 12/18/2023] Open
Abstract
Pyogenic liver abscesses are potentially fatal conditions that require prompt treatment with drainage and appropriate antimicrobial therapy. Fusobacterium necrophorum is a gram-negative rod that is found in the oral cavity, gastrointestinal tract and female genital tract. It is an extremely rare cause of liver abscess, particularly in the absence of risk factors or exposures. We describe an unusual case of a cryptogenic F. necrophorum hepatic abscess without a clear source despite extensive investigation in a young, immunocompetent patient without known risk factors or exposures for such an infection.
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Affiliation(s)
- Omar Salehi
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Chen
- Austin Hospital, Heidelberg, Victoria, Australia
| | - Jevan Cevik
- Royal Melbourne Hospital, Parkville, Victoria, Australia
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2
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Zhang X, Jiyun Zhou, Yinhong Zhu, Ye X, Bo D, Tianjiao Tang, Huang X, Qu T. A case report of liver abscesses caused by Fusobacterium necrophorum in immunocompetent patient and review of the literature. Heliyon 2023; 9:e18535. [PMID: 37520974 PMCID: PMC10374925 DOI: 10.1016/j.heliyon.2023.e18535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
Background Fusobacterium necrophorum is an anaerobic Gram-negative bacterium that can lead to opportunistic infections, including Lemierre's syndrome and less common presentations of metastatic diseases. However, liver abscesses infected by Fusobacterium necrophorum in clinical settings are rarely reported, particularly in people with normal immune function. Case presentation A 35-year-old Chinese man was admitted with hyperthermia and abdominal pain that had persisted for three days. The patient continued to have a fever with a maximum temperature of 39.8 °C during hospitalization. Computed Tomography revealed multiple low-density lesions in the liver, which were diagnosed as liver abscesses caused by Fusobacterium necrophorum infection through blood culture and anaerobic liver abscess fluid culture. After simple local percutaneous abscess drainage and effective anti-infective therapy, the patient achieved complete remission. Conclusions Results of our literature search query revealed rare reports of liver abscesses infected by Fusobacterium necrophorum. We recommend that Fusobacterium necrophorum infection be considered in diagnosis special situations of liver abscess.
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Affiliation(s)
- Xiaoqiang Zhang
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Jiyun Zhou
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Yinhong Zhu
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Xufang Ye
- Department of Laboratory Medicine, First People's Hospital of Linping District, Hangzhou, China
| | - Dehua Bo
- Department of Ultrasonography, First People's Hospital of Linping District, Hangzhou, China
| | - Tianjiao Tang
- Department of Infectious Disease, Liangzhu Hospital, Yuhang District, Hangzhou, China
| | - Xiaojing Huang
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Tingting Qu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Reihani AR, Ponce F, Spivak R. Pyogenic Liver Abscess: A Case of a Fussy Bug Seeking Unlikely Host. Cureus 2023; 15:e42263. [PMID: 37489179 PMCID: PMC10363015 DOI: 10.7759/cureus.42263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 07/26/2023] Open
Abstract
Pyogenic liver abscesses (PLAs) represent a rare yet life-threatening condition, and Fusobacterium species are an atypical etiology typically associated with immunocompromised patients or those with recent dental procedures or oro-gingival disease. Nonetheless, it is crucial to maintain a high level of suspicion for Fusobacterium infection in all cases, including immunocompetent individuals without known risk factors. In this case report, we present the clinical scenario of a young male with a history of COVID-19 pneumonia who exhibited subacute fever, abdominal pain, and pleuritic chest pain, leading to sepsis attributed to intraabdominal pathology. Subsequent imaging confirmed the presence of possible liver abscesses, prompting interventional radiology-guided drainage. Cultures obtained from the drained abscesses yielded Fusobacterium species, and significant clinical improvement was observed following the initiation of appropriate antibiotic therapy. This case report underscores the potential for disseminated Fusobacterium infections to occur in immunocompetent individuals without a history of oropharyngeal disease, highlighting the importance of early diagnosis and management to mitigate mortality risk.
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Affiliation(s)
- Amir R Reihani
- Medical Education, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
- Pulmonary and Critical Care Medicine, Eisenhower Hospital, Rancho Mirage, USA
| | - Fernanda Ponce
- Medical Education, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
| | - Roman Spivak
- Pulmonary and Critical Care Medicine, Griffin Hospital/Yale-Affiliated Hospital, Derby, USA
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P. micra and F. necrophorum: Hepatic Abscesses in a Healthy Soldier. Case Rep Infect Dis 2022; 2022:5500365. [PMID: 35345475 PMCID: PMC8957035 DOI: 10.1155/2022/5500365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Parvimonas micra (P. micra) and Fusobacterium necrophorum (F. necrophorum) are two pathogens known to cause odontogenic and oropharyngeal infections. It is exceedingly rare for these bacteria to cause coinfection and even systemic infection. There is limited literature on liver abscesses and bacteremia involving P. micra. Most cases are found in elderly patients with associated gastrointestinal malignancy (24%) or laryngeal pharynx malignancy (28%). However, a substantial portion of described cases were unable to identify a source (36%). A 36-year-old, otherwise healthy male presented for fevers and chills for 2 weeks. After testing negative for initial infectious workup, including COVID-19 multiple times, he was found to have multiple liver abscesses which grew P. micra and F. necrophorum. This case highlights a rare coinfection of hepatic abscesses in an otherwise healthy young immunocompetent adult with a solitary dental caries, resulting in septic shock.
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Toumeh N, Mudireddy M, Smith B, Guerrero DM. Fatal Case of Liver and Brain Abscesses Due to Fusobacterium nucleatum. Cureus 2021; 13:e19671. [PMID: 34976461 PMCID: PMC8682949 DOI: 10.7759/cureus.19671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
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Leroy R, Bourgeois J, Verleye L, Carvalho JC, Eloot A, Cauwels R, Declerck D. Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature. Clin Oral Investig 2021; 25:2537-2544. [PMID: 33791867 DOI: 10.1007/s00784-021-03862-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/24/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. MATERIALS AND METHODS Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. RESULTS Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. CONCLUSIONS At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. CLINICAL RELEVANCE There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.
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Affiliation(s)
- Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium.
| | - Jolyce Bourgeois
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium
| | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, B-1000, Brussels, Belgium
| | - Joana C Carvalho
- Faculty of Medicine and Dentistry, UCLouvain, Av. Hippocrate 10, B-1200, Brussels, Belgium
| | - Anouk Eloot
- Private Dental Practice, Emiel Verhaerenlaan 37, B-9050, Gentbrugge, Belgium
| | - Rita Cauwels
- Department of Oral Health Sciences, UGent, C. Heymanslaan 10, B-9000, Ghent, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Kapucijnenvoer 7/a-box 7001, B-3000, Leuven, Belgium
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Engevik MA, Danhof HA, Ruan W, Engevik AC, Chang-Graham AL, Engevik KA, Shi Z, Zhao Y, Brand CK, Krystofiak ES, Venable S, Liu X, Hirschi KD, Hyser JM, Spinler JK, Britton RA, Versalovic J. Fusobacterium nucleatum Secretes Outer Membrane Vesicles and Promotes Intestinal Inflammation. mBio 2021; 12:e02706-20. [PMID: 33653893 PMCID: PMC8092269 DOI: 10.1128/mbio.02706-20] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple studies have implicated microbes in the development of inflammation, but the mechanisms remain unknown. Bacteria in the genus Fusobacterium have been identified in the intestinal mucosa of patients with digestive diseases; thus, we hypothesized that Fusobacterium nucleatum promotes intestinal inflammation. The addition of >50 kDa F. nucleatum conditioned media, which contain outer membrane vesicles (OMVs), to colonic epithelial cells stimulated secretion of the proinflammatory cytokines interleukin-8 (IL-8) and tumor necrosis factor (TNF). In addition, purified F. nucleatum OMVs, but not compounds <50 kDa, stimulated IL-8 and TNF production; which was decreased by pharmacological inhibition of Toll-like receptor 4 (TLR4). These effects were linked to downstream effectors p-ERK, p-CREB, and NF-κB. F. nucleatum >50-kDa compounds also stimulated TNF secretion, p-ERK, p-CREB, and NF-κB activation in human colonoid monolayers. In mice harboring a human microbiota, pretreatment with antibiotics and a single oral gavage of F. nucleatum resulted in inflammation. Compared to mice receiving vehicle control, mice treated with F. nucleatum showed disruption of the colonic architecture, with increased immune cell infiltration and depleted mucus layers. Analysis of mucosal gene expression revealed increased levels of proinflammatory cytokines (KC, TNF, IL-6, IFN-γ, and MCP-1) at day 3 and day 5 in F. nucleatum-treated mice compared to controls. These proinflammatory effects were absent in mice who received F. nucleatum without pretreatment with antibiotics, suggesting that an intact microbiome is protective against F. nucleatum-mediated immune responses. These data provide evidence that F. nucleatum promotes proinflammatory signaling cascades in the context of a depleted intestinal microbiome.IMPORTANCE Several studies have identified an increased abundance of Fusobacterium in the intestinal tracts of patients with colon cancer, liver cirrhosis, primary sclerosing cholangitis, gastroesophageal reflux disease, HIV infection, and alcoholism. However, the direct mechanism(s) of action of Fusobacterium on pathophysiological within the gastrointestinal tract is unclear. These studies have identified that F. nucleatum subsp. polymorphum releases outer membrane vesicles which activate TLR4 and NF-κB to stimulate proinflammatory signals in vitro Using mice harboring a human microbiome, we demonstrate that F. nucleatum can promote inflammation, an effect which required antibiotic-mediated alterations in the gut microbiome. Collectively, these results suggest a mechanism by which F. nucleatum may contribute to intestinal inflammation.
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Affiliation(s)
- Melinda A Engevik
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Heather A Danhof
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Wenly Ruan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Amy C Engevik
- Department of Surgical Sciences, Vanderbilt University Medical Center, Nashville Tennessee, USA
| | - Alexandra L Chang-Graham
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Kristen A Engevik
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Zhongcheng Shi
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Yanling Zhao
- Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Colleen K Brand
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Evan S Krystofiak
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Susan Venable
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Xinli Liu
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, Texas, USA
| | - Kendal D Hirschi
- Department of Pediatrics and Human and Molecular Genetics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph M Hyser
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer K Spinler
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Robert A Britton
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - James Versalovic
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
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Volpe N, Connolly S, Cheema B, Angarone M. A Curious Case of Endocarditis and Liver Abscess in a Previously Healthy Man. Am J Med 2020; 133:186-190. [PMID: 31421067 DOI: 10.1016/j.amjmed.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Nicholas Volpe
- Northwestern University, Feinberg School of Medicine, Chicago, Ill
| | - Sean Connolly
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill.
| | - Baljash Cheema
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill
| | - Michael Angarone
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Ill
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Ghani AR, Hamid M, Raza A, Naseer R, Crocetti J. Some neck swellings are serious; a case of Lemierre's Syndrome. J Community Hosp Intern Med Perspect 2017; 7:251-254. [PMID: 29046755 PMCID: PMC5637642 DOI: 10.1080/20009666.2017.1369375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/10/2017] [Indexed: 10/26/2022] Open
Abstract
Lemierre's syndrome also termed post-anginal septicemia, is a disease characterized by internal jugular septic thrombophlebitis leading to Fusobacterium septicemia with multiple metastatic foci following an oropharyngeal infection. Diagnosis and management is challenging and can result in fatal consequences due to potential multisystem involvement and multiple complications. We describe here a case of Lemierre's syndrome with multifocal pneumonia, acute renal failure and protracted course of illness over forty days with successful recovery. A brief overview of literature is also presented.
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Affiliation(s)
- Ali Raza Ghani
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Mohsin Hamid
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Ahsan Raza
- LankenauInstitute for Medical Research., Wynnewood, Pa, USA
| | - Rizwan Naseer
- Department of Internal Medicine, King Edward Medical University, KEMU, Lahore, Punjab, Pakistan
| | - Joseph Crocetti
- Department of Pulmonary and Critical Care, Abington Jefferson Health, Abington, PA, USA
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