Skip to main content
Log in

Neurologic manifestations of Fusobacterium infections in children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Fusobacterium necrophorum causes various clinical syndromes, ranging from otitis media to life-threatening Lemierre’s syndrome. The purpose of this study was to review our experience with pediatric Fusobacterium infections. The medical records of all children aged 0 to 18 years who were diagnosed between 1999 and 2011 with Fusobacterium infection were reviewed. Fusobacterium was isolated from clinical samples of 27 children: blood cultures (n = 16), abscesses (n = 8), joint fluids (n = 2), and cerebrospinal fluid (n = 1). The median age at admission was 3.5 years (range, 7 months to 17 years). Eight children (30 %) had seizures at presentation. Ten children (37 %) underwent lumbar puncture. Fifteen children (56 %) underwent brain imaging, and in seven of these children, a thrombus was identified either in a sinus vein or in an internal jugular vein. The most common source of infection was otogenic in 19 (70 %) of the children. Six of the children presented in 2011. All patients recovered. Conclusions: Neurologic manifestations are common at presentation of children with Fusobacterium infections. In young children, the most common source of infection is otogenic. Thrombotic complications are common, and imaging should be considered in all children with Fusobacterium infections arising from the head or neck region. There was a recent increase in the isolation of this bacterium, either because of better culturing techniques and increased awareness to this entity or a true increase in infections due to this organism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media (2004) Diagnosis and management of acute otitis media. Pediatrics 113:1451–1465

    Article  Google Scholar 

  2. Baker GC, Smith JJ, Cowan DA (2003) Review and re-analysis of domain-specific 16S primers. J Microbiol Methods 55:541–555

    Article  PubMed  CAS  Google Scholar 

  3. Brazier JS, Hall V, Yusuf E, Duerden BI (2002) Fusobacterium necrophorum infections in England and Wales 1990–2000. J Med Microbiol 51:269–272

    PubMed  CAS  Google Scholar 

  4. Bondy P, Grant T (2008) Lemierre’s syndrome: what are the roles for anticoagulation and long-term antibiotic therapy? Ann Otol Rhinol Laryngol 117:679–683

    PubMed  Google Scholar 

  5. Brook I (1994) Fusobacterial infections in children. J Infect 28:155–165

    Article  PubMed  CAS  Google Scholar 

  6. Clinical and Laboratory Standards Institute (CLSI) (2008) Performance standards for antimicrobial susceptibility testing; eighteenth informational supplement. CLSI document M100-S1

  7. Ehlers Klug T, Rusan M, Fuursted K, Ovesen T (2009) Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis 49:1467–1472

    Article  PubMed  Google Scholar 

  8. Forrester LJ, Campbell BJ, Berg JN, Barrett JT (1985) Aggregation of platelets by Fusobacterium necrophorum. J Clin Microbiol 22:245–249

    PubMed  CAS  Google Scholar 

  9. Goldenberg NA, Knapp-Clevenger R, Hays T, Manco-Johnson MJ (2005) Lemierre’s and Lemierre’s-like syndromes in children: survival and thromboembolic outcomes. Pediatrics 116:e543–e548

    Article  PubMed  Google Scholar 

  10. Hagelskjaer Kristensen L, Prag J (2008) Localised Fusobacterium necrophorum infections: a prospective laboratory-based Danish study. Eur J Clin Microbiol Infect Dis 27:733–739

    Article  PubMed  CAS  Google Scholar 

  11. Jacobs JA, Hendriks JJ, Verschure PD et al (1993) Meningitis due to Fusobacterium necrophorum subspecies necrophorum. Case report and review of the literature. Infection 21:57–60

    Article  PubMed  CAS  Google Scholar 

  12. Karkos PD, Asrani S, Karkos CD, Leong SC, Theochari EG, Alexopoulou TD, Assimakopoulos AD (2009) Lemierre’s syndrome: a systematic review. Laryngoscope 119:1552–1559

    Article  PubMed  Google Scholar 

  13. Katz A, Leibovitz E, Greenberg D et al (2003) Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990 through 2001). Pediatr Infect Dis J 22:878–882

    Article  PubMed  Google Scholar 

  14. Lemierre A (1936) On certain septicaemias due to anaerobic organisms. Lancet 1:701–703

    Article  Google Scholar 

  15. Le Monnier A, Jamet A, Carbonnelle E et al (2008) Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review. Pediatr Infect Dis J 27:613–617

    Article  PubMed  Google Scholar 

  16. Nohrström E, Mattila T, Pettilä V et al (2011) Clinical spectrum of bacteraemic Fusobacterium infections: from septic shock to nosocomial bacteraemia. Scand J Infect Dis 43:463–470

    Article  PubMed  Google Scholar 

  17. Riordan T (2007) Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev 20:622–659

    Article  PubMed  CAS  Google Scholar 

  18. Trapp CM, Tamai J, Schleiss MR (2005) Septic arthritis secondary to Fusobacterium necrophorum in a 4-year-old girl: case report and review of the literature. Pediatr Infect Dis J 24:846–847

    Article  PubMed  Google Scholar 

  19. Van Zuijlen DA, Schilder AG, Van Balen FA, Hoes AW (2001) National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media? Pediatr Infect Dis J 20:140–144

    Article  PubMed  Google Scholar 

  20. Veldhoen ES, Wolfs TF, van Vught AJ (2007) Two cases of fatal meningitis due to Fusobacterium necrophorum. Pediatr Neurol 36:261–263

    Article  PubMed  Google Scholar 

  21. Zevallos JP, Vrabec JT, Williamson RA et al (2009) Advanced pediatric mastoiditis with and without intracranial complications. Laryngoscope 119:1610–1615

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Orli Megged.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Megged, O., Assous, M.V., Miskin, H. et al. Neurologic manifestations of Fusobacterium infections in children. Eur J Pediatr 172, 77–83 (2013). https://doi.org/10.1007/s00431-012-1847-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-012-1847-9

Keywords

Navigation