Current Infectious Disease Reports

, Volume 15, Issue 3, pp 288–294 | Cite as

Fusobacterial Infections in Children

Pediatric Infectious Diseases (I Brook, Section Editor)

Abstract

Fusobacteria are members of the oral and gastrointestinal flora and are important potential pathogens in children. They are increasingly recognized as a cause of infections in children. These include infections of the head and neck (Lemierre syndrome, acute and chronic mastoiditis, chronic otitis and sinusitis, tonsillitis, peritonsillar and retropharyngeal abscesses, postanginal cervical lymphadenitis, periodontitis), brain, lungs, abdomen, pelvis, bones, joints, and blood. This review describes the clinical spectrum of fusobacterial infection in children and their management.

Keywords

Fusobacteria Children Antibiotics Resistance 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Brook I. Indigenous microbial flora of humans. In: Howard R, Simmons RL, editors. Surgical infectious diseases. 3rd ed. East Norwalk: Appleton & Lange; 1995. p. 37–46.Google Scholar
  2. 2.
    Brook I. Anaerobic infections diagnosis and management. A textbook. New York: Informa Healthcare; 2007.CrossRefGoogle Scholar
  3. 3.
    Brazier JS. Human infections with Fusobacterium necrophorum. Anaerobe. 2006;12:165–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Hagelskjaer Kristensen L, Prag J. Human necrobacillosis, with emphasis on Lemierre's syndrome. Clin Infect Dis. 2000;31:524–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Hagelskjaer Kristensen L, Prag J. Localised Fusobacterium necrophorum infections: a prospective laboratory-based Danish study. Eur J Clin Microbiol Infect Dis. 2008;27:733–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Hagelskjær Kristensen L, Prag J. Lemierre's syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis. 2008;27:779–89.PubMedCrossRefGoogle Scholar
  7. 7.
    Eykyn SJ. Necrobacillosis. Scand J Infect Dis Suppl. 1989;62:41–6.PubMedGoogle Scholar
  8. 8.
    Citron DM. Update on the taxonomy and clinical aspects of the genus Fusobacterium. Clin Infect Dis. 2002;35 Suppl 1:S22–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Bolstad AI, Jensen HB, Bakken V. Taxonomy, biology, and periodontal aspects of Fusobacterium nucleatum. Clin Microbiol Rev. 1996;9:55–71.PubMedGoogle Scholar
  10. 10.
    Kim HS, Lee DS, Chang YH, et al. Application of rpoB and zinc protease gene for use in molecular discrimination of Fusobacterium nucleatum subspecies. J Clin Microbiol. 2010;48:545–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Brook I, Hunter V, Walker RI. Synergistic effect of Bacteroides, Clostridium, Fusobacterium, anaerobic cocci, and aerobic bacteria on mortality and induction of subcutaneous abscesses in mice. J Infect Dis. 1984;149:924–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Constantin J-M, Mira J-P, Guerin R, et al. Lemierre's syndrome and genetic polymorphisms: a case report. BMC Infect Dis. 2006;6:115.PubMedCrossRefGoogle Scholar
  13. 13.
    Goldenberg NA, Knapp-Clevenger R, Hays T, et al. Lemierre's and Lemierre's-like syndromes in children: survival and thromboembolic outcomes. Pediatrics. 2005;116:e543–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Schmid T, Miskin H, Schlesinger Y, et al. Respiratory failure and hypercoagulability in a toddler with Lemierre's syndrome. Pediatrics. 2005;115:e620–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Hoehn KS. Lemierre's syndrome: the controversy of anticoagulation. Pediatrics. 2005;115:1415–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Onoue S, Niwa M, Isshiki Y, Kawahara K. Extraction and characterization of the smooth-type lipopolysaccharide from Fusobacterium nucleatum JCM 8532 and its biological activities. Microbiol Immunol. 1996;40:323–31.PubMedGoogle Scholar
  17. 17.
    Van Dyke TE, Bartholomew E, Genco RJ, et al. Inhibition of neutrophil chemotaxis by soluble bacterial products. J Periodontol. 1982;53:502–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Garcia GG, Amoako KK, Xu DL, et al. Chemical composition of endotoxins produced by Fusobacterium necrophorum subsp. necrophorum and F. necrophorum subsp. funduliforme. Microbios. 1999;100:175–9.Google Scholar
  19. 19.
    Brook I. Infections caused by beta-lactamase-producing Fusobacterium spp. in children. Pediatr Infect Dis J. 1993;12:532–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Goldhagen J, Alford BA, Previtt LH, et al. Suppurative thrombophlebitis of the internal jugular vein: report of three cases and review of the pediatric literature. Pediatr Infect Dis J. 1988;7:410–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Smith GR, Thornton EA. Classification of human and animal strains of Fusobacterium necrophorum by their pathogenic effects in mice. J Med Microbiol. 1997;46:879–82.PubMedCrossRefGoogle Scholar
  22. 22.
    Rathore MH, Barton LL, Dunkle LM. The spectrum of fusobacterial infection in children. Pediatr Infect Dis J. 1990;9:505–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Batty A, Wren MWD, Gal M. Fusobacterium necrophorum as the cause of recurrent sore throat: comparison of isolates from persistent sore throat syndrome and Lemierre's disease. J Infect. 2005;51:299–305.PubMedCrossRefGoogle Scholar
  24. 24.
    Amess JA, O'Neill W, Giollariabhaigh CN, Dytrych JK. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Br J Biomed Sci. 2007;64:63–5.PubMedGoogle Scholar
  25. 25.
    Ramirez S, Hild TG, Rudolph CN, et al. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a children's hospital. Pediatrics. 2003;112:e380–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Brook I. Fusobacterial infections in children. J Infect. 1994;28:155–65.PubMedCrossRefGoogle Scholar
  27. 27.
    Bourgault AM, Lamothe F, Dolce P, et al. Fusobacterium bacteremia: clinical experience with 40 cases. Clin Infect Dis. 1997;25 Suppl 2:181–3.CrossRefGoogle Scholar
  28. 28.
    Brook I. Bacteremia due to anaerobic bacteria in newborns. J Perinatol. 1990;10:351–6.PubMedGoogle Scholar
  29. 29.
    Lemierre A. On certain septicaemias due to anaerobic organisms. Lancet. 1936;1:701–3.CrossRefGoogle Scholar
  30. 30.
    Riordan T. Human infection with Fusobacterium necrophorum (necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev. 2007;20:622–59.PubMedCrossRefGoogle Scholar
  31. 31.
    Brook I, Frazier EH, Gher ME. Aerobic and anaerobic microbiology of periapical abscess. Oral Microbiol Immunol. 1991;6:123–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Brook I, Foote PA, Slots J. Immune response to Fusobacterium nucleatum, Prevotella intermedia and other anaerobes in children with acute tonsillitis. J Antimicrob Chemother. 1997;39:763–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Brook I. Management of bacterial rhinosinusitis in children. Eur Respir Dis. 2012;8:56–60.Google Scholar
  34. 34.
    Cunningham M, Guardiani E, Kim HJ, Brook I. Otitis media. Future Microbiol. 2012;7:733–53.PubMedCrossRefGoogle Scholar
  35. 35.
    Brook I. Role of anaerobic bacteria in chronic otitis media and cholesteatoma. Int J Pediatr Otorhinolaryngol. 1995;31:153–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Brook I. Aerobic and anaerobic bacteriology of chronic mastoiditis in children. Am J Dis Child. 1981;135:478–9.PubMedGoogle Scholar
  37. 37.
    • Gorphe P, de Barros A, Choussy O, et al. Acute mastoiditis in children: 10 years experience in a French tertiary university referral center. Eur Arch Otorhinolaryngol. 2012;269:455–60. This is a retrospective review of 36 French children hospitalized for acute mastoiditis from 1999 to 2009. There were 10 periosteitis and 26 subperiosteal abscesses. There was a trend toward increased incidence over the past 10 years. The recovered pathogens were Streptococcus pneumoniae (36.1 %), GABHS (14 %), staphylococcus coagulase-negative (14 %), Pseudomonas aeruginosa (8.3 %), Fusobacterium necrophorum (8.3 %), and Haemophilus influenzae (3 %). All patients received intravenous antibiotics. Eleven patients underwent bilateral myringotomy with or without tympanostomy tubes. Mastoidectomy was performed in 24 patients. S. pneumoniae, F. necrophorum and P. aeruginosa were mostly found in children older than 2 years. Mastoidectomy was performed in 92.3 % of subperiosteal abscesses.PubMedCrossRefGoogle Scholar
  38. 38.
    Yarden-Bilavsky H, Raveh E, Livni G, et al. Fusobacterium necrophorum mastoiditis in children – emerging pathogen in an old disease. Int J Pediatr Otorhinolaryngol. 2013;77:92–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Brook I. Aerobic and anaerobic bacteriology of peritonsillar abscess in children. Acta Paediatr Scand. 1981;70:831–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Brook I. Microbiology of retropharyngeal abscesses in children. Am J Dis Child. 1987;141:202–4.PubMedGoogle Scholar
  41. 41.
    Jensen A, Hagelskjær Kristensen L, Prag J. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect. 2007;13:695–701.PubMedCrossRefGoogle Scholar
  42. 42.
    Jousimies-Somer H, Savolainen S, Mäkitie A, et al. Bacteriologic findings in peritonsillar abscesses in young adults. Clin Infect Dis. 1993;16(Suppl):S292–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Brook I, Yocum P. Immune response to Fusobacterium nucleatum and Prevotella intermedia in patients with chronic maxillary sinusitis. Ann Otol Rhinol Laryngol. 1999;108:293–5.PubMedGoogle Scholar
  44. 44.
    Brook I, Yocum P, Friedman EM. Aerobic and anaerobic bacteria in tonsils of children with recurrent tonsillitis. Ann Otol Rhinol Laryngol. 1981;90:261–3.PubMedGoogle Scholar
  45. 45.
    Kielmovitch IH, Keleti G, Bluestone CD, et al. Microbiology of obstructive tonsillar hypertrophy and recurrent tonsillitis. Arch Otolaryngol Head Neck Surg. 1989;115:721–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Brook I. Role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection. Rev Infect Dis. 1984;6:601–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Brook I. The role of anaerobic bacteria in tonsillitis. Int J Pediatr Otorhinolaryngol. 2005;69:9–19.PubMedCrossRefGoogle Scholar
  48. 48.
    Brook I, Yocum P. Quantitative measurement of beta-lactamase level in tonsils of children with recurrent tonsillitis. Acta Otolaryngol Scand. 1984;98:446–60.Google Scholar
  49. 49.
    Brook I, Hirokawa R. Treatment of patients with a history of recurrent tonsillitis due to group A beta-hemolytic streptococci. A prospective randomized study comparing penicillin, erythromycin and clindamycin. Clin Pediatr. 1985;24:331–6.CrossRefGoogle Scholar
  50. 50.
    Brook I. Treatment of patients with acute recurrent tonsillitis due to group A beta-haemolytic streptococci: a prospective randomized study comparing penicillin and amoxicillin/clavulanate potassium. J Antimicrob Chemother. 1989;24:227–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Kaplan EL, Johnson DR. Eradication of group A streptococci from the upper respiratory tract by amoxicillin with clavulanate after oral penicillin V treatment failure. J Pediatr. 1988;113:400–3.PubMedCrossRefGoogle Scholar
  52. 52.
    Casey JR, Pichichero ME. Meta-analysis of cephalosporins versus penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Clin Infect Dis. 2004;38:1526–34.PubMedCrossRefGoogle Scholar
  53. 53.
    Batty A, Wren MW. Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci. 2005;62:66–70.PubMedGoogle Scholar
  54. 54.
    Klug TE, Rusan M, Fuursted K, et al. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis. 2009;49:1467–72.CrossRefGoogle Scholar
  55. 55.
    Brook I, Frazier EH, Thompson DH. Aerobic and anaerobic microbiology of peritonsillar abscess. Laryngoscope. 1991;101:289–92.PubMedGoogle Scholar
  56. 56.
    Brook I, Foote Jr PA, Slots J. Immune response to anaerobic bacteria in patients with peritonsillar cellulitis and abscess. Acta Otolaryngol. 1996;116:888–91.PubMedCrossRefGoogle Scholar
  57. 57.
    Finegold SM, Flynn MJ, Rose FV, et al. Bacteriologic findings associated with chronic bacterial maxillary sinusitis in adults. Clin Infect Dis. 2002;35:428–33.PubMedCrossRefGoogle Scholar
  58. 58.
    Sherlock R, Le Saux N. Fifteen-year-old girl with fever, headache and vomiting. Pediatr Infect Dis J. 2002;21(439):449–50.Google Scholar
  59. 59.
    Bair-Merritt MH, Shah SS, Zaoutis TE, et al. Suppurative intracranial complications of sinusitis in previously healthy children. Pediatr Infect Dis J. 2005;24:384–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Heckmann JG, Lang CJG, Hartl H, et al. Multiple brain abscesses caused by Fusobacterium nucleatum treated conservatively. Can J Neurol Sci. 2003;30:266–8.PubMedGoogle Scholar
  61. 61.
    Ewald C, Kuhn S, Kalff R. Pyogenic infections of the central nervous system secondary to dental affections – a report of six cases. Neurosurg Rev. 2006;29:163–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Khouzam RN, El-Dokla AM, Menkes DL. Undiagnosed patent foramen ovale presenting as cryptogenic brain abscess: case report and review of the literature. Heart Lung. 2006;35:108–11.PubMedCrossRefGoogle Scholar
  63. 63.
    Masterson T, El-Hakim H, Magnus K, et al. A case of the otogenic variant of Lemierre's syndrome with atypical sequelae and a review of pediatric literature. Int J Pediatr Otorhinolaryngol. 2005;69:117–22.PubMedCrossRefGoogle Scholar
  64. 64.
    Figueras G, Garcia O, Vall O, et al. Otogenic Fusobacterium necrophorum meningitis in children. Pediatr Infect Dis J. 1995;14:627–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Larsen PD, Chartrand SA, Adickes ED. Fusobacterium necrophorum meningitis associated with cerebral vessel thrombosis. Pediatr Infect Dis J. 1997;16:330–1.PubMedCrossRefGoogle Scholar
  66. 66.
    Morrison A, Weir I, Silber T. Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent. South Med J. 2004;97:416–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Le Monnier A, Jamet A, Carbonnelle E, et al. Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review. Pediatr Infect Dis J. 2008;27:613–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Vincent QB, Labedan I, Madhi F. Lemierre syndrome with meningo-encephalitis, severe cerebral artery stenosis, and focal neurological symptoms. J Pediatr. 2010;157:345.PubMedCrossRefGoogle Scholar
  69. 69.
    Aspesberro R, Siebler T, Van Nieuwenhuyse J-P, et al. Lemierre syndrome in a 5-month-old male infant: case report and review of the pediatric literature. Pediatr Crit Care Med. 2008;9:e35–7.PubMedCrossRefGoogle Scholar
  70. 70.
    Brook I. Lung abscesses and pleural empyema in children. Adv Pediatr Infect Dis. 1993;8:159–76.PubMedGoogle Scholar
  71. 71.
    Brook I, Finegold SM. Bacteriology of aspiration pneumonia in children. Pediatrics. 1980;65:1115–20.PubMedGoogle Scholar
  72. 72.
    Trapp CM, Tamai J, Schleiss MR. Septic arthritis secondary to Fusobacterium necrophorum in a 4-year-old girl: case report and review of the literature. Pediatr Infect Dis J. 2005;24:846–7.PubMedCrossRefGoogle Scholar
  73. 73.
    Syed MI, Baring D, Addidle M, et al. Lemierre syndrome: two cases and a review. Laryngoscope. 2007;117:1605–10.PubMedCrossRefGoogle Scholar
  74. 74.
    Murray SJ, Lieberman JM. Fusobacterium osteomyelitis in a child with sickle cell disease. Pediatr Infect Dis J. 2002;21:979–81.PubMedCrossRefGoogle Scholar
  75. 75.
    Brook I. Anaerobic osteomyelitis in children. Pediatr Infect Dis. 1986;5:550–6.PubMedCrossRefGoogle Scholar
  76. 76.
    Brook I. Aerobic and anaerobic bacteriology of intracranial abscesses. Pediatr Neurol. 1992;8:210–4.PubMedCrossRefGoogle Scholar
  77. 77.
    Saez-Llovens XJ, Umana MA, Odin CM, et al. Brain abscess in infants and children. Pediatr Infect Dis J. 1989;8:449–58.CrossRefGoogle Scholar
  78. 78.
    Tarnivk A, Sundquist G, Grothefors L, et al. Meningitis caused by Fusobacterium necrophorum. Eur J Clin Microbiol. 1986;5:353–5.CrossRefGoogle Scholar
  79. 79.
    Megged O, Assous MV, Miskin H, et al. Neurologic manifestations of Fusobacterium infections in children. Eur J Pediatr. 2013;172:77–83.PubMedCrossRefGoogle Scholar
  80. 80.
    Brook I, Frazier EH. Microbiology of liver and spleen abscesses. J Med Microbiol. 1998;47:1075–80.PubMedCrossRefGoogle Scholar
  81. 81.
    Brook I. Microbiology of subphrenic abscesses in children. Pediatr Infect Dis J. 1992;11:679–80.PubMedGoogle Scholar
  82. 82.
    Brook I, Martin WJ. Aerobic and anaerobic bacteriology of perirectal abscess in children. Pediatrics. 1980;66:282–4.PubMedGoogle Scholar
  83. 83.
    Brook I, Anderson KD, Controni G, et al. Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children. Am J Dis Child. 1980;134:679–80.PubMedGoogle Scholar
  84. 84.
    Brook I. Microbiology of human and animal bite wounds in children. Pediatr Infect Dis J. 1987;6:29–32.PubMedCrossRefGoogle Scholar
  85. 85.
    Falkler Jr WA, Enwonwu CO, Idigbe EO. Isolation of Fusobacterium necrophorum from cancrum oris (noma). AmJTrop Med Hyg. 1999;60:150–6.Google Scholar
  86. 86.
    Enwonwu CO, Falkler Jr WA, Idigbe EO. Oro-facial gangrene (noma/cancrum oris): pathogenetic mechanisms. Crit Rev Oral Biol Med. 2000;11:159–71.PubMedCrossRefGoogle Scholar
  87. 87.
    Paster BJ, Falkler Jr WA, Enwonwu CO, et al. Prevalent bacterial species and novel phylotypes in advanced noma lesions. J Clin Microbiol. 2002;40:2187–91.PubMedCrossRefGoogle Scholar
  88. 88.
    Adriaans B, Drasar BS. The isolation of fusobacteria from tropical ulcers. Epidemiol Infect. 1987;99:361–72.PubMedCrossRefGoogle Scholar
  89. 89.
    Busch DF, Kureshi LA, Sutter VL, Finegold SM. Susceptibility of respiratory tract anaerobes to orally administered penicillins and cephalosporins. Antimicrob Agents Chemother. 1976;10:713–20.PubMedCrossRefGoogle Scholar
  90. 90.
    Wybo I, Piérard D, Verschraegen I, et al. Third Belgian multicentre survey of antibiotic susceptibility of anaerobic bacteria. J Antimicrob Chemother. 2007;59:132–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Aldridge K, Aldridge KE, Ashcraft D, et al. Multicenter survey of the changing in vitro antimicrobial susceptibilities of clinical isolates of Bacteroides fragilis group, Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus species. Antimicrob Agents Chemother. 2001;45:1238–43.PubMedCrossRefGoogle Scholar
  92. 92.
    Sutter VL, Finegold SM. Susceptibility of anaerobic bacteria to 23 antimicrobial agents. Antimicrob Agents Chemother. 1976;10:736–52.PubMedCrossRefGoogle Scholar
  93. 93.
    Wexler HM, Molitoris E, Molitoris D, Finegold SM. In vitro activity of moxifloxacin against 179 strains of anaerobic bacteria found in pulmonary infections. Anaerobe. 2000;6:227–31.CrossRefGoogle Scholar
  94. 94.
    Goldstein EJC, Citron DM, Merriam CV. Linezolid activity compared to those of selected macrolides and other agents against aerobic and anaerobic pathogens isolated from soft tissue bite infections in humans. Antimicrob Agents Chemother. 1999;43:1469–74.PubMedGoogle Scholar
  95. 95.
    Mitre RJ, Rotheram Jr EB. Anaerobic septicemia from thrombophlebitis of the internal jugular vein. Successful treatment with metronidazole. JAMA. 1974;230:1168–9.PubMedCrossRefGoogle Scholar
  96. 96.
    Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore). 1989;68:85–94.Google Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Departments of Pediatrics and MedicineGeorgetown University School of MedicineWashingtonUSA

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