Clinical Features and Outcomes of Fusobacterium Species Infections in a Ten-Year Follow-up

Open access

Abstract

Objective: Although uncommon, Fusobacterium infections have a wide clinical spectrum, ranging from local pharyngeal infections to septic shock. Our aim was to characterize and analyze the clinical features and outcomes in patients with Fusobacterium infections, and determine which variables were able to predict a poor outcome.

Methods: We conducted a retrospective, hospital-based study using the computerized records of a second-level Spanish general hospital, serving a population of 155,000 inhabitants. The cohort was enrolled among patients cared for at the hospital between 2007 and 2016. Demographic, clinical data, microbiological characterization and outcomes at discharge, were analyzed.

Results: We collected data for all 26 patients over a 10-year period (annual incidence of 1.78 per 100,000), with an incidence of bacteremia of 0.53 cases per 100,000 population per year. F. nucleatum and F. necrophorum were the most frequent isolations (53.8% and 38.5%, respectively). F. necrophorum was found to be associated with a younger population. Although we found no deaths attributable to Fusobacterium, 15 patients (57%) were found to have severe infections due to this pathogen, and 7 patients (26.9%) were admitted to the Intensive Care Unit (ICU). The only identifiable risk factor for a severe infection (sepsis, septic shock or ICU admission) was the presence of bacteremia.

Conclusions: Fusobacterium infections are uncommon. F. necrophorum tends to cause infection in younger individuals, while F. nucleatum has a preference for older patients. The clinical spectrum is wide, ranging from local, non-severe infections, such as sinusitis or pharyngitis, to abscess formation and life-threatening infections.

1. Lemierre A. On certain septicaemias due to anaerobic organisms. Lancet. 1936;227(5874):701–3.

2. Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre’s syndrome. Clin Microbiol Rev. 2007 Oct;20(4):622–59.

3. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004 Dec;39(11):1654–9.

4. Iwasaki T, Yamamoto T, Inoue K, Takaku K. A Case of Lemierre’s Syndrome in Association with Liver Abscess without Any Other Metastatic Lesions. Intern Med. 2012;51(11):1419–23.

5. Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol. 2004 Nov;2(11):1032–8.

6. Yoneda M, Kato S, Mawatari H, Kirikoshi H, Imajo K, Fujita K, et al. Liver abscess caused by periodontal bacterial infection with Fusobacterium necrophorum. Hepatol Res. 2011 Feb;41(2):194–6.

7. Afra K, Laupland K, Leal J, Lloyd T, Gregson D. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC Infect Dis. 2013;13(1):264.

8. Nohrström E, Mattila T, Pettilä V, Kuusela P, Carlson P, Kentala E, et al. Clinical spectrum of bacteraemic Fusobacterium infections: from septic shock to nosocomial bacteraemia. Scand J Infect Dis. 2011;43(6–7):463–70.

9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb;315(8):801–10.

10. Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):775–87.

11. O’Hara CM. Manual and Automated Instrumentation for Identification of Enterobacteriaceae and Other Aerobic Gram-Negative Bacilli. Clin Microbiol Rev. 2005 Jan;18(1):147–62.

12. Kierzkowska M, Majewska A, Kuthan RT, Sawicka-Grzelak A, Mlynarczyk G. A comparison of Api 20A vs MALDI-TOF MS for routine identification of clinically significant anaerobic bacterial strains to the species level. J Microbiol Methods. 2013 Feb;92(2):209–12.

13. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria; 2014.

14. Goldberg EA, Venkat-Ramani T, Hewit M, Bonilla HF. Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia. Epidemiol Infect. 2013;141(2):325–9.

15. Pett E, Saeed K, Dryden M. Fusobacterium species infections: clinical spectrum and outcomes at a district general hospital. Infection. 2014;42(2):363–70.

16. Bytyci F, Khromenko E. Hepatic abscess caused by Fusobacterium necrophorum after a trip to the dentist. BMJ Case Rep. 2016 Mar;2016.

17. Buelow BD, Lambert JM, Gill RM. Fusobacterium liver abscess. Case Rep Gastroenterol. 2013;7(3):482–6.

18. Ahmed Z, Bansal SK, Dhillon S. Pyogenic liver abscess caused by Fusobacterium in a 21-year-old immunocompetent male. World J Gastroenterol. 2015 Mar 28;21(12):3731–5.

19. Li Y-Y, Ge Q-X, Cao J, Zhou Y-J, Du Y-L, Shen B, et al. Association of Fusobacterium nucleatum infection with colorectal cancer in Chinese patients. World J Gastroenterol. 2016;22(11):3227.

20. Huggan PJ, Murdoch DR. Fusobacterial infections: clinical spectrum and incidence of invasive disease. J Infect. 2008;57(4):283–9.

21. Yang C-C, Ye J-J, Hsu P-C, Chang H-J, Cheng C-W, Leu H-S, et al. Characteristics and outcomes of Fusobacterium nucleatum bacteremia—a 6-year experience at a tertiary care hospital in northern Taiwan. Diagn Microbiol Infect Dis. 2011;70(2):167–74.

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 256 222 15
PDF Downloads 117 106 5