Afra K, Laupland K, Leal J, Lloyd T, Gregson D.3 In rare cases, surgical intervention is warranted for abscess formation. Sequencing of the 16S RNA gene and 16S-23S rRNA gene spacer region can be used to determine the different species 3,9įusobacterium species are usually susceptible to penicillin, clindamycin, metronidazole, and chloramphenicol and resistant to macrolides. necrophorum shows positive indole and negative nitrate testing. nucleatum is susceptible to all three drugs. Typically, Fusobacterium species are resistant to vancomycin, but susceptible to colistin and kanamycin disk identification tests however, F. nucleatum cultures.įusobacterium species can be identified using mass spectrometry MALDI-TOF. This could be attributed to co-morbidities in elderly patients with positive F. According to Afra et al most of the mortality cases were due to F. nucleatum 1 which is associated more with the elderly population. necrophorum usually causes infection in young, otherwise healthy adults in contrast to F. This syndrome is known as Lemiere’s disease first described in 1936 by Andre Lemierre. necrophorum, which is associated with oropharyngeal infection followed by septic thrombophlebitis of the internal jugular vein with sepsis and metastatic diseases typically involving the lungs. 8 The other commonly isolated species is F. 7, 10 One of the proposed theories is the involvement of the Fap2 virulence factor that has been described to inhibit tumor cell clearance in colorectal cancer cells. It is associated with poor prognosis in colon, rectal, pancreatic and esophageal cancers by promoting pro-tumorigenic immune microenvironment and reduction in the number of tumor-infiltrating lymphocytes. 6 Recent studies have reported this species to be abundant in colon, esophageal carcinoma, pancreatic and breast cancers. nucleatum has been detected in various fetal and placental tissues associated with adverse pregnancy outcomes, such as preeclampsia, chorioamnionitis and preterm rupture of membranes. 4 It has been also described as the most likely cause of extra-oral infections among oral anaerobes. nucleatum is a member of oropharyngeal flora and unsurprisingly involved in gingival and periodontal diseases. 1 Fusobacterium nucleatum and necrophorum are commonly isolated in human diseases, although other species such as Fusobacterium mortiferum, as described in our case, have occasionally been documented as a secondary cause of septicemia 2 or bacteremia 1 and in rare instances implicated in the development of thyroid abscess. They are part of the upper respiratory and gastrointestinal flora in humans but can cause diseases ranging from tonsillitis to septic shock. Images of Gram stain demonstrating long, slender, gram negative rods (top) and bacterial growth on anaerobic plate (bottom) from positive blood culture bottle.įusobacteria are anaerobic, gram negative, spindle-shaped rods with pointed ends. Further follow-up of the patient showed normal white blood count and normal urinalysis. Ampicillin/sulbactam was started and patient was given Amoxicillin/clavulanic acid for outpatient treatment. Growth was determined to be Fusobacterium mortiferum by MALDI-TOF. Three days later after blood was drawn, his blood cultures flagged positive for gram negative, elongated, thin rods. Patient was treated with Zosyn for broad coverage. His physical examination at that time was consistent with appendicitis. A 34 year old male presented to the emergency department (ED) with acute onset abdominal pain, nausea, vomiting, persistent fever, and chills.
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