Infective endocarditis due to fusobacterium nucleatum: Case report and review of the literature

Abstract

Summary: Endocarditis caused by Fusobacterium nucleatum is exceedingly rare. We report a case of E nucleatum right-sided endocarditis in a patient with no known intravenous drug abuse. A detailed computer and manual search of the literature using Med-Line and Index Medicus, respectively, revealed a total of five cases of endocarditis due to this species. The clinical characteristics and the patient's hospital course are summarized and reviewed.Key words: endocarditis, tricuspid valve, Fusobacterium nucleatum revealed a total of five previously reported cases of endocarditis in which this species has been identified as a single causative agent,3*4 or as part of a polymicrobial infect i~n .~+~ The total number of cases of endocarditis due to the genus Fusobacterium included 15 cases: 7 of these were E necrophor~m,~ 5 were E n~c l e a t u m ,~-~ and 3 were unidentified Fusobacterium species."* Our case brings the total number of cases of identified E nucleatum endocarditis to six. The clinical features and hospital course of our patient, as well as those documented for E nucleatum, are reviewed and summarized (Table I). Case Report IntroductionInfections due to anaerobic gram-negative nonsporeforming bacilli, including the genera Bacteroides and Fusobacterium, have been well documented.' However, endocarditis caused by these organisms remains relatively uncommon and is mostly due to Bacteroidesfragilis.* Endocarditis caused by the Fusobacterium genus is exceedingly rare. We report a case of right-sided endocarditis due to Fusobacterium nucleatum (previously known as E fisiform).

Associations between bacteremia from oral sources and distant-site infections: tooth brushing versus single tooth extraction

“…For example, the frequency of bacteremia from Fusobacterium nucleatum was decreased by 90% (see Table IIIA), but we could find only six reported cases of IE caused by this organism. 11,12 Another rare cause of IE is Peptostreptococcus micros, which was reduced by 85% by amoxicillin, but we found only 21 reported cases of IE caused by this species (see Table IIIA). 13 Similar trends hold true for other anaerobic species detected in our study but which rarely cause IE.…”

“…However, F. nucleatum and P. micros are not common causes of IE. [11][12][13] The bacterial species identified in blood to be associated with PJI were Actinomyces naeslundii, Granulicatella adiacens, Haemophilus aphrophilus, Peptostreptococcus micros, Prevotella melaninogenica, Propionibacterium acnes, Staphylococcus epidermidis, Streptococcus mitis, Streptococcus mutans, Streptococcus oralis, Streptococcus sanguinis, and Veillonella dispar/ parvulla. 1 Overall, AP decreased the frequency of these 12 bacterial species by 81% (P < .0001) ( Table IIIB).…”

Fusobacterium nucleatum

“…It has been isolated from numerous inflammatory processes, including sinusitis, endocarditis, septic arthritis, tonsillitis and abscesses of the brain, skin and liver. [9][10][11][12] It has also been found in lung and urinary tract infections and has been recently shown to invade the amniotic membrane during pregnancy, leading to preterm labor and stillbirth. [13][14][15] Most of the research on F. nucleatum has focused on its role as one of the principal pathogens in gingivitis and periodontitis.…”

Taxonomy, biology, and periodontal aspects of Fusobacterium nucleatum.

“…Of the periodontal species that are statistically associated with periodontal disease, it is the most common in clinical infections of other body sites (208). It has been isolated from several parts of the body (25) and from infections such as tropical skin ulcers (80), peritonsillar abscesses (146), pyomyositis and septic arthritis (106), bacteremia and liver abscesses (58,249), intrauterine infections (51), bacterial vaginosis (126), urinary tract infections (233), pericarditis and endocarditis (255,292), and lung and pleuropulmonary infections (20,196). The origin of F. nucleatum in infection has been dental in several cases (58,106).…”