Lemierre Syndrome and Nosocomial Transmission of Fusobacterium Necrophorum From Patient to Physician

Bonhoeffer, Jan; Trachsel, Daniel; Hammer, Jürg; Nava, Evelinda; Heininger, Ulrich

doi:10.1055/s-0030-1263144

Cited by 6 publications

(2 citation statements)

References 8 publications

(10 reference statements)

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“…There is some evidence that oral trauma can facilitate infection. 5 On the basis of the frequency of primary sources it is likely that our patient's infection arose outside of the aneurysm, most likely in the head and neck, and that the infection of the aneurysm was a metastatic event. It is unclear how much the F. necrophorum contributed to the development and extension of the aneurysm or whether it opportunistically infected the thrombus within the aneurysm.…”

Section: Introductionmentioning

confidence: 95%

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Fusobacterium necrophorum in an Abdominal Aortic Aneurysm, Treated by Once Daily Ertapenem

et al. 2012

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Inflammatory aneurysms account for 5 to 10% of all abdominal aortic aneurysms.1 The thrombus can become infected, making management slightly more complex. We believe that this is first recorded case of Fusobacterium necrophorum being implicated in an inflammatory aortic aneurysm. Case ReportA 68-year-old man presented with right-sided back and groin pain, vomiting, night sweats, and rigors. He was febrile, spiking temperatures of up to 38°C. Inflammatory markers included a white cell count of 18.2 Â 10 9 /L and C-reactive protein of 359 mg/L. Computed tomography (CT) scan of abdomen revealed a 10 cm by 9 cm infrarenal, inflammatory aneurysm, extending to and including the bifurcation (►Fig. 1). The aortic wall was thickened and ill-defined with stranding in the adjacent retroperitoneum. At surgery, a malodorous smell was noted on opening the aneurysm sac. Repair was performed with a silver impregnated graft coated with rifampicin. There were no intraoperative complications. Postoperatively he had a 6-week course of intravenous antibiotics, commencing with Tazocin (Wyeth Pharmaceuticals, Madison, NJ) doses, followed by ciprofloxacin, and then ertapenem. The antibiotics were changed on the advice of the infectious diseases specialists. Culture of the intramural thrombus was positive for the anaerobe F. necrophorum. He improved with the antibiotic therapy and was discharged home to complete the course in the community. Postoperatively he recovered well having no fever or rigors. All postoperative blood cultures were negative for any organisms. Surveillance CT scan performed 3 months following surgery showed a thick rim of enhancing tissue surrounding the sac, but no fluid or air or significant adjacent inflammatory change to suggest definite infection. A further CT scan performed 5months later revealed a slight decrease in the periaortic inflammation, and still no evidence of infection (►Fig. 2). DiscussionFusobacterium necrophorum is a nonspore forming anaerobe, capable of causing monomicrobial infections.2 It is implicated in less than 1% of bacteremias (usually postanginal sepsis), and is more commonly associated with head and neck infections such as Lemierre disease or intra-abdominal sepsis.3 In addition to infections arising from the head and neck, F. necrophorum has been shown to spread from the gastrointestinal and female genitourinary tract. A comprehensive review of human infections caused by F. necrophorum found 251 cases where this organism had been isolated since 1970 (►Table 1). AbstractInflammatory aneurysms may make up a small percentage of the total number of abdominal aortic aneurysms, but they present their own unique challenges. We present a case of a 65-year-old man whose aneurysm was found to be colonized by Fusobacterium necrophorum.

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Section: Introductionmentioning

confidence: 95%

“…This allows F. necrophorum to cause the typical findings in Lemierre disease and cause septicemia. 5 There is minimal evidence that F. necrophorum is part of the normal flora and it can be acquired in a nosocomial fashion. 4 Our patient reported recent dental work approximately 1 month before admission.…”

Section: Introductionmentioning

confidence: 99%