ABSTRACT
Fusobacterium spp. son bacterias anaerobias Gram negativas. La osteomielitis vertebral por dichas bacterias es muy rara, de hecho, sólo podemos encontrar 11 casos en la literatura. Se presenta un caso de un varón de 46 años con dolor lumbar irradiado a la pierna derecha, de varias semanas de evolución y que no respondió al tratamiento con AINEs. Para el diagnóstico se utiliza la RMN, una biopsia con drenaje de la colección y una PCR universal seguida de secuenciación de ADNr 16S, con la que se obtuvo el diagnóstico microbiológico del paciente, identificando un Fusobacterium nucleatum como responsable. Posteriormente se pautó clindamicina como tratamiento final. En conclusión, la espondilodiscitis por Fusobacterium spp. es una entidad rara y su diagnóstico es a menudo difícil, tanto por las características clínicas como por la dificultad de obtener el diagnóstico microbiológico apropiado. La biopsia vertebral y las técnicas moleculares microbiológicas como la PCR ADNr Universal, son esenciales para la identificación del organismo y permiten la determinación de un diagnóstico y un tratamiento antibiótico apropiados.
Fusobacterium spp. are Gram negative anaerobe bacteria. Vertebral osteomyelitis caused by these bacteria is very unusual; in fact, we could only find 11 cases in the literature. We report the case of a male, 46 year-old patient who had had lumbar pain for several weeks that irradiated to the right leg, and did not respond to NSAID treatment. The work-up included MRI, biopsy with draining of the collection and a universal PCR followed by 16S rDNA sequencing. The latter was used to make the microbiologic diagnosis, which identified Fusobacterium nucleatum as the causative agent. Final treatment consisted of clindamycin. In conclusion, spondylodiscitis due to Fusobacterium spp. is a rare and difficult to diagnose entity, due both to its clinical characteristics and to the difficulty in making the right microbiologic diagnosis. Vertebral biopsy and molecular microbiologic techniques such as Universal PCR rDNa, are essential to identifying the organism, making the diagnosis and prescribing appropriate antibiotic therapy.
Subject(s)
Humans , Male , Middle Aged , Discitis/diagnosis , Discitis/microbiology , Fusobacterium nucleatum , Fusobacterium Infections/diagnosisABSTRACT
A síndrome de Lemierre é caracterizada pela infecção aguda da orofaringe, complicada por trombose venosa jugular interna secundária à tromboflebite séptica, e por infecções metastáticas a vários órgãos distantes-mais freqüentemente os pulmões. Relatamos um caso de síndrome de Lemierre em uma mulher de 56 anos que se apresentou com massa cervical à direita e febre. Trombose venosa jugular interna foi demonstrada na ecografia. A tomografia computadorizada de tórax revelou múltiplas opacidades em ambos os pulmões. Uma biópsia pulmonar cirúrgica foi realizada por suspeita de metástases pulmonares. O exame anatomopatológico revelou êmbolos sépticos em parênquima pulmonar. Retrospectivamente, a paciente relatou história de faringite duas semanas antes da hospitalização. Após o diagnóstico, foi tratada com antibióticos de amplo espectro (cefuroxima por 7 dias e azitromicina por 5 dias e, posteriormente, devido à persistência de febre, cefepime por 7 dias). A tomografia computadorizada de tórax, realizada um mês após, mostrou resolução das opacidades.
Lemierre's syndrome is characterized by acute oropharyngeal infection, complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and by metastatic infections in various distant organs-most commonly in the lungs. We report a case of Lemierre's syndrome in a 56-year-old female who presented with right-sided neck mass and fever. Right internal jugular venous thrombosis was demonstrated on an ultrasound. A computed tomography scan of the chest revealed multiple opacities throughout both lungs. An open surgical biopsy was performed due to suspicion of pulmonary metastases. Anatomopathological examination revealed septic emboli in lung parenchyma. Retrospectively, the patient reported a history of pharyngitis two weeks prior to hospitalization. After the diagnosis had been made, the patient was treated with broad-spectrum antibiotics (cefuroxime for 7 days and azithromycin for 5 days; subsequently, because fever persisted, cefepime for 7 days). One month later, a computed tomography scan of the chest revealed resolution of the opacities.
Subject(s)
Female , Humans , Middle Aged , Fusobacterium Infections/diagnosis , Jugular Veins , Pulmonary Embolism/etiology , Thrombophlebitis/complications , Fusobacterium Infections/drug therapy , Pharyngitis/complications , Pulmonary Embolism/diagnosis , Syndrome , Sepsis/microbiology , Tomography, X-Ray ComputedABSTRACT
Fusobacterium nucleatum is considered a bridge organism between earlier and later colonizers in dental biofilms and a putative periodontopathogen. In Dentistry, antimicrobial agents are used for treatment and control of infectious diseases associated with dental plaque. Antiseptics have been used in association with antibiotics to reduce infections after oral surgeries. In this study, the influence of subinhibitory concentrations (SC) of chlorhexidine, triclosan, penicillin G and metronidazole, on hydrophobicity, adherence to oral epithelial cells, and ultra-structure of F. nucleatum was examined. All isolates were susceptible to chlorhexidine, triclosan, and metronidazole; however, most of the isolates were susceptible to penicillin G, and all of them were hydrophilic when grown with or without antimicrobials. Adherence was decreased by all antimicrobials. Results suggest that adherence of F. nucleatum was influenced by adhesins because structures such as fimbries or capsule were not observed by transmission electronic microscope.
Subject(s)
Anti-Bacterial Agents/isolation & purification , Anti-Bacterial Agents , Fusobacterium nucleatum , In Vitro Techniques , Fusobacterium Infections/diagnosis , Fusobacterium Infections/pathology , Periodontium , Methods , MethodsABSTRACT
Lemierre's syndrome is characterized by acute pharyngotonsillitis with secondary thrombophlebitis of the internal jugular vein which is complicated by multiple metastatic foci of infections. This syndrome is caused by Fusobacterium necrophorum in healthy young persons and is extremely rare in occurrence. A pre-school child with Lemierre's syndrome is reported. The diagnostic and therapeutic aspects are emphasized in order to sensitize physicians to this uncommon condition.
Subject(s)
Child, Preschool , Fatal Outcome , Fusobacterium Infections/diagnosis , Fusobacterium necrophorum , Humans , Jugular Veins , Male , Pharyngitis/diagnosis , Sepsis/diagnosis , Syndrome , Thrombosis/diagnosis , Tonsillitis/diagnosisABSTRACT
Se estudiaron 14 muestras clínicas provenientes de ganado vacuno de las Haciendas El Joque y La Atalaya, Mérida, con el propósito de aislar bacterias anaeróbicas involucradas en procesos infecciosos que afectan al ganado y que muchas veces son causas de pérdida económicas en las explotaciones lecheras de la región. En 11 casos, de los 14 estudiados, se aislaron bacterias anaeróbicas. Fusobacterium necrophorum fue el micro-organismo anaerobio más frecuente aislado, asociado con otras bacterias anaeróbicas y facultativas anaerobias como Corynebacterium (Actinomyces) pyogenes. Bacteroides pigmentados fue aislado de los casos de pododermatitis estudiados, Clostridium perfrigens de un cuadro clínico de enterotexemia fulminante en un becerro y Actinomyces sp de muestras clínicas de un absceso en la región cervical de uno de los ejemplares estudiados. Los resultados obtenidos nos permiten presumir que probablemente la incidencia de estas infecciones por bacterias anaeróbicas sea alta y que muchas veces pueden pasar desapercibidas si no se hace un diagnóstico micro-biológico. Por lo tanto, es de gran interés para el veterinario tener conocimiento de estas infecciones para prevenirlas y controlarlas