A prospective interventional trial on the effect of periodontal treatment on Fusobacterium nucleatum abundance in patients with colorectal tumours.

Fusobacterium nucleatum is associated with the progression of colorectal cancer. Thus, the possibility of preventing colorectal cancer or its progression by targeting F. nucleatum has been explored. As F. nucleatum is associated with periodontitis, we analysed whether treating periodontitis could influence F. nucleatum abundance in the colon. Patients with colorectal tumours who underwent colonoscopy were recruited. Patients diagnosed with periodontitis by a dentist were treated for approximately 3 months. Endoscopic resection of colorectal tumours was performed after periodontitis treatment, and resected tumours were pathologically classified as high-(HGD) or low-grade dysplasia (LGD). Saliva and stool samples were collected before and after the treatment. Of the 58 patients with colorectal tumours, 31 were included in the study, 16 showed improvement in periodontitis, and 11 showed no improvement. Stool F. nucleatum levels before treatment were significantly lower in the LGD group than in the HGD group. A significant decrease in faecal F. nucleatum levels was observed in patients who underwent successful treatment but not in those whose treatment failed. Salivary F. nucleatum levels were not altered in patients despite periodontal treatment. Thus, successful periodontitis treatment reduces stool F. nucleatum levels and may aid research on periodontitis and suppression of colorectal cancer development.

Septic Shock Caused by Fusobacterium Necrophorum after Sexual Intercourse during Recovery from Infectious Mononucleosis in an Adolescent: A Case Report.

BACKGROUND: Infectious mononucleosis (IM) develops after primary infection with Epstein-Barr virus. We report a case of septic shock from pelvic inflammatory disease caused by Fusobacterium necrophorum in an adolescent after sexual intercourse during recovery from IM. CASE: A 17-year-old girl with a 7-day history of fever was diagnosed with IM. During follow-up, she developed lower abdominal pain and high fever after sexual intercourse and was transferred to our hospital. She was in shock and had a right ovarian abscess. Emergency laparotomy, drainage, and right adnexectomy were performed. F necrophorum was subsequently detected in blood and abscess cultures.

Fusobacterial brain abscess caused by paradoxical embolization associated with Ebstein's anomaly in an adult patient: A case report.

Brain abscess remains a life-threatening condition. Here, we are reporting a case of brain abscess due to Fusobacterium nucleatum in a previously known case of Ebstein anomaly. A 44-year-old male presented with the complaints of headache, and fever. Cerebral imaging revealed parieto-occipital (PO) abscess. The abscess was drained and culture showed growth of Fusobacterium nucleatum. This report illustrates the importance of considering anaerobes as the cause of brain abscess, underscores the usefulness of MALDI, which facilitated the selection of appropriate and prompt adjuvant antibiotic therapy and a favourable outcome.

Fusobacterium nucleatum bacteremia with pneumopathy in a patient receiving eculizumab: A case report.

Fusobacterium nucleatum is a common oral commensal bacterium capable of severe invasive infections. We report a case of a diffuse bilateral pneumopathy with F. nucleatum-positive blood culture successfully treated by common antibiotics in a patient receiving eculizumab for a drug-induced thrombotic microangiopathy (TMA). It is the first described case of a severe F. nucleatum-associated infection in a patient undergoing terminal complement inhibitor therapy. We suggest providing preventive dental care before eculizumab initiation.

[A Case of Cerebellum Abscess due to Fusobacterium nucleatum that Developed Because of Poor Dental Hygiene].

We report a case of cerebellum abscess due to Fusobacterium nucleatum(F. nucleatum) in a 60-year-old man. He was admitted to our hospital complaining of headache and dizziness. On admission, he was lucid with the following vital data:blood pressure, 136/89 mmHg;heart rate, 65 beats/min;body temperature, 37.0℃;and oxygen saturation, 100%. He had a moderate headache and could not walk straight. In general, there were no abnormal findings except for his poor dental hygiene. Laboratory findings revealed elevated white blood cell counts(10,900/mm3)and brain MRI revealed a mass shadow that was suspected to be an abscess in the left side of his cerebellum. Elective surgery was scheduled. However, consciousness of disorder was observed on the second hospital day and the size of mass shadow extended;hence, emergent drainage under craniotomy was performed. The diagnosis was cerebellum abscess, and F. nucleatum, which is a normal flora in the oral cavity, was isolated in his cerebellum abscess. After the surgery, his hospital course was positive under the treatment of antibiotics for F. nucleatum. The route of bacterial infection entry was unclear;however, it will be considered that abscesses in the central nervous system occur because of poor dental hygiene.

Neonatal Lemierre Syndrome: Youngest Reported Case and Literature Review.

A previously healthy 5-week-old female was admitted for sepsis secondary to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. After several days of hospitalization, she experienced acute decompensation in mental status despite having received targeted antibiotic therapy. Imaging revealed left peritonsillar/parapharyngeal space abscess, left venous thrombophlebitis of the internal jugular vein, and septic emboli of the lungs and brain consistent with Lemierre syndrome. Bedside needle aspiration of the parapharyngeal abscess confirmed MRSA involvement. Unfortunately, the patient continued to deteriorate over the next several days and life support was withdrawn on hospital day 16. We present the youngest reported case of Lemierre syndrome and review the literature.

Fusobacterial liver abscess: a case report and review of the literature.

BACKGROUND: Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature. CASE PRESENTATION: A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords "Fusobacterium" and "Liver abscess". Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre's Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks. CONCLUSION: Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.

Gehirnabszess nach parodontaler Therapie. Ein Fallbericht über einen Gehirnabszess assoziiert mit Fusobacterium nucleatum nach parodontaler Therapie.

Background Nonsurgical periodontal treatment implicates bacteraemia. In rare cases oral pathogens can be found associated with abscesses of brain or liver Case Description A brain abscess was found in a patient after several periodontal treatments causing neurological seizures. In the drain masses of Fusobacterium nucleatum were found. An oral examination revealed a severe periodontally damaged dentition. The woman had been in a generally healthy condition before the event. After neurosurgical treatment and intravenous antibiotic therapy the patient fully recovered. In order to eradicate any possible focus of inflammation, several teeth had to be extracted. Clinical Implications This case report implicates that also patients without particular need for antibiotic prophylaxis can be at risk of developing a brain abscess caused by bacteraemia after periodontal treatments.

[Brain abscess mediated through a pulmonary arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia].

The patient is a 66-year-old man with hereditary telangiectasia. He was diagnosed with pulmonary arteriovenous malformation (PAVM), which was revealed by contrast-enhanced chest computed tomography at the age of 65. He developed headache, right homonymous hemianopsia, and right hemiparesis and was admitted to our hospital. Contrast-enhanced magnetic resonance imaging revealed multiple lesions in the left hemisphere, which indicates brain abscesses. Thus, the diagnosis of brain abscess mediated through PAVM was established. Following management with drainage and coil embolization, all neurological symptoms resolved. Therefore, coil embolization should be considered for PAVM at an early stage to prevent brain abscess, even if it is asymptomatic.

Rare but numerous serious complications of acute otitis media in a young child.

Acute otitis media is a very common disease in children. Most children recover with symptomatic therapy like potent analgesics, but occasionally serious complications occur. We present a 3-year-old girl who suffered from acute otitis media for already 2 weeks and presented with fever, abducens nerve palsy of her left eye and vomiting. She was finally diagnosed with an acute otitis media complicated by a mastoiditis, sinus thrombosis, meningitis and cerebellar empyema. Fusobacterium necrophorum was cultured from cerebrospinal fluid. The girl recovered following appropriate antibiotic and anticoagulation treatment.

Invasive potential of gut mucosa-derived Fusobacterium nucleatum positively correlates with IBD status of the host.

BACKGROUND: Fusobacterium nucleatum is a heterogeneous oral pathogen that is also a common resident of the human gut mucosa. Given that some strains of F. nucleatum are known to be invasive and proinflammatory in the oral mucosa, we compared strains isolated from patients with inflammatory bowel disease (IBD) with strains isolated from healthy controls to determine 1) whether this species was more commonly associated with IBD patients; and 2) whether gut-derived F. nucleatum strains from IBD patients showed an increased capacity for invasion. METHODS: Biopsy material was obtained from 56 adult patients undergoing colonoscopy for colon cancer screening purposes or assessment of irritable bowel syndrome status (34 patients), or to assess for presence of gastrointestinal disease (i.e., IBD or indeterminate colitis, 22 patients). We enumerated Fusobacterium spp. strains isolated from human gut biopsy material in a blinded fashion, and then compared the virulence potential of a subset of F. nucleatum strains using an invasion assay in a Caco-2 model system. RESULTS: Fusobacterium spp. were isolated from 63.6% of patients with gastrointestinal disease compared to 26.5% of healthy controls (P = 0.01). In total, 69% of all Fusobacterium spp. recovered from patients were identified as F. nucleatum. F. nucleatum strains originating from inflamed biopsy tissue from IBD patients were significantly more invasive in a Caco-2 cell invasion assay than strains that were isolated from healthy tissue from either IBD patients or control patients (P < 0.05 to 0.001). CONCLUSIONS: This study indicates that colonization of the intestinal mucosa by highly invasive strains of F. nucleatum may be a useful biomarker for gastrointestinal disease.

[Brain abscess as the first clinical manifestation of isolated pulmonary arteriovenous malformation without Rendu-Osler disease]. / Abcès cérébelleux révélant une malformation artérioveineuse pulmonaire isolée en dehors de la maladie de Rendu-Osler.

INTRODUCTION: Brain abscesses occur in 5 to 13 % of patients with pulmonary arteriovenous malformation (PAVM), more often present in Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia (HHT). CASE REPORT: A 51-year-old man with a history of transient Parinaud syndrome at 37 years complained of headache for 2 months before acute onset of a left cerebellar syndrome without fever. CT-scan and MRI of the head revealed a heterogeneous left cerebellar lesion. A brain abscess was drained and all signs resolved. CT-scan of the chest revealed a left lingual PAVM; occlusion was incomplete after coil embolization. He had no feature of HHT and no mutation in ENG and ACVRL1 genes. A second embolization was performed 5 months later, but the malformation was not occluded at 6 months. DISCUSSION: We report the seventh case of PAVM complicated by a cerebellar abscess. The right to left shunt in PAVM results in hypoxemia, secondary polycythemia and paradoxical embolization of infective organisms bypassing the pulmonary filter. CONCLUSION: Combining different MRI techniques (in particular diffusion and proton MR spectroscopy) provides invaluable data for the diagnosis of brain abscess. Careful search for PAVM must be undertaken, particularly in adults with cryptogenic abscess, to avoid further abscess formation or stroke.

The Pott's puffy tumor: an unusual complication of frontal sinusitis, methods for its detection.

This is a case report of a Pott's puffy tumor, characterized by a subperiosteal abscess associated with frontal bone osteomyelitis, as a consequence of a frontal sinusitis, in a 15-year-old boy. Pott's puffy tumor is a rare condition usually seen as a complication of frontal sinusitis and more commonly described in children. Given that, superficial temporal artery pseudoaneurysms might be interpreted as a cyst or lipoma, it is imperative that physicians be aware of their presentation.

Lemierre’s Syndrome: A serious complication of an odontogenic infection

Necrobacillosis, postanginal septicaemia or Lemierre’s Syndrome is characterised by suppurative thrombophlebitisof the internal jugular vein with embolization to several sites, including the lungs. We report the case of a38-year-old man who was initially hospitalized because of odontogenic cellulitis. Given the deterioration of hisclinical state (septic shock and multiple organ failure), neck computed tomography was performed, revealingboth cervical and parotid abscesses, and thrombosis of the right internal jugular vein. Streptococcus salivariuswas isolated. The patient was treated with intravenous antibiotics, and surgical drainage and after 6 weeks oftreatment, recovered completely. Lemierre’s Syndrome is an uncommon, but potentially lethal complication of anodontogenic infection. The case reported here is interesting since the pathogen and the site of primary infectionare unusual. Fusobacterium necrophorum is the most common pathogen in Lemierre’s Syndrome, and to the bestof our knowledge there are no similar case reports with Streptococcus salivarius as the causative bacteria. Earlyrecognition and high-dose antibiotics are critical elements in reducing mortality (AU)

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