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Objectives: Clinically significant infections caused by members of the genus Fusobacterium are rare. We sought to describe the spectrum of clinical disease and epidemiology of these conditions presenting to an acute hospital over a five year period., Methods: Clinical records relating to consecutive laboratory isolates of Fusobacterium species were reviewed and cases classified according to pre-specified definitions of primary site and invasive infection., Results: 78 Fusobacterium isolates were identified, 25 of which were associated with invasive disease, most commonly in men (76% of cases). Invasive Fusobacterium necrophorum infection of the head and neck was not observed in patients over 50. Invasive intra-abdominal disease was not observed amongst those under 60. 2 cases of Fusobacterium nucleatum bacteraemia were identified in neutropenic children. One retroperitoneal abscess may have represented secondary infection due to periodontitis. Obstetric infections were the most common clinical syndromes associated with isolates from the female genital tract. The incidence of invasive head and neck disease in the population aged 15-50 was 6.7 per million/year. There were no deaths., Conclusions: Invasive fusobacterial infections are rare, affect distinct patient groups and are associated with good clinical outcomes in the majority of cases.

A total of 243 strains of Fusobacteria species was recovered from 226 of 1399 (16%) specimens obtained from 213 children. The strains included 65 (27%) Fusobacterium sp., 144 (59%) Fusobacterium nucleatum, 25 (10%) Fusobacterium necrophorum, five (2%) Fusobacterium varium, three (1%) Fusobacterium mortiferum, and one (0.4%) Fusobacterium gonidiaformans. Most Fusobacteria species were recovered from patients with abscesses (100), aspiration pneumonia (24), paronychia (15), bites (14), chronic sinusitis (ten), chronic otitis media (nine), and osteomyelitis (eight). Predisposing conditions were noted in 32 (15%) of the cases. These included immunodeficiency in nine (4%), steroid therapy in eight (4%), previous surgery in six (3%), diabetes in six (3%) and malignant neoplasms in five (2%). Fusobacteria sp. was the only isolate in 16 (8%) instances while mixed infections were encountered in 197 (92%) patients. The organisms most commonly isolated with Fusobacteria sp. were anaerobic cocci (155), pigmented Prevotella sp. and Porphyromonas sp. (95), Bacteroides fragilis group (80), Escherichia coli (43) and Bacteroides sp. (39). Most strains of B. fragilis group and E. coli were recovered from intra-abdominal infections and skin and soft tissue infections proximal to the rectal area. Most pigmented Prevotella sp. and Porphyromonas sp. were recovered from oropharyngeal and pulmonary sites and from sites around the head and neck. Antimicrobial therapy was administered to all patients; surgical drainage was performed in 85 (40%). All patients, except two who died, recovered. These findings illustrate the prevalence of Fusobacteria sp. associated with infections in children.