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Background: Infections with Fusobacterium, an anaerobic bacterium, have various clinical presentations, including bacteremia and Lemierre syndrome. Here, we report a case series of Fusobacterium bacteremia (FBB) from the largest academic center in Riyadh, Saudi Arabia, and provide a review of cases in the available literature., Method: Records were retrospectively reviewed for all patients with at least one blood culture positive for Fusobacterium spp. admitted at King Khalid University Hospital, Riyadh, Saudi Arabia, between May 2015 to April 2019., Literature Review: We conducted a MeSH Search on MedLine using the following terms: ("Bacteremia"[Mesh]) AND "Fusobacterium"[Mesh] for studies conducted from January 1, 1990, until March 30, 2019, excluding articles that lacked adequate clinical or microbiological details for individuals patients. Odds ratios and results of Chi-Square testing obtained in SPSS (Version 23.0, SPSS, Inc., Chicago, IL, USA) were considered statistically significant at p-values < 0.05., Results: Seven cases from our center and 205 cases from the literature were reviewed in this first reported case series for the region. Our patient series was similar to previous ones in terms of median age (45 vs. 45.5 years) and male predominance (85% vs. 65.9%). The species of Fusobacterium cultured from our cases were F. nucleatum (4 cases), F. varium (1 case), F. mortiferum (1 case), and one that could not be identified to the species level (1 case). We also report one case of FBB with renal vein thrombosis resembling that of atypical Lemierre syndrome. Analysis of literature cases revealed that bacteremia caused by the species most commonly associated with FBB, F. necrophorum, tended to be present in patients less than 40 years of age and be associated with head and neck infections and other complications, whereas F. nucleatum tended to affect people more than 40 years of age and be associated with mortality., Conclusion: Although FBB is rarely reported in the literature, this case series and review of the literature suggests it is associated with morbidity and mortality. The type and duration of therapy used in these cases are underreported. Further research is needed to determine the most appropriate screening approach for FBB-associated complications and explore the relationship between FBB and specific malignancies, as well as optimal treatment type and duration., Competing Interests: Declaration of competing interest The authors disclose no financial or personal relationships with other people or organizations that could inappropriately influence this work., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Altered microbial communities are thought to play an important role in eosinophilic oesophagitis, an allergic inflammatory condition of the oesophagus. Identification of the majority of organisms present in human-associated microbial communities is feasible with the advent of high throughput sequencing technology. However, these data consist of non-negative, highly skewed sequence counts with a large proportion of zeros. In addition, hierarchical study designs are often performed with repeated measurements or multiple samples collected from the same subject, thus requiring approaches to account for within-subject variation, yet only a small number of microbiota studies have applied hierarchical regression models. In this paper, we describe and illustrate the use of a hierarchical regression-based approach to evaluate multiple factors for a small number of organisms individually. More specifically, the zero-inflated negative binomial mixed model with random effects in both the count and zero-inflated parts is applied to evaluate associations with disease state while adjusting for potential confounders for two organisms of interest from a study of human microbiota sequence data in oesophagitis.

Background: Fusobacterium spp. from clinical specimens are increasingly reported. We sought to describe the epidemiology, the microbiological, and the clinical characteristics of head and neck infections caused by Fusobacterium necrophorum and other Fusobacterium spp., Materials and Methods: Retrospective cohort study between October 1st, 2004 and September 30(th), 2014 performed in an academic hospital. Electronic patient charts and the laboratory information system were reviewed for demographic and microbiological data. The number and percentages of specific diagnosis and treatment among patients with positive Fusobacterium spp. culture were calculated. The incidence was calculated based on the number of specimens investigated each year., Results: Included were 230 cultures of 230 patients (median age of 28 years, 61.7% men). F. necrophorum was often found in young patients with high C-reactive protein (CRP) and high number of leukocytes in blood. Other Fusobacterium spp. were often found in middle aged patients with relatively high CRP and slightly increased leukocytes. Three major causes of the isolation of F. necrophorum and other Fusobacterium spp. were acute tonsillitis (n = 18, incidence of 0.2%), peritonsillar abscess (n = 39, 0.5%) and acute otitis (n = 45, 0.1%). While F. necrophorum was found in majority (37/57) of patients with acute tonsillitis or peritonsillar abscess, Fusobacterium spp. other than F. necrophorum were found in the majority (35/45) of patients with acute otitis. Isolated fusobacteria were susceptible to beta-lactam antibiotics, clindamycin and metronidazole. The outcomes of patients with Fusobacterium spp. were good., Conclusion: F. necrophorum and other Fusobacterium spp. are rare cause of head and neck infections. The infections are well treated by combination of antibiotics and surgery., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: Fusobacterium species infections are rare. Recently, however, this potentially deadly pathogen has been attracting interest, and efforts are being made to characterise its epidemiology and clinical spectrum of disease. The aim of our study is to provide further evidence towards this cause, in what is, to date, the largest study of its kind from the UK., Method: A 22-year, retrospective, descriptive study was performed at Royal Hampshire County Hospital. An electronic database was used to identify patients with microbiologically confirmed infection with Fusobacterium, and clinical records were examined to provide further information on the presentation, source, treatment and outcome., Results: Fusobacterium species infections were identified in 18 patients during the study period, which is an incidence of 0.76 cases/100,000/year. The overall death rate was 29 %. Half of these patients had Fusobacterium necrophorum infections and were a predominantly young, fit and uniquely male population who had excellent outcomes. Among the remaining patients with Fusobacterium species infections, 22 % had infection with F. varium and 11 % with F. nucleatum. These patients were an older cohort who tended to have co-morbidities and unsurprisingly worse outcomes. We identified a number of Fusobacterium bacteraemias likely to have resulted from pressure ulcers, a presentation that has been rarely reported. Interestingly, we also identified a case of neonatal F. nucleatum bacteraemia that was not associated with premature nor stillborn birth., Conclusion: As work continues to depict the spectrum of disease caused by this enigmatic bacterium, it is hoped that improved clinical suspicion will result in better outcomes and management.

The purpose of this investigation was to describe the clinical and biological characteristics and evolution of invasive Fusobacterium infections in children admitted to two French paediatric tertiary care centres. Children who were admitted from 1998 to 2009 to two tertiary care centres for invasive Fusobacterium infection were included in a retrospective study. Thirty-one children with a median age of 5.7 years (interquartile range, IQR [2.3; 9.3]) were included. Nine children had an underlying condition, most commonly sickle cell disease (n = 3) or immunodeficiency (n = 3). Two children had skin effraction prior to the infection. The major sites of infection were the head and neck (n = 14) and abdomen (n = 10). Three children suffered from atypical Lemierre's syndrome. More than half of the children had a bacterial co-infection (58 %). Six children were hospitalised in an intensive care unit, and 67 % of them had a chronic underlying disease. None of the children died. Six children with negative cultures had Fusobacterium identified through 16S RNA-PCR. Fusobacterium is responsible for severe infection in children. Microbiological diagnosis might be improved by the wider use of molecular detection.

Background: Fusobacterium species (spp.) bacteremia is uncommon and has been associated with a variety of clinical presentations. We conducted a retrospective, population based study to determine the relative proportion of species in this genus causing bacteremia and the risk factors for infection and adverse clinical outcomes., Methods: All cases of Fusobacterium spp. bacteremia detected at a regional microbiology laboratory serving outpatient and acute care for a population of approximately 1.3 million people over 11 years were identified from a computerized database. Clinical data on these cases was extracted from an administrative database and analyzed to determine underlying risk factors for and outcomes of infection., Results: There were 72 incident cases of Fusobacterium spp. bacteremia over the study period (0.55 cases/100,000 population per annum). F. nucleatum was the most frequent species (61%), followed by F. necrophorum (25%). F. necrophorum bacteremia occurred in a younger population without underlying comorbidities and was not associated with mortality. F. nucleatum bacteremia was found in an older population and was associated with underlying malignancy or receiving dialysis. Death occurred in approximately 10% of F. nucleatum cases but causality was not established in this study., Conclusions: Fusobacterium spp. bacteremia in our community is uncommon and occurs in approximately 5.5 cases per million population per annum. F. necrophorum occurred in an otherwise young healthy population and was not associated with any mortality. F. nucleatum was found primarily in older patients with chronic medical conditions and was associated with a mortality of approximately 10%. Bacteremias from other Fusobacterium spp. were rare.

Udder-thigh dermatitis (UTD) is a common disease in dairy cattle. The aim of this study was to define UTD incidence, its risk factors and the involved pathogens. Of 74 respondents, 72 (97%) reported having had the disease. On those farms the incidence was 5.3 cases per 100 cow years. The odds ratio (OR) of UTD in primiparous compared to multiparous cows was 23.4 (95% CI 17.3-33.8). Compared to tied stalls, the ORs of UTD were 0.65 (95% CI 0.45-0.92) and 0.43 (95% CI 0.24-0.71) for free stalls and straw yards, respectively. Udder oedema was reported in 98.3% of cows with UTD. The most common bacteria isolated from affected skin were Fusobacterium spp. (12/14 cases). This study suggests that UTD management should focus on local treatment, reducing udder oedema and increasing exercise., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The etiology of ulcerative colitis (UC) is unknown, while an exacerbating factor of this disease is associated with infectious agents. Recently, Fusobacterium varium has been found in the mucosa of a significant number of patients with UC. The aim of this study was to estimate the prevalence of F. varium infection based on serology, evaluate the relationship between F. varium seropositivity and UC, and determine the clinical characteristics of infected UC individuals. Seropositive patients were determined by immunoblotting with F. varium ATCC 8501 antigen. We also identified cross-reactive protein spots by peptide mass mapping analysis. These protein spots showed putative caseinolytic protease protein, putative translation elongation factor G, and putative enolase. Immunoblotting with F. varium antigen revealed signals with sera from 45 (40.2%) of the 112 UC patients and 20 (15.6%) of the 128 healthy controls, respectively (P<0.01). In terms of disease activity, seropositive UC patients were more likely to have clinically severe disease than seronegative UC patients. Disease location in seropositive patients was more extensive than the seronegative patients. In conclusion, F. varium is a predominant infection in the UC population and is a potential pathogen of UC.

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 retrospective study was conducted of 26 adult cases of fusobacterium bacteraemia that occurred between 1998 and 2003 at Center Hospitalier Universitaire de Grenoble, France. Most patients presented with pre-existing adverse medical conditions, including evolving malignant diseases (eight patients), recent surgery (four patients), and chronic organ failure (six patients). Only one patient presented with a classic Lemierre's syndrome. These results suggest an opportunistic pattern of modern fusobacterium infections.

An outbreak of Fusobacterium necrophorum-induced septicemia occurred in a group of 40 captive wild-caught pronghorns (Antilocapra americana). Primary pododermatitis or necrotic stomatitis progressed to produce fatal septicemia with metastatic lesions in the forestomachs, lung, liver, and cecum in 38 of the animals. Two remaining animals were euthanatized because of chronic pododermatitis. Housing the animals in a pasture previously used by bovids and heavy rains with persistence of ground water pools in the pasture were contributing factors in the pathogenesis of this outbreak.