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.

中文翻译：

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梭菌血流感染：文献复习和基于医院的病例系列。

背景

厌氧菌Fusobacterium的感染具有多种临床表现，包括菌血症和Lemierre综合征。在这里，我们报道了来自沙特阿拉伯利雅得最大的学术中心的一例细菌性梭状芽孢杆菌（FBB）病例系列，并对现有文献进行了病例回顾。

方法

记录进行回顾性分析了所有患者的至少一个血培养阳性梭杆菌属。于2015年5月至2019年4月期间在沙特阿拉伯利雅得国王哈立德大学医院住院。

文献评论

我们使用以下术语在MedLine上进行了MeSH搜索：（“细菌血症” [Mesh]）和“ Fusobacterium ” [Mesh]，用于从1990年1月1日至2019年3月30日进行的研究，但缺少缺乏足够临床或微生物学内容的文章个人患者的详细信息。在SP值（版本23.0，SPSS，Inc.，芝加哥，伊利诺伊州，美国）中获得的奇数比和卡方检验结果被认为在p值<0.05时具有统计学意义。

结果

在该地区的第一个报告病例系列中，对来自我们中心的7例病例和来自文献的205例病例进行了回顾。我们的患者系列在中位年龄（45岁对45.5岁）和男性优势（85％对65.9％）方面与以前的相似。从我们的病例中培养的梭状芽胞杆菌的种类是核镰刀菌（4例），var。varium（1例），mort。mortiferum（1例），以及在物种水平上无法鉴定的一种（1例）。我们还报告了1例FBB，其肾静脉血栓形成与非典型Lemierre综合征相似。对文献病例的分析表明，由最常与FBB，坏死镰孢相关的物种引起的菌血症核糖核酸倾向于存在于40岁以下的患者中，并与头颈部感染和其他并发症有关，而核仁镰孢倾向于影响40岁以上的人并与死亡率相关。

结论

尽管在文献中很少报道FBB，但是该病例系列和文献回顾表明，它与发病率和死亡率有关。在这些情况下使用的治疗类型和持续时间均未报告。需要进一步的研究来确定最适合FBB相关并发症的筛查方法，并探索FBB与特定恶性肿瘤之间的关系，以及最佳治疗类型和持续时间。