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In the Anglo-American literature botrymycosis is described as a chronic cutaneous granulomatous reaction to bacterial infection, containing granules resembling the sulphur granules seen in actinomycosis. The diagnostic and therapeutic aspects are discussed with reference to a recently observed patient. Fusobacterium nucleatum was isolated as the bacterial cause of the pathologic disorder.
Necrobacillosis is an infection caused by the anaerobic Gram-negative rod Fusobacterium necrophorum. The infection is most common in previously healthy young adults and is characterised by sore throat followed by rigors, septicaemia and the formation of metastatic abscesses, often in the lungs. The infection has a certain mortality, which is reduced when early and sufficient treatment is administered. The treatment is a prolonged course of penicillin and/or metronidazole. Two case histories and a review of the literature are presented. The purpose of this article is to make the clinician aware of the syndrome, which is so characteristic that the diagnosis can be made from the clinical picture alone before bacteriological verification.
Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.
Changes in serum alpha 1-acid glycoprotein (alpha 1AG) concentration in cattle with hepatic abscesses were observed, and function of alpha 1AG was evaluated, particularly its influence on cellular immune response. Test cattle (n = 4) were inoculated with Fusobacterium necrophorum, control cattle (n = 2) were inoculated with inactivated bacteria, and naturally affected cattle (n = 11) were found in a slaughterhouse. Determination of alpha 1AG was made by use of a single radial immunodiffusion method. The action on lymphocyte blastogenesis was determined by [3H]thymidine incorporation. Cultured lymphocytes from healthy cattle were treated with variable concentrations of alpha 1AG purified from serum obtained from cattle with hepatic abscesses and suppression of blastogenesis stimulated by each of 3 mitogens was measured. In cattle with experimentally induced abscesses, serum alpha 1AG concentration increased for 7 to 10 days after F necrophorum inoculation, its change being parallel to that of sialic acid. High concentration of alpha 1AG was found in naturally affected cattle and was highly correlated to sialic acid concentration. Suppression of lymphocyte blastogenesis in cattle with experimentally induced hepatic abscesses was highly correlated to serum alpha 1-AG concentration.
BACKGROUND: Lemierre's syndrome (postanginal sepsis) usually complicates an oropharyngeal infection as septicemia, septic thrombophlebitis of the internal jugular vein, and metastatic lesions, most frequently in the lungs. Fusobacterium necrophorum is the usual etiologic agent. Lemierre's syndrome is not widely known by clinicians. This study aims at creating awareness amongst the clinicians of existence of this potentially fatal but curable clinical entity. METHODS: All the patients admitted in the ENT department of Ayub Teaching Hospital, during the period of January 2000 to December 2002, for the treatment of acute oropharyngeal infection, were critically assessed by consultants, for features of Lemierre's syndrome, and investigated further, accordingly. RESULTS: 156 patients were admitted with acute oropharyngeal infection. Two patients (1.28%) had features suggestive of Lemierre's syndrome. A male and a female, 25 and 28 years old respectively, had a history of a preceding sore throat for a variable duration followed by complications. Attempts were made to make the diagnosis of Lemierre's syndrome and they were treated appropriately, as per recommendations, to a successful outcome. CONCLUSIONS: Widespread use of antibiotics for pharyngeal infections has significantly reduced the incidence. Rare and a forgotten complication, Lemierre's syndrome is potentially fatal. Early diagnosis and prolonged treatment with appropriate antibiotics are usually curative. A high degree of clinical suspicion is necessary for diagnosis. Modern day clinician should be aware of this potentially life threatening clinical entity that may complicate a trivial oropharyngeal infection.
Lemierre's syndrome is a rare, potentially severe disease consisting of septic emboli from an internal jugular vein thrombus after oropharyngeal infection. We report a 20-year-old man who had a tonsillitis with fever for 3 days. After a 2-day defervescence, fever relapsed as well as painful swelling over the left side of the neck. Computed tomography scan and sonography of the neck revealed thrombosis of left internal jugular vein and swelling of surrounding soft tissue. Chest radiograph demonstrated cavitary infiltrates over the left upper lobe. Septic thrombophlebitis of the internal jugular vein and metastatic pulmonary emboli was highly suspected. Intravenous ceftriaxone and metronidazole were given empirically. Fusobacterium necrophorum was isolated from the blood culture with susceptibility to metronidazole. Complete defervescence and resolution of the neck swelling and pulmonary infiltrates occurred after antibiotic administration for 21 days. Lemierre's syndrome should be considered when encountering a febrile patient with painful neck swelling.
We report the case of a 14 years old girl patient with recurrent tonsillitis who had been diagnosed and admitted previously with Plaut-Vincent's angina. Six weeks after leaving the hospital she was assited in Emergencies by an infectious mononucleosis associated to unilateral tonsillar necrotizing ulceration from which a sample was taken to microbiological exam finding the fusospirochaetal complex Borrelia vincenti and Fusobacterium necrophorum. A literature review at the respect of such association and its treatment is performed.
At an abattoir, lesion specimens from 140 condemned sheep livers were collected for bacteriologic culture and for pathologic examination. Grossly, 23 lesions were abscesses; from 9 of which, Fusobacterium necrophorum biovar A (3 in pure culture and 6 in mixed culture) was isolated and from 14 of which, biovar B (6 in pure culture and 8 in mixed culture) was isolated. Escherichia coli was the predominant facultative anaerobic bacterium and Clostridium perfringens was the predominant obligate anaerobic bacterium isolated from the 14 lesions with mixed bacterial infection. Histologically, these lesions had a core of coagulation necrosis, encircled by a zone of necrotic phagocytic cells and bacteria with cellular characteristics of F necrophorum biovars A or B, and a connective tissue capsule. Of the 117 lesions without F necrophorum, 49 were culture-positive (for other organisms) and 69 were culture-negative. These 117 lesions were fibrous and were smaller than the 23 abscesses. A variety of gram-positive and gram-negative facultative anaerobic and obligate anaerobic bacteria was isolated from the culture-positive lesions, but always in low numbers. Eleven culture-negative and 18 culture-positive lesions were examined and had histologic characteristics of parasite-induced granulomas, with numerous eosinophils and epithelioid giant cells. Results of the study indicated that the histologic appearance of ovine hepatic lesions with F necrophorum was similar to bovine liver abscesses caused by F necrophorum, but unlike bovine liver abscesses, F necrophorum biovar B was isolated more frequently than was biovar A and often in pure culture. Most of the lesions in the condemned livers were parasite-induced granulomas.
We present 2 cases of the Lemierre syndrome (also called postanginal septicemia), along with 36 other cases from a review of recent literature. A review of the literature during the preantibiotic era is also included. This disease is caused by an acute oropharyngeal infection with secondary thrombophlebitis of the internal jugular vein complicated by multiple metastatic infection. The majority of cases are caused by anaerobic gram-negative organisms, most frequently Fusobacterium necrophorum. An enhanced computed tomographic scan of the neck is the technique of choice to demonstrate the thrombosis of the internal jugular vein. Prolonged intravenous administration of antimicrobial agents known to have a good antianaerobic coverage, along with drainage of purulent collections, will usually be successful in the overwhelming majority of patients.
The killing ability of bovine peripheral blood neutrophils did not vary during the oestrous cycle. Administration of sex steroids to ovariectomised cows reduced the intrinsic killing ability of neutrophils but enhanced the opsonising ability of serum. Exudate from experimental uterine infection with Corynebacterium pyogenes and Fusobacterium necrophorum impaired neutrophil function, probably as a result of the action of bacterial leucotoxins.
Fusobacterium necrophorum, an anaerobe for which numerous synonyms exists, causes a severe septicaemic illness in man. This, in common with various animal infections with the organism, has been called necrobacillosis. These septicaemias usually occur in previously healthy children and adolescents. A total of 45 cases were studied from over 20 hospitals in England and Wales. The commonest presentation (two thirds of cases) was of post-anginal septicaemia, in which a sore throat was followed by rigors and metastatic abscesses, usually in the lung, but also in bone, central nervous system and other sites. Multisystem disturbance was frequent. Other cases presented without a previous sore throat but with otitis, mastoiditis, sinusitis or dental infection, or with acute osteomyelitis. Two patients died of their infection. In those who survived, recovery was usually prolonged, despite appropriate antibiotics. In many cases there was considerable diagnostic confusion, and few doctors were familiar with the disease. F. necrophorum was often initially misidentified in the laboratory. Necrobacillosis is a serious, if uncommon, infection of healthy young people, it deserves wider recognition.
Anaerobic bacteria have been increasingly implicated as important pathogens in animals. To determine the prevalence of anaerobic bacterial infection, the results of anaerobic bacteriologic culture of 599 specimens obtained from dogs and cats hospitalized at the Colorado State University Veterinary Teaching Hospital were reviewed. Obligate anaerobic bacteria were isolated from 35% of properly submitted specimens; Bacteroides spp and Fusobacterium spp were the organisms most commonly isolated. Infections most often containing anaerobes were abscesses, pleuropulmonary infections, and abdominal infections. A complication rate of 28% was observed with anaerobic bacterial infections; failure to initially treat with an effective antibiotic increased the rate of recurrence of infection.
Twenty holstein heifers were intradermally inoculated in the interdigital skin with a suspension containing Fusobacterium necrophorum and Bacteroides melaninogenicus to induce acute foot rot. Lesions, lameness, and swelling were evaluated during the study, using a subjective scoring system. Rectal temperature, species and number of bacteria isolated, and change in body weight were monitored throughout the study. Ten heifers (treated) were given amoxicillin trihydrate (10 mg/kg of body weight, IM) for 5 days, beginning at the onset of lameness. The remaining 10 heifers (controls) were given physiologic saline solution IM. Treated heifers had less severe lesions and greater weight gain than did control heifers. Rectal temperatures of treated heifers did not differ significantly from those of control heifers. It was concluded that administration of amoxicillin trihydrate early in the course of acute foot rot may reduce the severity of lesions associated with foot rot in cattle.
Oxytetracycline, administered at 40 mg kg-1 by intravenous injection, was used as part of the treatment of three female red-necked wallabies, Macropus rufogriseus, with suspected Fusobacterium necrophorum infections. The plasma concentrations of this drug in blood samples collected at intervals up to 24 hours after administration were measured using a biological assay. The pattern of decline in plasma oxytetracycline concentration with time was consistent with a two-compartment model. The half-life of the elimination phase was calculated to be 11.4 hours and the apparent volume of distribution was found to be 2.041 litres kg-1. These results provide a basis for devising appropriate oxytetracycline dosage regimes for the species.
A one and one-half year old steer killed in a slaughterhouse had necrobacillary fibrinous bronchopneumonia with abscessation. Histologically, there were variably sized areas of coagulation necrosis in the lungs, thrombosis of pulmonary lymphatics, and fibrin deposits in the bronchioli and adjacent alveoli. Fusobacterium necrophorum in pure culture was isolated from the lung.
Anaerobic bacterial endophthalmitis was studied in rabbits following intravitreal injection of live Fusobacterium necrophorum. Clinical response, bacterial recovery, and histopathology were studied. An inoculum of approximately 50 organisms produced endophthalmitis in 59% of injected eyes, while 1000 or more organisms produced endophthalmitis in 100% of injected eyes. The course and severity of disease seemed to be independent of the concentration of bacteria above a minimal inoculum size. Affected eyes showed progressive endophthalmitis. Histopathologic changes corresponded to the clinical gradation of endophthalmitis, including progressive retinal necrosis.
Ethylenediamine dihydriodide (EDDI) was administered by capsule and as a feed premix to cattle in 2 studies. In study I (32 steers), EDDI was given at 0, 12.5, 50, and 200 mg/animal each day and in study II (36 steers) at 0, 30, and 200 mg/animal each day. Serum iodine levels were monitored during the studies. The cattle were inoculated intradermally in the interdigital space with a mixture of Fusobacterium necrophorum and Bacteroides melaninogenicus to induce acute foot rot at day 15 (study I) or day 28 (study II) after EDDI administration was started. Lesions and lameness were evaluated 5 days after challenge exposure, using a subjective scoring system. The cattle receiving EDDI had significantly less severe lesions and lameness than control cattle in both studies (study I, P less than 0.003; study II, P less than 0.001). The results indicated that EDDI was efficacious in prevention of foot rot. The studies demonstrated a direct relationship between dosage levels of EDDI and serum iodine levels. However, at the large dosage level (200 mg) there were some individuals that showed an inability to metabolize and excrete the iodine as demonstrated by high serum iodine levels (600 to 700 micrograms of iodine/dl of serum).
Fusobacterium necrophorum is considered to be a member of the normal rumen flora and is the primary etiologic agent of bovine liver abscesses. Of the three biotypes of F. necrophorum, A, B, and C, only biotypes A and B have been implicated in the disease. Type B is the predominant biotype isolated from ruminal lesions and type A is the predominate biotype isolated from liver abscesses. Type A is usually found in pure culture in the liver abscesses; whereas, type B is usually found in mixed culture with either type A or with other bacterial species. Corynebacterium pyogenes, Streptococcus spp., Staphylococcus spp., and Bacteroides spp. are the most prevalent bacteria recovered from mixed cultures. Corynebacterium pyogenes is the most common species isolated and can cause disease synergistically with type B isolates.