1 - Paediatric Infectious Unit. Hospital Dona Estefânia. Centro Hospitalar Universitário Lisboa Central. Lisbon, Portugal
2 - Departamento da Mulher e da Criança, Hospital Espírito Santo de Évora. Évora Portugal
- 39th Annual Meeting of the European Society for Paediatric Infectious Diseases.
- Publicação sob a forma de poster
Resumo:
Background Fusobacterium family is a non-spore forming anaerobe present on the oropharynx’s normal flora. Fusobacterium necrophorum and Fusobacterium nucleatum are the most common and virulent. It’s a rare cause of disease in pediatric patients presenting with severe suppurative manifestations. Its incidence is increasing worldwide.
Cases Presentation Summary We report five pediatric cases between 3-17 years old with Fusobacterium infection over a period of 2 years (2019-20). Four had predisposing factors like dental cavities. All children presented with prolonged fever and negative blood cultures. Two patients presented meningitis associated with pansinusitis and otomastoiditis, one patient pneumonia with empyema, one patient osteomyelitis complicated with septic arthritis, pyomyositis and femoral head necrosis and one patient a retropharyngeal abscess complicated by Lemièrre syndrome and septic shock. Fusobacterium was identified in cerebrospinal fluid culture in one patient and four were identified by 16s PCR: Fusobacterium necrophorum (3) and Fusobacterium nucleatum (2). Coinfections with Candida albicans, Staphylococcus lugdunensis, Streptococcus constallatus infections were observed in 3 patients. The most frequent combination of antibiotics was meropenem with clindamycin or metronidazole. One patient needed hyperbaric oxygen therapy. All patients required surgical interventions. Three patients required intensive care. The average length of stay and of antibiotic therapy were 65 and 62 days, respectively. None of the patients died but all presented sequelae as hypoacusis, movement limitation and long-term respiratory disfunction.
Learning Points/Discussion Fusobacterium infections were associated with extended hospital stay, prolonged antibiotic therapy, and surgical intervention. As anaerobic cultures have low sensitivity, 16s PCR is a helpful but more costly option in these situations to establish the etiological agent and adjust antibiotic therapy. Despite no mortality in this series, Fusobacterium infections are known to be aggressive with high morbidity and short-to-medium-term sequelae.