gms | German Medical Science

Introduction: The genus Fusobacterium shows obligate anaerobic, gram-negative, non spore-forming, immobile rod-shaped bacteria that are part of the physiologic oral and intestinal flora in humans. Gold standard for the microbiological detection is the anaerobic culture on special blood an serum containing nutrient media. A subclassification is based on the production of organic acids being end products of various metabolic processes. Infections involving the genus Fusobacterium are mostly caused endogenically. These infections are characterized by subacute to chronic, purulent gangrenous-necrotizing inflammation localized in the orofacial area, the neck, the respiratory tract, the abdomen and also in the female genitalia. In addition to Plaut’s angina and Lemierre’s syndrome, fusobacteriosis is also an important differential diagnosis of osteomyelitis. The treatment of choice is the antibiosis with Clindamycin, Metronidazole or Amoxicillin.

Case report: During emergency service we saw a somnolent tow year old child in severely reduced condition. The clinical examnation showed a pain on palpation as well as redness and swelling behind the rihgt auricle. For two weeks otorrhea and otalgia of the right ear and relapsing fever were described. The otoscopy showed a reduction of the posterior superior external auditory canal and a putride secretory otitis media.Inflammation parameters were massivly increased (leucocytes 22,0 gpt/l, CRP 222,9 mg/l). Therapy was started with Rocephin 1g, mastectomy on the right side, adenotomy and drainage of the middle ear on both sides. In the anarobic culture Fusobacterium necrophorum could be grown. The histodiagnosis showed a chronic-fibrotic, florid inflammation containing devitalized bone particles. CT and MR imaging were performed because of persisting fever and a slow process of recovering, showing osteolysis of the temporal bone, the zygomatic process and the mandibular condyle as well as thrombosis of the sigmoid sinus on the right side.

Summary: Causing mastoiditis and osteomyleitis Streptococcus spp., Haemophilus influenzae, Branhamella catarrhalis and Staphylococcus aureus occur more frequently than Fusobacterium necrophorum. Observing a prolonged recovery from mastoiditis and osteomyelitis one should consider Fusobacterium necrophorum as the causing pathogen and treatment with Clindamycin should be started.