[Bacterial meningitis as a complication of Fusobacterium necroforum infection in adults].
Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F. necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F. necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F. necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.
Spitzer
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Klinik für Neurologie, Universitätsklinikum Aachen. christoph.spitzer@post.rwth-aachen.de
Foltys
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Lemmen
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D000328:Adult; D000900:Anti-Bacterial Agents; D001786:Blood Glucose / Q000378:metabolism; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005675:Fusobacterium necrophorum; D006801:Humans; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D007958:Leukocyte Count; D008169:Lung Abscess / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D000077731:Meropenem; D008795:Metronidazole / Q000627:therapeutic use; D015840:Oculomotor Nerve Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy; D010033:Otitis Media / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D010612:Pharyngitis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D018805:Sepsis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D013845:Thienamycins / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins; D013845:Thienamycins; D008795:Metronidazole; D019344:Lactic Acid; D000077731:Meropenem