Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review.
BACKGROUND
Fusobacterium necrophorum is associated with Lemierre syndrome (pharyngitis with septic thrombosis of the internal jugular veins) but it can also be involved in other head and neck infections, including sinusitis, parotitis, dental infections, and otitis media.


METHODS
This retrospective study analyzes a series of 25 pediatric cases of acute otitis media caused by F. necrophorum and treated in our institution between 1995 and 2006.


RESULTS
We observed 3 clinical presentations: (1) uncomplicated otitis media (44%; n = 11); (2) acute mastoiditis (40%; n = 10); and (3) otogenic variant of Lemierre syndrome (16%; n = 4) associating acute mastoiditis, suppurative thrombophlebitis of the lateral and/or cavernous sinuses, meningitis syndrome, and sometimes distant septic metastasis or extensive osteolysis of the temporal bone. Sixty percent of these cases were diagnosed during the last 4 years of the study. Children less than 1 year of age were at increased risk for Lemierre syndrome. Broad range 16S rDNA polymerase chain reaction and sequencing were used to confirm the identification of F. necrophroum and to detect secondary sites of infection. All patients had favorable clinical outcome, but complicated cases (mastoiditis and otogenic variant of Lemierre syndrome) required prolonged hospital stays and duration of treatment.


CONCLUSIONS
Based on bacteriologic investigation, we recommend systematic culture for anaerobes and that antibiotic treatment of F. necrophorum middle ear infections and subsequent complications includes coverage for anaerobic bacteria.
Laboratoire de Microbiologie, Assistance Publique Hôpitaux de Paris, Paris, France.
Alban
A
Le Monnier
Anne
A
Jamet
Etienne
E
Carbonnelle
Gwladys
G
Barthod
Kaoutar
K
Moumile
Fabrice
F
Lesage
Jean-Ralph
JR
Zahar
Yves
Y
Mannach
Patrick
P
Berche
Vincent
V
Couloigner
D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics; D005260:Female; D005674:Fusobacterium Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005675:Fusobacterium necrophorum / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008417:Mastoiditis / Q000382:microbiology; D010033:Otitis Media / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S