Fusobacterial brain abscess: a review of five cases and an analysis of possible pathogenesis

Restricted access

Object. The cases of five patients with fusobacterial brain abscess are presented. The authors discuss their attempt to determine the pathogenesis.

Methods. The clinical and microbiological features of five cases of fusobacterial brain abscess are reviewed. Isolates of 2031 Fusobacterium spp. and other anaerobes collected (1989–2002) at our institution were analyzed and compared for incidences and isolation sources. The findings were correlated with extensive literature on the subject.

The five patients were men between 45 and 74 years of age. All experienced an insidious onset of the disease and probable hematogenous seeding of the organism(s). One patient had a monomicrobic Fusobacterium necrophorum abscess, whereas the others had polymicrobic F. nucleatum abscesses. Despite surgery and a regimen of antibiotic medications and dexamethasone, three patients experienced a paradoxical deterioration 3 days postoperatively that necessitated reevacuation of the lesion. The evacuants observed at that time contained numerous leukocytes but no microorganisms, suggesting intensified inflammation as the likely cause of deterioration. This explanation is supported by literature that fusobacteria strongly activate neutrophils. An analysis of the 2031 anaerobes from blood, wounds, and abscesses showed the considerable virulence of Fusobacterium spp., which were able to enter and/or sustain themselves in the blood circulation. This pattern was similar to that of Clostridium spp., but different from those of Peptostreptococcus spp., Bacteroides spp., and Prevotella spp., which were less invasive but more abundant.

Conclusions. Some fusobacterial brain abscesses may be associated with a paradoxical postoperative deterioration, which is probably due to intensified inflammation following treatment. The blood-borne dissemination and invasive behavior of fusobacteria likely initiate such a brain abscess, and further seeding of other synergic bacteria leads to a polymicrobic abscess.

Article Information

Address reprint requests to: Xiang Y. Han, M.D., Ph.D., Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 84, Houston, Texas 77030. email: xhan@mdanderson.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 3. Left: Gadolinium-enhanced T1-weighted MR image obtained before the first aspiration, revealing a ring-enhancing lesion with significant perilesional edema in the left posterior frontal region. Center: A CT scan demonstrating a reduced abscess cavity (arrow) 24 hours after the aspiration. Right: An MR image obtained 3 days after the aspiration, demonstrating recurrence of the lesion.

References

1.

Annane DSebille VCharpentier Cet al: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:8628712002Annane D Sebille V Charpentier C et al: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871 2002

2.

Asensi VAlvarez MCarton JAet al: Eikenella corrodens brain abscess after repeated periodontal manipulations cured with imipenem and neurosurgery. Infection 30:2402422002Asensi V Alvarez M Carton JA et al: Eikenella corrodens brain abscess after repeated periodontal manipulations cured with imipenem and neurosurgery. Infection 30:240–242 2002

3.

Athavale NVLeitch DGCowling P: Liver abscesses due to Fusobacterium spp. that mimick malignant metastatic liver disease. Eur J Clin Microbiol Infect Dis 21:8848862002Athavale NV Leitch DG Cowling P: Liver abscesses due to Fusobacterium spp. that mimick malignant metastatic liver disease. Eur J Clin Microbiol Infect Dis 21:884–886 2002

4.

Bauer CSchoonbroodt DWagner Cet al: Liver abscesses due to Fusobacterium species. Liver 20:2672682000 (Letter)Bauer C Schoonbroodt D Wagner C et al: Liver abscesses due to Fusobacterium species. Liver 20:267–268 2000 (Letter)

5.

Bieger RCBrewer NSWashington JA II: Haemophilus aphrophilus: a microbiologic and clinical review and report of 42 cases. Medicine 57:3453551978Bieger RC Brewer NS Washington JA II: Haemophilus aphrophilus: a microbiologic and clinical review and report of 42 cases. Medicine 57:345–355 1978

6.

Bolstad AIJensen HBBakken V: Taxonomy, biology, and periodontal aspects of Fusobacterium nucleatum. Clin Microbiol Rev 9:55711996Bolstad AI Jensen HB Bakken V: Taxonomy biology and periodontal aspects of Fusobacterium nucleatum.Clin Microbiol Rev 9:55–71 1996

7.

Bourgault AMLamothe FDolce Pet al: Fusobacterium bacteremia: clinical experience with 40 cases. Clin Infect Dis 25 (Suppl 2):S181S1831997Bourgault AM Lamothe F Dolce P et al: Fusobacterium bacteremia: clinical experience with 40 cases. Clin Infect Dis 25 (Suppl 2):S181–S183 1997

8.

Bowden DK: Eosinophilic meningitis in the New Hebrides: two outbreaks and two deaths. Am J Trop Med Hyg 30:114111431981Bowden DK: Eosinophilic meningitis in the New Hebrides: two outbreaks and two deaths. Am J Trop Med Hyg 30:1141–1143 1981

9.

Bradshaw DJMarsh PDWatson GKet al: Role of Fusobacterium nucleatum and coaggregation in anaerobe survival in planktonic and biofilm oral microbial communities during aeration. Infect Immunol 66:472947321998Bradshaw DJ Marsh PD Watson GK et al: Role of Fusobacterium nucleatum and coaggregation in anaerobe survival in planktonic and biofilm oral microbial communities during aeration. Infect Immunol 66:4729–4732 1998

10.

Brazier JSHall VYusuf Eet al: Fusobacterium necrophorum infections in England and Wales 1990–2000. J Med Microbiol 51:2692722002Brazier JS Hall V Yusuf E et al: Fusobacterium necrophorum infections in England and Wales 1990–2000. J Med Microbiol 51:269–272 2002

11.

Brook I: Aerobic and anaerobic bacteriology of intracranial abscesses. Pediatr Neurol 8:2102141992Brook I: Aerobic and anaerobic bacteriology of intracranial abscesses. Pediatr Neurol 8:210–214 1992

12.

Brook I: Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals. J Clin Microbiol 26:118111881988Brook I: Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals. J Clin Microbiol 26:1181–1188 1988

13.

Bruggemann HBaumer SFricke WFet al: The genome sequence of Clostridium tetani, the causative agent of tetanus disease. Proc Natl Acad Sci USA 100:131613212003Bruggemann H Baumer S Fricke WF et al: The genome sequence of Clostridium tetani the causative agent of tetanus disease. Proc Natl Acad Sci USA 100:1316–1321 2003

14.

Chaudhry RDhawan BLaxmi BVet al: The microbial spectrum of brain abscess with special reference to anaerobic bacteria. Br J Neurosurg 12:1271301998Chaudhry R Dhawan B Laxmi BV et al: The microbial spectrum of brain abscess with special reference to anaerobic bacteria. Br J Neurosurg 12:127–130 1998

15.

Cheng VCHo PLLee RAet al: Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 21:8038092002Cheng VC Ho PL Lee RA et al: Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. Eur J Clin Microbiol Infect Dis 21:803–809 2002

16.

Cheng VCYuen KYChan WMet al: Immunorestitution disease involving the innate and adaptive response. Clin Infect Dis 30:8828922000Cheng VC Yuen KY Chan WM et al: Immunorestitution disease involving the innate and adaptive response. Clin Infect Dis 30:882–892 2000

17.

Chirinos JALichtstein DMGarcia Jet al: The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine 81:4584652002Chirinos JA Lichtstein DM Garcia J et al: The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine 81:458–465 2002

18.

Choremis KPadiatellis CZoumboulakis Det al: Transitory exacerbation of fever and roentgenographic findings during treatment of tuberculosis in children. Am Rev Tuberculosis 72:5275361955Choremis K Padiatellis C Zoumboulakis D et al: Transitory exacerbation of fever and roentgenographic findings during treatment of tuberculosis in children. Am Rev Tuberculosis 72:527–536 1955

19.

Chryssagi AMBrusselmans CBRombouts JJ: Septic arthritis of the hip due to Fusobacterium nucleatum. Clin Rheumatol 20:2292312001Chryssagi AM Brusselmans CB Rombouts JJ: Septic arthritis of the hip due to Fusobacterium nucleatum.Clin Rheumatol 20:229–231 2001

20.

Chun CHJohnson JDHofstetter Met al: Brain abscess a study of 45 consecutive cases. Medicine 65:4154311986Chun CH Johnson JD Hofstetter M et al: Brain abscess a study of 45 consecutive cases. Medicine 65:415–431 1986

21.

Cockerill FRHughes JG IIIVetter EAet al: Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis 24:4034181997Cockerill FR Hughes JG III Vetter EA et al: Analysis of 281797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis 24:403–418 1997

22.

de Gans Jvan de Beek D: Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:154915562002de Gans J van de Beek D: Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:1549–1556 2002

23.

Finegold SM: Anaerobic bacteria: general concepts in Mandell GLBennett JEDolin R (eds): Mandell Douglas and Bennett's Principles and Practice of Infectious Diseasesed 5. Philadelphia: Churchill Livingstone2000 pp 25192537Finegold SM: Anaerobic bacteria: general concepts in Mandell GL Bennett JE Dolin R (eds): Mandell Douglas and Bennett's Principles and Practice of Infectious Diseases ed 5. Philadelphia: Churchill Livingstone 2000 pp 2519–2537

24.

Guo MHan YWSharma Aet al: Identification and characterization of human immunoglobulin G Fc receptors of Fusobacterium nucleatum. Oral Microbiol Immunol 15:1191232000Guo M Han YW Sharma A et al: Identification and characterization of human immunoglobulin G Fc receptors of Fusobacterium nucleatum. Oral Microbiol Immunol 15:119–123 2000

25.

Hagelskjaer LPedersen G: Fusobacterium necrophorum septicemia complicated by liver abscess. A case report. APMIS 101:9049061993Hagelskjaer L Pedersen G: Fusobacterium necrophorum septicemia complicated by liver abscess. A case report. APMIS 101:904–906 1993

26.

Han XYPham ASNguyen KUet al: Pulmonary granuloma caused by Pseudomonas andersonii sp. nov. Am J Clin Pathol 116:3473532001Han XY Pham AS Nguyen KU et al: Pulmonary granuloma caused by Pseudomonas andersonii sp. nov. Am J Clin Pathol 116:347–353 2001

27.

Han XYPham ASTarrand JJet al: Rapid and accurate identification of mycobacteria by sequencing hypervariable regions of the 16S ribosomal RNA gene. Am J Clin Pathol 118:7968012002Han XY Pham AS Tarrand JJ et al: Rapid and accurate identification of mycobacteria by sequencing hypervariable regions of the 16S ribosomal RNA gene. Am J Clin Pathol 118:796–801 2002

28.

Han YWShi WHuang GTet al: Interactions between periodontal bacteria and human oral epithelial cells: Fusobacterium nucleatum adheres to and invades epithelial cells. Infect Immunol 68:314031462000Han YW Shi W Huang GT et al: Interactions between periodontal bacteria and human oral epithelial cells: Fusobacterium nucleatum adheres to and invades epithelial cells. Infect Immunol 68:3140–3146 2000

29.

Javaid AAyres JG: Intracranial tuberculoma: paradoxical deterioration during chemotherapy. J Pak Med Assoc 38:3033051988Javaid A Ayres JG: Intracranial tuberculoma: paradoxical deterioration during chemotherapy. J Pak Med Assoc 38:303–305 1988

30.

Kapatral VAnderson IIvanova Net al: Genome sequence and analysis of the oral bacterium Fusobacterium nucleatum strain ATCC 25586. J Bacteriol 184:200520182002Kapatral V Anderson I Ivanova N et al: Genome sequence and analysis of the oral bacterium Fusobacterium nucleatum strain ATCC 25586. J Bacteriol 184:2005–2018 2002

31.

Kawamura CNakamura TWatanabe Ket al: [Retrospective analysis of Fusobacterium associated infections: experience at Aomori Prefectural Hospital with 108 cases from 1995 to 1999.] Kansenshogaku Zasshi 76:23312002 (Jpn)Kawamura C Nakamura T Watanabe K et al: [Retrospective analysis of Fusobacterium associated infections: experience at Aomori Prefectural Hospital with 108 cases from 1995 to 1999.] Kansenshogaku Zasshi 76:23–31 2002 (Jpn)

32.

Khatib RRamanathan JBaran J Jr: Streptococcus intermedius: a cause of lobar pneumonia with meningitis and brain abscesses. Clin Infect Dis 30:3963972000Khatib R Ramanathan J Baran J Jr: Streptococcus intermedius: a cause of lobar pneumonia with meningitis and brain abscesses. Clin Infect Dis 30:396–397 2000

33.

Koornstra JJVeenendaal DBruyn GAet al: Septic arthritis due to Fusobacterium nucleatum. Br J Rheumatol 37:12491998 (Letter)Koornstra JJ Veenendaal D Bruyn GA et al: Septic arthritis due to Fusobacterium nucleatum.Br J Rheumatol 37:1249 1998 (Letter)

34.

Kremer BHvan Steenbergen TJ: Peptostreptococcus micros coaggregates with Fusobacterium nucleatum and non-encapsulated Porphyromonas gingivalis. FEMS Microbiol Lett 182:57622000Kremer BH van Steenbergen TJ: Peptostreptococcus micros coaggregates with Fusobacterium nucleatum and non-encapsulated Porphyromonas gingivalis.FEMS Microbiol Lett 182:57–62 2000

35.

Lemierre A: On certain septicaemias due to anaerobic organisms. Lancet 1:7017031936Lemierre A: On certain septicaemias due to anaerobic organisms. Lancet 1:701–703 1936

36.

Li XTronstad LOlsen I: Brain abscesses caused by oral infection. Endod Dent Traumatol 15:951011999Li X Tronstad L Olsen I: Brain abscesses caused by oral infection. Endod Dent Traumatol 15:95–101 1999

37.

Moore TA: Therapy for parasitic infections in Braunwald EFauci ASKasper DLet al (eds): Harrison's Principles of Internal Medicineed 15. New York: McGraw-Hill2001 pp 11921198Moore TA: Therapy for parasitic infections in Braunwald E Fauci AS Kasper DL et al (eds): Harrison's Principles of Internal Medicine ed 15. New York: McGraw-Hill 2001 pp 1192–1198

38.

Mukaida N: Interleukin-8: an expanding universe beyond neutrophil chemotaxis and activation. Int J Hematol 72:3913982000Mukaida N: Interleukin-8: an expanding universe beyond neutrophil chemotaxis and activation. Int J Hematol 72:391–398 2000

39.

Nagashima HTakao AMaeda N: Abscess forming ability of streptococcus milleri group: synergistic effect with Fusobacterium nucleatum. Microbiol Immunol 43:2072161999Nagashima H Takao A Maeda N: Abscess forming ability of streptococcus milleri group: synergistic effect with Fusobacterium nucleatum.Microbiol Immunol 43:207–216 1999

40.

Nagatomo TOhga SSaito Met al: Streptococcus intermedius-brain abscess in chronic granulomatous disease. Eur J Pediatr 158:8728731999 (Letter)Nagatomo T Ohga S Saito M et al: Streptococcus intermedius-brain abscess in chronic granulomatous disease. Eur J Pediatr 158:872–873 1999 (Letter)

41.

Narayan KKhare PMKelkar SS: Anaerobic bacteria in brain abscess, a review; observation of 18 consecutive cases. Indian J Pathol Microbiol 32:57611989Narayan K Khare PM Kelkar SS: Anaerobic bacteria in brain abscess a review; observation of 18 consecutive cases. Indian J Pathol Microbiol 32:57–61 1989

42.

Navas EMartinez-San Millan JGarcia-Villanueva Met al: Brain abscess with intracranial gas formation: case report. Clin Infect Dis 19:2192201994 (Letter)Navas E Martinez-San Millan J Garcia-Villanueva M et al: Brain abscess with intracranial gas formation: case report. Clin Infect Dis 19:219–220 1994 (Letter)

43.

Press OWRamsey PG: Central nervous system infections associated with hereditary hemorrhagic telangiectasia. Am J Med 77:86921984Press OW Ramsey PG: Central nervous system infections associated with hereditary hemorrhagic telangiectasia. Am J Med 77:86–92 1984

44.

Rao GPNadh BRHemaratnan Aet al: Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases. J Neurosurg 83:3593621995Rao GP Nadh BR Hemaratnan A et al: Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases. J Neurosurg 83:359–362 1995

45.

Roos KLTyler KL: Bacterial meningitis and other suppurative infections in Braunwald EFauci ASKasper DLet al (eds): Harrison's Principles of Internal Medicineed 15. New York: McGraw-Hill2001 pp 24622471Roos KL Tyler KL: Bacterial meningitis and other suppurative infections in Braunwald E Fauci AS Kasper DL et al (eds): Harrison's Principles of Internal Medicine ed 15. New York: McGraw-Hill 2001 pp 2462–2471

46.

Shelburne SA IIIHamill RJRodriguez-Barradas MCet al: Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine 81:2132272002Shelburne SA III Hamill RJ Rodriguez-Barradas MC et al: Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine 81:213–227 2002

47.

Shimizu TOhtani KHirakawa Het al: Complete genome sequence of Clostridium perfringens, an anaerobic flesh-eater. Proc Natl Acad Sci USA 99:99610012002Shimizu T Ohtani K Hirakawa H et al: Complete genome sequence of Clostridium perfringens an anaerobic flesh-eater. Proc Natl Acad Sci USA 99:996–1001 2002

48.

Slom TJCortese MMGerber SIet al: An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean. N Engl J Med 346:6686752002Slom TJ Cortese MM Gerber SI et al: An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis in travelers returning from the Caribbean. N Engl J Med 346:668–675 2002

49.

Sotelo JEscobedo FRodriguez-Carbajal Jet al: Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med 310:100110071984Sotelo J Escobedo F Rodriguez-Carbajal J et al: Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med 310:1001–1007 1984

50.

Su TMLin YCLu CHet al: Streptococcal brain abscess: analysis of clinical features in 20 patients. Surg Neurol 56:1891942001Su TM Lin YC Lu CH et al: Streptococcal brain abscess: analysis of clinical features in 20 patients. Surg Neurol 56:189–194 2001

51.

Taguchi YSato JNakamura N: Gas-containing brain abscess due to Fusobacterium nucleatum. Surg Neurol 16:4084101981Taguchi Y Sato J Nakamura N: Gas-containing brain abscess due to Fusobacterium nucleatum.Surg Neurol 16:408–410 1981

52.

Yamamoto MFukushima TOhshiro Set al: Brain abscess caused by Streptococcus intermedius: two case reports. Surg Neurol 51:2192221999Yamamoto M Fukushima T Ohshiro S et al: Brain abscess caused by Streptococcus intermedius: two case reports. Surg Neurol 51:219–222 1999

53.

Young KAAllaker RPHardie JMet al: Interactions between Eikenella corrodens and ‘Streptococcus milleri-group’ organisms: possible mechanisms of pathogenicity in mixed infections. Antonie Van Leeuwenhoek 69:3713731996Young KA Allaker RP Hardie JM et al: Interactions between Eikenella corrodens and ‘Streptococcus milleri-group’ organisms: possible mechanisms of pathogenicity in mixed infections. Antonie Van Leeuwenhoek 69:371–373 1996

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 29 29 11
Full Text Views 177 177 45
PDF Downloads 114 114 20
EPUB Downloads 0 0 0

PubMed

Google Scholar