Fusobacterial liver abscess: a case report and review of the literature

• Published in: BMC infectious diseases Vol. 17; no. 1; pp. 440 - 9
• Main Authors: Jayasimhan, Dilip, Wu, Linus, Huggan, Paul
• Format: Journal Article
• Language: English
• Published: London BioMed Central 20.06.2017; BioMed Central Ltd; BMC
• Subjects: Abdomen; Abscesses; Bacilli; Bacterial and fungal diseases; Bacterial infections; Bacteroidaceae Infections - etiology; Care and treatment; Case Report; Case reports; Diarrhea; Drainage; English language; Female; Fever; Fusobacterium; Fusobacterium Infections - drug therapy; Fusobacterium Infections - etiology; Fusobacterium Infections - microbiology; Fusobacterium nucleatum - pathogenicity; Gram-negative bacilli; Gram-negative bacteria; Gum disease; Humans; Infections; Infectious Diseases; Internal Medicine; Laboratories; Lemierre’s syndrome; Lethargy; Literature reviews; Liver; Liver abscess; Liver Abscess, Pyogenic - drug therapy; Liver Abscess, Pyogenic - etiology; Liver Abscess, Pyogenic - microbiology; Liver cancer; Male; Medical imaging; Medical Microbiology; Medical Subject Headings-MeSH; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Pain; Parasitology; Periodontal diseases; Periodontal Diseases - microbiology; Prevotella - pathogenicity; Review; Surveying; Tropical Medicine; Ultrasonic imaging; Periodontal diseases; Case reports; Liver abscess; Review; Fusobacterium; Lemierre’s syndrome
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2548-9

Background Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature. Case presentation A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords “Fusobacterium” and “Liver abscess”. Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre’s Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks. Conclusion Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.