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Fusobacterium necrophorum Middle Ear Infections in Children and Related Complications: Report of 25 Cases and Literature Review

Le Monnier, Alban PharmD, PhD*∥; Jamet, Anne MD*; Carbonnelle, Etienne MD, PhD*∥; Barthod, Gwladys MD; Moumile, Kaoutar PharmD*; Lesage, Fabrice MD; Zahar, Jean-Ralph MD; Mannach, Yves MD†∥; Berche, Patrick MD, PhD*∥; Couloigner, Vincent MD, PhD†∥

The Pediatric Infectious Disease Journal: July 2008 - Volume 27 - Issue 7 - p 613-617
doi: 10.1097/INF.0b013e318169035e
Original Studies

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.

From the *Laboratoire de Microbiologie, †Service d’Oto-rhino-laryngologie, and ‡Service de Réanimation Pédiatrique, Hôpital Necker-Enfants malades, Assistance Publique Hôpitaux de Paris; §Unité Mobile d’Infectiologie; and ∥Université Paris Descartes Paris 5, Faculté de médecine, site Necker, Paris, France.

Accepted for publication January 15, 2008.

Address for correspondence: Vincent Couloigner, MD, PhD, Service d’ORL Pédiatrique, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.