Fusobacterium Species

Cells of Fusobacterium spp. are moderately long and thin with tapered ends and have typical fusiform morphology. The species of Fusobacterium seen most often in clinical infections are Fusobacterium nucleatum, Fusobacterium necrophorum, Fusobacterium mortiferum, and Fusobacterium varium. F. nucleatum is the predominant Fusobacterium from clinical specimens, often associated with infections of the mouth, lung (38,60), and brain (37). They are often isolated from abscesses, obstetrical and gynecological infections, chest infections, blood, and wounds (77).

Since these organisms are part of the normal flora of the oral and gastrointestinal flora, they are found in almost all types of infections in children. These include bacteremia (11,32), meningitis associated with otologic diseases (37,44,45), peritonitis following rupture of viscus (18), and subcutaneous abscesses and burns near the oral or anal orifices (Fig. 3) (58,59).

FIGURE 3 Gram stain of Fusobacterium nucleatum.

A growing resistance of anaerobic gram-negative bacilli previously susceptible to penicillins has been noticed in the last three decades (78,79). Resistance grew among members of the pigmented Prevotella and Porphyromonas, Fusobacterium spp., P. oralis, P. disiens, P. bivia, and P. oris-buccae. The main mechanism of resistance is through the production of the enzyme beta-lactamase. Complete identification and susceptibility testing and ability to produce beta-lactamase of members of the B. fragilis group as well as other anaerobic gramnegative bacilli are factors of practical importance when making choices between antimicrobials for the therapy of infections involving these organisms.

The recovery rate of the different anaerobic gram-negative bacilli in infected sites is similar to their distribution in the normal flora (1,7). While B. fragilis group were more often isolated in sites proximal to the gastrointestinal tract (abdomen, bile), pigmented Prevotella and Porphyromonas and Fusobacterium spp. were more prevalent in infections proximal to the oral cavity (bones, sinuses, chest), and P. bivia and P. disiens were more often isolated in obstetric and gynecologic infections. Knowledge of this common mode of distribution allows for logical choice of antimicrobials adequate for the therapy of infections in these sites.

GRAM-POSITIVE COCCI

Anaerobic cocci have been most often reported either as "anaerobic streptococci" or "anaerobic gram-positive cocci." These organisms were previously divided into Peptococcus spp. and Peptostreptococcus sp. However, they are currently all named Peptostreptococcus spp. and further divided according to species primarily on the basis of their metabolic products (76). The species most commonly isolated are Peptostreptococcus magnus (18% of all anaerobic gram-positive cocci isolated in Table 2), Peptostreptococcus asaccharolyticus (17%), Peptostreptococcus anaerobius (16%), Peptostreptococcus prevotii (13%), and Peptostreptococcus micros (4%) (2,3,76).

The infectious sites where anaerobic cocci predominate are in descending order of frequency: ear, bone, cysts, obstetric and gynecologic, abscesses, and sinuses. These organisms are part of the normal flora of the mouth, upper respiratory tract, intestinal tract, vagina, and skin (7). Their presence has been documented in adults in a variety of syndromes, including endocarditis, brain abscesses, puerperal sepsis, traumatic wounds, and postoperative necro-tizing fasciitis (2,3). They have been recovered in children in subcutaneous abscesses and burns around the oral and anal areas, intra-abdominal infections (18), decubitus ulcers (80), and also have been isolated as causes of bacteremia (11), and brain abscesses (37,81). These organisms are predominant isolates also in all types of respiratory infections in children and adults including chronic sinusitis (15), mastoiditis (16), acute (82,83) and chronic (14) otitis media, aspiration pneumonia (38,60), and lung abscess (60,61). They generally are recovered mixed with other aerobic or anaerobic organisms but in many cases, they are the only pathogens recovered. This may be of particular significance in cases of bacteremia (11,32,82) or acute otitis media (83).

Microaerophilic streptococci are not true anaerobes as they can become also tolerant after subculture, however they grow better anaerobically, and are often grouped under anaerobes in many studies. These organisms include the Streptococcus anginosus group (previously called Streptococcus milleri group, that include Streptococcus constellatus and S. intermedius), and Gemella morbillorum (previously called Streptococcus morbillorum) (84). Microaerophilic streptococci are of particular importance in chronic sinusitis (14) and brain abscess (37,81,85,86). They were also recovered from obstetric and gynecologic infections and abscesses(85,86).

GRAM-NEGATIVE COCCI

There are three species described as anaerobic gram-negative cocci: Veillonella, Acidaminococcus, and Megasphaera. There are two described species of Veillonella and only one each of the other two genera. The veillonellae are the most frequently involved of the three species and are part of the normal flora of the mouth, vagina, and the small intestine of some persons (7). Although they rarely are isolated from clinical infections, these organisms have been recovered occasionally from almost every type of infection mostly mixed with other bacteria (3,87,88). Veillonella spp. were recovered from abscesses, aspiration pneumonias, endocarditis, meningitis, burns, bites, and sinuses.

CONCLUSION

Many infectious diseases can be produced by anaerobic bacteria. Anaerobes of major clinical importance tend to follow certain predictable patterns according to anatomic sites and their virulence. In the upper respiratory passages and lung, the major anaerobic pathogens are Peptostreptococcus spp., pigmental Prevotella and Porphyromonas spp., and Fusobacterium spp. In intra-abdominal infections and female genital infections, the most frequent isolates are of the B. fragilis group followed by anaerobic gram-positive cocci and Clostridium species.

Recognition of the pathogenic features of these organisms enables prompt identification and initiation of appropriate management of the infections that they cause.

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