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Published on: November 5, 2019
[Bacterial meningitis as a complication of Fusobacterium necroforum infection in adults]
C Spitzer1, H Foltys, S W Lemmen
1Klinik für Neurologie, Universitätsklinikum Aachen. christoph.spitzer@post.rwth-aachen.de
Abstract:
Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F. necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F. necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F. necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.
Insights
Fusobacterium necrophorum, a bacterium normally found in the throat, can cause meningitis in adults. Prompt identification and treatment with antibiotics like meropenem and metronidazole are crucial for recovery.
Area of Science:
- Microbiology
- Infectious Diseases
- Neurology
Background:
- Fusobacterium necrophorum is an anaerobic, gram-negative bacterium part of the oropharyngeal flora.
- It is known to cause Lemierre's syndrome, a severe condition involving neck thrombophlebitis and metastatic abscesses.
- While rare, F. necrophorum can cause meningitis, predominantly in children.
Observation:
- A case of a 25-year-old woman with F. necrophorum meningitis is presented.
- The patient initially exhibited an incomplete right third nerve palsy.
- Symptoms progressed to include fever, meningism, and decreased vigilance.
Findings:
- Cerebrospinal fluid analysis confirmed bacterial meningitis.
- Identification of F. necrophorum led to a change in antibiotic treatment to meropenem.
- Addition of metronidazole was necessary due to persistent cerebrospinal fluid inflammation.
Implications:
- This case highlights F. necrophorum as a potential cause of bacterial meningitis in adults.
- Early recognition and appropriate antibiotic therapy are vital for managing F. necrophorum meningitis.
- The findings emphasize the importance of including F. necrophorum in the differential diagnosis for adult meningitis.
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