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Invasive Fusobacterium Infections in Children: A Retrospective Multicenter Study
Adi Hirschhorn1, Diana Averbuch2, Nadav Michaan3,4
1From the Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Pediatric Fusobacterium infections rose 2.5-fold in a decade, often originating from the ear and leading to serious complications. Prompt antibiotic and surgical treatment ensured survival for all children studied.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Fusobacterium infections in children have notably increased over the past decade.
- This rise necessitates a comprehensive understanding of the associated epidemiology and clinical characteristics.
Purpose of the Study:
- To describe the epidemiology, clinical features, and outcomes of invasive Fusobacterium infections (IFI) in hospitalized children.
- To identify common sources, complications, and demographic factors associated with IFI in pediatric patients.
Main Methods:
- Retrospective analysis of medical records for children under 18 with IFI diagnosed between 2010 and 2020.
- Data collected included clinical, laboratory, and microbiological findings; IFI diagnosis confirmed by culture or 16S rRNA PCR.
Main Results:
- A 2.5-fold increase in IFI hospitalizations was observed, from 19 to 50 per 100,000 admissions.
- Otogenic sources (55%) were most common, particularly in younger children (median age 1.9 years).
- Common complications included subperiosteal and epidural abscesses; 11 children developed thrombosis, mostly sinus vein thrombosis.
Conclusions:
- Invasive Fusobacterium infections in children have significantly increased, with otogenic sources being predominant, especially in younger populations.
- High rates of complications underscore the severity of these infections.
- Combined antibiotic and surgical management resulted in favorable outcomes, with all patients surviving.
Background:
The past decade has witnessed a rise in Fusobacterium infections. This study aimed to describe the epidemiology, clinical and demographic characteristics and outcomes associated with Fusobacterium infections in hospitalized children in central Israel.
Methods:
We retrospectively analyzed the medical records of children <18 years old who had been admitted with a diagnosis of invasive Fusobacterium infection (IFI) between January 2010 and April 2020. Clinical, laboratory and microbiologic data were retrieved. IFI diagnosis was based upon microbiological identification in any specimen by culture or by 16S ribosomal RNA polymerase chain reaction.
Results:
Fifty-one children (26 boys) with a median age of 3 years (range, 5-16 years) were included. Hospitalizations for IFI increased from 19 of 100,000 admissions between 2010 and 2015 to 50 of 100,000 between 2016 and 2020, representing a 2.5-fold increase. Most of the infections were from an otogenic source (n = 28, 55%) followed by an oropharyngeal/respiratory source (n = 21, 41%). The most common complications were subperiosteal and epidural abscesses (41% and 37%, respectively). Thrombosis was diagnosed in 11 children, 10 of whom had sinus vein thrombosis. All had an otogenic source. Children with otogenic compared with all other infection sources were significantly younger (median age of 1.9 vs. 3 years; P < 0.001). Forty-seven children (92%) underwent a surgical intervention. All patients survived, one with neurologic sequelae.
Conclusions:
The admissions for IFI in children increased 2.5-fold during the last decade. The most common source is otogenic, especially among younger children, and it is associated with high complication rates. Current management, including combinations of antibiotics and surgical interventions, leads to favorable outcome.
