Fusobacterium Necrophorum

Background: Fusobacterium species are anaerobic bacteria that relatively rarely cause sepsis with a variable clinical presentation. Methods: We reviewed the records of 52 consecutive patients who had Fusobacterium bacteraemia over a 10-y period.

Anaerobic and aerobic cultures of facial and mandibular abscesses were made from 12 blue duiker (Cephalophus monticola fusicolor) housed at the Deer and Duiker Research Facility of the Pennsylvania State University (USA). Increases in concentrations of total protein and serum globulin occurred in all cases. Actinomyces pyogenes was isolated from nine animals. Fusobacterium necrophorum was present in eight and Bacteroides sp. was found in seven animals; other genera of isolated bacteria included: Streptococcus (from two animals), Lactobacillus (one), Staphylococcus (one) and Actinomyces (two). Eight (67%) of affected animals were 2 yr of age. Facial soft tissues and mandibles were the tissues most often affected. Tissues within the oral cavity were not affected at the time of presentation. A common finding, not reported in other host species with necrobacillosis, was the presence of nondestructive mandibular proliferation.

Fusobacterium necrophorum is a non-spore-forming gram-negative anaerobic bacillus that may be the causative agent of localized or severe systemic infections. Systemic infections due to F.necrophorum are known as Lemierre's syndrome, postanginal sepsis or necrobacillosis. The most common clinical course of severe infections in humans is a progressive illness from tonsillitis to septicemia in previously healthy young adults. A septic thrombophlebitis arising from the tonsillar veins and extending into the internal jugular vein leads to septicemia and septic emboli contributing to the development of necrotic abscesses especially in lungs and other tissues such as liver, bone and joints. In this case report, a previously healthy man with pneumonia and empyema due to F.necrophorum has been presented. A 22 year-old man suffering from sore throat for seven days was admitted to emergency department with ongoing fever and dysphagia for three days. On admission he was already taking amoxi...

This study assessed the prevalence and microbial interactions of Fusobacterium nucleatum and Fusobacterium necrophorum in primary endodontic infections from a Brazilian population and their antimicrobial susceptibility to some antibiotics by the E-test. One hundred ten samples from infected teeth with periapical pathologies were analyzed by culture methods. Five hundred eighty individual strains were isolated; 81.4% were strict anaerobes. F. nucleatum was found in 38 root canals and was associated with Porphyromonas gingivalis, Prevotella spp., and Eubacterium spp. F. necrophorum was found in 20 root canals and was associated with Peptostreptococcus prevotii. The simultaneous presence of F. nucleatum and F. necrophorum was not related to endodontic symptoms (p Ͼ 0.05). They were 100% susceptible to amoxicillin, amoxicillin/ clavulanate, and cephaclor. Fusobacterium spp. is frequently isolated from primary-infected root canals of teeth with periapical pathologies. Amoxicillin is a useful antibiotic against F. nucleatum and F. necrophorum in endodontic infections and has been prescribed as the first choice in Brazil. (J Endod 2008;34:1451-1456

Objective. The aim of this study was to identify microorganisms from root canals with periapical abscesses and to ascertain the susceptibility of Peptostreptococcus prevotii and Fusobacterium necrophorum to antimicrobials. Study design. Thirty root canals were microbiologically sampled by using sterile paper points. The concomitant microorganisms were identified through the use of established methods. The susceptibility of P prevotii and F necrophorum to antimicrobials was evaluated by using the E test method. Results. A total of 117 different bacterial strains were recovered, including 75 strict anaerobes or microphilic species. The most frequently isolated strict anaerobes were P prevotii, Peptostreptococcus micros, and F necrophorum. Facultative bacteria such as Gemella morbillorum and Streptococcus mitis were also found, albeit less frequently. The data revealed that P prevotii and F necrophorum were susceptible to the tested antibiotics. Conclusions. Gram-positive anaerobic bacteria predominate in the mixed microbiota of root canals with periapical abscesses. Moreover, P prevotii and F necrophorum are susceptible to the tested antibiotics.

Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from I to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with F usobacterium necrophorum (Fn) and P revotella intermedia ...

Objective : Since dentures can serve as a reservoir for halitosis-causing oral bacteria, halitosis development is a concern for denture wearers. In this study, we surveyed the prevalence of four selected halitosis-related species (Fusobacterium nucleatum, Tannerella forsythia, Veillonella atypica and Klebsiella pneumoniae) in clinical denture plaque samples, and developed denture biofilm models for these species in vitro to facilitate assessment of antimicrobial treatment efficacy. Design : Denture plaque from ten healthy and ten denture stomatitis patients was screened for the presence of aforementioned four species by PCR. Biofilm formation by these halitosis-associated species on the surfaces of denture base resin (DBR) discs was evaluated by crystal violet staining and confocal laser scanning microscopy. The efficacy of denture cleanser treatment on these mono-species biofilms was evaluated by colony counting. Results : 80% of the subjects in the denture stomatitis group and 60% in the healthy group contained at least one of the targeted halitosis-related species in their denture plaque. All halitosis species tested were able to form biofilms on DBR disc surfaces to varying degrees. These in vitro mono-species resin biofilm models were used to evaluate the efficacy of denture cleansers, which exhibited differential efficacies. When forming biofilms on resin surfaces, the halitosis-related species displayed enhanced resistance to denture cleansers compared with their planktonic counterparts. Conclusion : The four selected halitosis-related bacterial species examined in this study are present on the majority of dentures. The mono-species biofilm models established on DBR discs for these species are an efficient screening tool for dental product evaluation.

This study was undertaken to evaluate acute phase response via assessing the concentration of serum sialic acids (total, lipid-bound and protein-bound), inflammatory mediators (IFN-c and TNF-a) and acute phase proteins [haptoglobin (Hp) and serum amyloid A (SAA)] in lame cattle with interdigital dermatitis. Fifteen hoof scrapings from lame cows were collected from eight commercial dairy farms. As a consequence of the difficulty in culturing and isolation, a PCR technique was used to detect the organism. None of the colonies on enriched blood agar was identified as Fusobacterium necrophorum. Four (26.6%) out of the 15 hoof scrapings examined tested positive for the presence of the lktA gene (402 bp) of F. necrophorum. It seems that culture cannot be considered as the gold standard method for F. necrophorum isolation. Molecular detection is suggested as an alternative method. In the blood serum of different groups of animals (control, lameness and F. necrophorum-positive lameness) Hp, SAA, total sialic acid, lipid-bound sialic acid, and protein-bound sialic acid, and IFN-c and TNF-a were measured using validated standard procedures. All parameters were significantly higher in the lameness group and the F. necrophorum-positive lameness group compared with the healthy group (P \ 0.01 in all cases). Mean SAA concentrations in the lameness group and the F. necrophorum-positive lameness group was relatively 4.6 and 8.0 times higher than the control group. Corresponding measures for Hp indicate a 3.3 times increase in the lameness group compared to the control. In the lameness group, significant associations were observed for Hp with PBSA, SAA with TSA, TSA with PBSA, TSA with LBSA, PBSA with LBSA, and SAA with IFN-c.

This study describes biochemical and biological properties of Naja kaouthia (Indian monocled cobra) venom of North-East India. The LD 50 of the crude venom was found to be 0.148mg/kg and neurotoxicitic symptoms like paralysis of lower limbs and heavy difficulty in breathing at sub-lethal dose in mice was observed. The venom exhibited PLA 2 , indirect hemolytic and myotoxic activities but showed weak proteolytic and low direct hemolytic activities. It did not exhibit any hemorrhage when injected intradermally to mice. Anticoagulant activity was prominent when recalcification, prothrombin and activated partial thrombinplastin time were tested on platelet poor plasma. Rotem analysis of whole citrated blood in presence of venom showed delay in coagulation time and clot formation time. Fibrinogen of whole citrated blood was depleted by venom when analyzed in Sonoclot. Crude venom at 10µg and after 16hr of incubation was found to degrade α chain of fibrinogen. Neutralization study showed that Indian polyvalent antivenom could neutralize some of the biochemical and biological activities as well as its fibrinogenolytic activity.

Background. Group A streptococci are commonly regarded as the most prevalent cause of acute bacterial tonsillitis and peritonsillar abscess (PTA). However, the majority of PTA aspirates also contain strains of anaerobes, and accumulating evidence indicates that Fusobacterium necrophorum (FN) could be involved in acute tonsillitis. The purpose of the present study was to describe the epidemiology and bacteriology of PTA in Denmark, with particular emphasis on correlations between microbiological, clinical, and laboratory data.

Anaerobic and aerobic cultures of facial and mandibular abscesses were made from 12 blue duiker (Cephalophus monticola fusicolor) housed at the Deer and Duiker Research Facility of the Pennsylvania State University (USA). Increases in concentrations of total protein and serum globulin occurred in all cases. Actinomyces pyogenes was isolated from nine animals. Fusobacterium necrophorum was present in eight and Bacteroides sp. was found in seven animals; other genera of isolated bacteria included: Streptococcus (from two animals), Lactobacillus (one), Staphylococcus (one) and Actinomyces (two). Eight (67%) of affected animals were 2 yr of age. Facial soft tissues and mandibles were the tissues most often affected. Tissues within the oral cavity were not affected at the time of presentation. A common finding, not reported in other host species with necrobacillosis, was the presence of nondestructive mandibular proliferation.

Das Lemierre Syndrom, auch als Post-Angina-Sepsis bekannt, ist eine akute oropharyngeale Infektion verbunden mit einer Jugularvenenthrombophlebitis und metastatischen Abszessabsiedlungen. Die Infektion wird meist durch Fusobacterium necrophorum hervorgerufen. Im Folgenden berichten wir über einen 19-jährigen Patienten, welcher mit Fieber, Halsschmerzen, und progredienter Atemnot an unserer Abteilung aufgenommen wurde. In der Computertomographie von Hals und Thorax zeigten sich ein parapharyngealer Abszess, eine Jugularvenenthrombose, eine nekrotisierende Mediastinitis sowie bilaterale intrapulmonale Konsolidierungen mit Kavernenbildung. Die Blutkultur zeigte eine anaerobe Bakteriämie mit Fusobakterium necrophorum. Durch eine rasche und umfassende chirurgische Sanierung der Abszessformationen im Hals und Thorax, verbunden mit einer Breitband-Antibiotikatherapie und intensivmedizinischer Betreuung gelang es das Krankheitsbild zu beherrschen. Lemierre syndrome is characterized by an acute oropharyngeal infection, suppurative thrombophlebitis of the internal jugular vein and metastatic infections. The infection is usually caused by Fusobacterium necrophorum. We report on a 19-year-old male patient who was admitted with a five-day history of fever, sore throat and progressive dyspnea. Computed tomography of the neck and chest revealed a parapharyngeal abscess, jugular vein thrombosis, descending necrotizing mediastinitis and multiple areas of bilateral consolidation and cavitations within the lungs. Fusobacterium necrophorum was identified in the blood culture. Early combined abscess drainage with neck and chest incisions, together with broad spectrum intravenous antibiotic treatment and medical management in an intensive care unit resulted in a good clinical outcome.

Fusobacterium necrophorum is a non-spore-forming gram-negative anaerobic bacillus that may be the causative agent of localized or severe systemic infections. Systemic infections due to F.necrophorum are known as Lemierre's syndrome, postanginal sepsis or necrobacillosis. The most common clinical course of severe infections in humans is a progressive illness from tonsillitis to septicemia in previously healthy young adults. A septic thrombophlebitis arising from the tonsillar veins and extending into the internal jugular vein leads to septicemia and septic emboli contributing to the development of necrotic abscesses especially in lungs and other tissues such as liver, bone and joints. In this case report, a previously healthy man with pneumonia and empyema due to F.necrophorum has been presented. A 22 year-old man suffering from sore throat for seven days was admitted to emergency department with ongoing fever and dysphagia for three days. On admission he was already taking amoxi...

A 40-year-old man was admitted with a continuous high grade fever accompanying a relatively large solitary liver abscess with septations. A puncture of the abscess revealed gram-negative rods that could be identified histologically as Fusobacterium necrophorum, which was later confirmed by tissue culture. The patient was switched to meropenem and penicillin, and cured of the infection. Fusobacterium necrophorum is a rare bacterium causing potentially fatal liver abscesses in humans. Clinicians should bear Fusobacterium necrophorum in mind when treating patients with an enlarged solitary liver abscess.

Background: Fusobacterium species are anaerobic bacteria that relatively rarely cause sepsis with a variable clinical presentation. Methods: We reviewed the records of 52 consecutive patients who had Fusobacterium bacteraemia over a 10-y period. Results: The clinical pictures could be classifi ed into 4 groups: (1) patients who had Lemierre ' s syndrome with Fusobacterium necrophorum sepsis and internal jugular vein thrombosis, n ϭ 5 (10%); (2) previously healthy patients who had F. necrophorum sepsis without any signs of macroscopic vascular thrombosis (but 5 of them had abscesses), n ϭ 14 (27%); (3) women who had puerperal infections, n ϭ 6 (12%); and (4) patients who were on average older than the patients in the previous groups, who had cardiovascular, pulmonary, neoplastic, or other underlying diseases, n ϭ 27 (52%). Of these latter 27 patients, 23 had nosocomial Fusobacterium nucleatum bacteraemia presenting as a febrile illness associated with chemotherapy or instrumentation. Conclusions: Patients with chronic underlying diseases are more likely to be infected with F. nucleatum than F. necrophorum. F. nucleatum bacteraemia may present as a febrile illness without severe symptoms. F. necrophorum caused sepsis mainly in previously healthy individuals. These infections may be accompanied with a jugular vein thrombosis characteristic of Lemierre ' s syndrome and septic shock. However, F. necrophorum infections present more frequently without any apparent venous thrombosis and may be accompanied by abscesses.

Fusobacterium necrophorum causes Lemièrre's syndrome, a serious disease with septic thrombophlebitis of the internal jugular vein, pulmonary involvement, and systemic inflammation. The contact system is a link between inflammation and coagulation, and contact activation by the bacteria could therefore contribute to the abnormal coagulation and inflammation seen in patients with Lemièrre's syndrome. In this study, F. necrophorum was found to bind radiolabeled high-molecular-weight kininogen (HK), a central component of the contact system. Binding was inhibited by the addition of unlabeled HK and domain D5 of HK but not other components of the contact system, indicating a specific interaction mediated through the D5 region. Binding of HK was significantly reduced after pretreatment of the bacteria with trypsin, suggesting that surface proteins are involved in HK binding. Incubation of the bacteria with human plasma resulted in an HK breakdown pattern suggestive of bradykinin release, and bradykinin was also detected in the supernatant. In addition, we show that factor XI (FXI), another component of the contact system, binds to F. necrophorum and that the bound FXI reconstitutes the activated partial thromboplastin time of FXI-deficient plasma. Thrombin activity was detected at the surface of the bacteria following incubation with plasma, indicating that the intrinsic pathway of coagulation is activated at the surface. This activity was completely blocked by inhibitors of the contact system. The combined results show that the contact system is activated at the surface of F. necrophorum, suggesting a pathogenic role for this system in Lemièrre's syndrome.

Fusobacterium necrophorum is a gram-negative, anaerobic bacterium, which has been suggested to be a normal inhabitant of the oral flora. In rare cases, it can invade the tonsils and deeper tissues, causing the serious condition Lemièrre's syndrome. Recruitment of host plasminogen is a well-known bacterial virulence mechanism, and plasmin activity at the bacterial surface is thought to be important for bacterial invasion. Herein we show that plasminogen can be recruited to the surface of F. necrophorum, that surface-bound plasminogen is more easily converted to active plasmin than plasminogen in buffer, and that bound plasminogen is protected against inactivation by a 2-antiplasmin. These findings add to the understanding of the pathogenesis of Lemièrre's syndrome.

Footrot is a debilitating disease of sheep resulting in lameness, production losses and suffering. To study the basic bacteriology of the disease, a survey was initiated across commercial farms and noncommercial research flocks to compare the bacteriology of symptomatic footrot infected sheep with healthy asymptomatic sheep. Of the 80 farmers initially contacted, 14 collected hoof swabs and returned the swabs by post. Following DNA extraction, species-specific PCR was used to identify if Dichelobacter nodosus (D. nodosus) or Fusobacterium necrophorum (F. necrophorum) species were present on each swab. Of the 42 swabs taken from symptomatic footrot infected sheep, 17 were positive for both F. necrophorum and D. nodosus, two were positive for F. necrophorum only, two for D. nodosus only and 23 swabs were negative for both F. necrophorum and D. nod osus. Of the 50 swabs received from healthy asymptomatic sheep, one was positive for F. necrophorum only and 49 were negative for both D. nodosus and F. necrophorum. This suggests that both F. necrophorum and D. nodosus are linked to footrot in the field in a pastoral farming system. If these bacteria are linked together and collectively cause footrot, this may need to be considered when managing a footrot outbreak, or maintaining a quarantine.

Infective endocarditis is uncommon in young children, especially in the absence of structural heart disease. We report the case of a 2-year-old boy who presented with acute rupture of the mitral valve chordae 6 weeks after an episode of Fusobacterium necrophorum septicemia. His heart had been structurally normal before. Mitral valve replacement was successfully performed. This is the first recorded case of endocarditis in a child caused by necrobacillosis.

Background: Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli. These symptoms typically develop after acute oropharyngeal infection by Fusobacterium necrophorum.
Case Report: We present an unusual case of 54 years old lady suffering from Lemierre syndrome with bilateral internal jugular vein and carotid artery thrombosis with fatal outcome.
Conclusion: Lemierre syndrome is a rare disease. Thrombosis of bilateral Internal Jugular Vein associated with Lemierre syndrome has never been reported.

Das Lemierre Syndrom, auch als Post-Angina-Sepsis bekannt, ist eine akute oropharyngeale Infektion verbunden mit einer Jugularvenenthrombophlebitis und metastatischen Abszessabsiedlungen. Die Infektion wird meist durch Fusobacterium necrophorum hervorgerufen. Im Folgenden berichten wir über einen 19-jährigen Patienten, welcher mit Fieber, Halsschmerzen, und progredienter Atemnot an unserer Abteilung aufgenommen wurde. In der Computertomographie von Hals und Thorax zeigten sich ein parapharyngealer Abszess, eine Jugularvenenthrombose, eine nekrotisierende Mediastinitis sowie bilaterale intrapulmonale Konsolidierungen mit Kavernenbildung. Die Blutkultur zeigte eine anaerobe Bakteriämie mit Fusobakterium necrophorum. Durch eine rasche und umfassende chirurgische Sanierung der Abszessformationen im Hals und Thorax, verbunden mit einer Breitband-Antibiotikatherapie und intensivmedizinischer Betreuung gelang es das Krankheitsbild zu beherrschen. Lemierre syndrome is characterized by an acute oropharyngeal infection, suppurative thrombophlebitis of the internal jugular vein and metastatic infections. The infection is usually caused by Fusobacterium necrophorum. We report on a 19-year-old male patient who was admitted with a five-day history of fever, sore throat and progressive dyspnea. Computed tomography of the neck and chest revealed a parapharyngeal abscess, jugular vein thrombosis, descending necrotizing mediastinitis and multiple areas of bilateral consolidation and cavitations within the lungs. Fusobacterium necrophorum was identified in the blood culture. Early combined abscess drainage with neck and chest incisions, together with broad spectrum intravenous antibiotic treatment and medical management in an intensive care unit resulted in a good clinical outcome.

Objective. To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children's hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites.

Footrot is a debilitating disease of sheep resulting in lameness, production losses and suffering. To study the basic bacteriology of the disease, a survey was initiated across commercial farms and noncommercial research flocks to compare the bacteriology of symptomatic footrot infected sheep with healthy asymptomatic sheep. Of the 80 farmers initially contacted, 14 collected hoof swabs and returned the swabs by post. Following DNA extraction, species-specific PCR was used to identify if Dichelobacter nodosus (D. nodosus) or Fusobacterium necrophorum (F. necrophorum) species were present on each swab. Of the 42 swabs taken from symptomatic footrot infected sheep, 17 were positive for both F. necrophorum and D. nodosus, two were positive for F. necrophorum only, two for D. nodosus only and 23 swabs were negative for both F. necrophorum and D. nod osus. Of the 50 swabs received from healthy asymptomatic sheep, one was positive for F. necrophorum only and 49 were negative for both D. nodosus and F. necrophorum. This suggests that both F. necrophorum and D. nodosus are linked to footrot in the field in a pastoral farming system. If these bacteria are linked together and collectively cause footrot, this may need to be considered when managing a footrot outbreak, or maintaining a quarantine.

An unusual case of necrotic infection of the tongue and unilateral necrotic maxillar sinusitis, in a cow is reported. The prominent clinical findings were: a marked salivation, unilateral mucopurulent nasal discharge, diffuse necrotic lesions on the ventral side of the tongue and fetid breath. Clinico-pathological and pathological findings and abnormalities in the haemogram were probably caused by the toxins produced by the causative organism--Fusobacterium necrophorum like microorganism.

Lemierre's syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly Fusobacterium necrophorum. It was once called the forgotten disease because of its rarity, but it may not be that uncommon after all. This review aims to provide physicians with an update on the etiology, management, and prognosis of Lemierre's syndrome. Systematic review using the terms: Lemierre's syndrome, postanginal septicemia, fusobacterium, internal jugular vein thrombosis. English literature; reviews, case reports, and case series. variants or atypical Lemierre's syndrome cases, negative fusobacteria cultures, and papers without radiological evidence of thrombophlebitis. Eighty-four studies fulfilled our inclusion criteria. The male to female ratio was 1:1, 2, and the ages ranged from 2 months to 78 years (median, 22 years). Main sources of infection were tonsil, pharynx, and chest. Most common first clinical presentation was a sore throat, followed by a neck mass and neck pain. The most common offending micro-organism was F. necrophorum. Treatment modalities used were antimicrobial, anticoagulant, and surgical treatment. Morbidity was significant with prolonged hospitalization in the majority of patients. The overall mortality rate was 5%. Lemierre's syndrome may not be as rare as previously thought. This apparent increase in the incidence may be due to antibiotic resistance or changes in antibiotic prescription patterns. Successful management rests on the awareness of the condition, a high index of suspicion, and a multidisciplinary team approach.

Lemierre's syndrome is an oropharyngeal infection associated with the pathogen Fusobacterium necrophorum compounded with possible septic thrombosis to the internal and external jugular veins, lungs, liver, and kidneys. Lemierre's syndrome is a virulent infection, and its clinical presentation may be fatal if unrecognized by the clinician. Patients with this infectious entity classically present complaining of dysphagia and odynophagia associated with an acute oropharyngitis. Although uncommon, Lemierre's syndrome is insidious and highly fatal if not treated promptly. The purpose of this case report is to stress early surgical debridement and aggressive antibiotic therapy as crucial in the management of Lemierre's syndrome.

Although intracranial mass lesions that occur as a result of infection have commonly been reported in patients infected with human immunodeficiency virus, polymicrobial pyogenic brain abscess has not been described in this setting. We report the first case of a patient with a polymicrobial brain abscess involving Streptococcus bovis, Fusobacterium necrophorum, Peptostreptococcus, and group G Streptococcus, and we review the relevant world literature.

Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from I to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of microorganisms , with Fusobacterium necrophorum (Fn) and Prevotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the twofold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction.

Fusobacterium necrophorum subspecies funduliforme is an obligate anaerobic Gram-negative rod causing invasive infections such as the life-threatening Lemierre's syndrome (sore throat, septicemia, jugular vein thrombosis, and disseminated infection). The aim of our study was to understand if and how F. necrophorum avoids C activation. We studied 12 F. necrophorum subsp. funduliforme strains isolated from patients with sepsis. All strains were resistant to serum killing after a 1-h incubation in 20% serum. The bacteria bound, at different levels, the C inhibitor factor H (fH). Binding was ionic and specific in nature and occurred via sites on both the N terminus and the C terminus of fH. Bound fH remained functionally active as a cofactor for factor I in the cleavage of C3b. Interestingly, patients with the most severe symptoms carried strains with the strongest ability to bind fH. An increased C3b deposition and membrane attack complex formation on the surface of a weakly fH-binding strain was observed and its survival in serum at 3.5 h was impaired. This strain had not caused a typical Lemierre's syndrome. These data, and the fact that fH-binding correlated with the severity of disease, suggest that the binding of fH contributes to virulence and survival of F. necrophorum subsp. funduliforme in the human host. Our data show, for the first time, that an anaerobic bacterium is able to bind the C inhibitor fH to evade C attack.