ISSN 2398-2969      

Necrobacillosis

Clapis

Synonym(s): Schmorl's disease, Lemierre's syndrome


Introduction

  • Cause: necrobacillosis (Schmorl's disease) is an uncommon skin infection caused by the bacterium Fusobacterium necrophorum.
  • This organism may also be associated with dental abscesses Abscess Abscess 02: secondary to dental disease, and Lemierre's syndrome, which refers to a condition in man of oropharyngeal infection with F. necrophorum → septic thrombophlebitis and embolic abscesses.

In man Schmorl's disease can also refer to herniation of the nucleus pulposus of intervertebral disc.

  • Signs: swelling, abscesses, ulcers and necrosis.
  • Diagnosis: clinical examination and bacterial culture.
  • Treatment: antimicrobials, debridement, anti-inflammatory and supportive therapy.
  • Prognosis: good to grave.

Presenting signs

  • Swelling, inflammation, abscessation, ulceration and necrosis, usually on face and neck, and occasionally the feet.
  • Underlying bones can be involved.
  • Anorexia, lethargy, depression, death (Lemierre's syndrome).

Geographic incidence

  • Worldwide distribution.

Public health considerations

  • Fusobacterium is a zoonosis, with infection in man occurring via animal bites or contamination of wounds with animal feces.
  • In man:
    •  F. necrophorum is part of the normal indigenous flora on all mucosal surfaces, and a normal inhabitant of the mouth, upper respiratory tract, gastrointestinal tract and urogenital tract.
    • It can invade tissues after surgical or accidental trauma, edema, anoxia and tissue destruction (from infection with other organisms or malignancies), animal bites.
    • Other predisposing factors include antibiotic treatment (that eliminate aerobes and thus fosters invasiveness) or immunosuppressive treatment.
    • It has a predisposition to abscess formation ('necrobacillus' - this is very rare - affecting one per million of the human population).
    • It may also be associated with platelet aggregation and virulent toxin production resulting in internal jugular venous thrombosis (Lemierre's syndrome), and cavitating pulmonary lesions and hemoptysis, occurring as a result of septic embolization.
    • Other possible features in man include empyema, septic arthritis, and abscesses in the liver, spleen and muscles. Bacteremia, sepsis and meningitis are also reported.

Cost considerations 

  • Moderate to expensive, depending on site and severity of infection.
  • Costs include bacterial culture and sensitivity, antibiotic treatment Therapeutics: antimicrobials, which may be prolonged, supportive therapy (fluids Fluid therapy, assisted feeding and gastrointestinal support), and in some cases surgical removal of abscesses or debridement (soft-tissue or bone) and use of antibiotic-impregnated beads Abscess or other local therapy.

Special risks, eg anesthetic

  • Septicemic or debilitated animals will present an increased anesthetic risk.

Pathogenesis

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Diagnosis

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Treatment

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Prevention

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Sequelae

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Benato L (2019) Guide to skin diseases in rabbits. In Pract 41 (10), 488-497.
  • Scarff D (2008) Skin diseases of pet rabbits. UK Vet: Companion Animal 13 (2), 66-75 VetMedResource.
  • Riordan T (2007) Human Infection with Fusobacterium necrophorum (Necrobacillosis) with a focus on Lemierre’s Syndrome. Clin Microbiol Rev 20 (4), 622-659 PubMed.
  • Jenkins J R (2001) Skin disorders of the rabbit. Vet Clin North Am Exotic Anim Pract 4 (2), 543-563 PubMed.
  • Narayanan S K, Nagaraja T G, Chengappa M M & Stewart G C (2001) Cloning, sequencing and expression of the leukotoxin gene from Fusobacterium necrophorum. Infect Immun 69 (9), 5447-5455 PubMed.
  • Seps S L, Battles A H, Nguyen L et al (1999) Oropharyngeal necrobacillosis with septic thrombophlebitis and pulmonary embolic abscesses: Lemierre's Syndrome in a New Zealand White Rabbit. Contemp Topics Lab Anim Sci 38 (5), 44-46 PubMed.
  • Tan Z L, Nagaraja T G & Chengappa M M (1996) Fusobacterium necrophorum infections: virulence factors, pathogenic mechanism and control measures. Vet Res Commun 20 (2), 113-140 PubMed.
  • Garibaldi B A, Moyer C & Fox J G (1990) Diagnostic exercise: mandibular swelling in a rabbit. Lab Anim Sci 40 (1), 77-78 PubMed.
  • Nakajima Y, Ueda H, Takeuchi S et al (1987) The effects of Escherichia coli endotoxin as a trigger for hepatic infection of rabbits with Fusobacterium necrophorum. J Comp Pathol 97 (2), 207-215 PubMed.
  • Langworth B F (1977) Fusobacterium necrophorum: its characteristics and role as an animal pathogen. Bacteriol Rev 41 (2), 373-390 PubMed.

Other sources of information

  • Meredith A (2014) Dermatoses. In: BSAVA Manual of Rabbit Medicine & Surgery. Eds: Meredith A & Lord B. BSAVA, UK. pp 255-263.
  • Miller W H, Scott D W, Griffin C E & Campbell K L (2013) Dermatoses of Exotic Small Mammals. In: Muller and Kirk’s Small Animal Dermatology. 7th edn. Elsevier, USA. pp 844-887.
  • Hess L & Tater K (2012) Dermatologic Diseases. In: Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery. 3rd edn. Eds: Quesenberry K E & Carpenter J W. Elsevier, USA. pp 232-244.
  • Scott D W, Miller W H & Griffin C E (2001) Dermatoses of Pet Rodents, Rabbits and Ferrets. In: Muller and Kirks Small Anim Derm. 6th edn. W B Saunders Co, USA. pp 1415-1458.
  • Scott D W, Miller W H & Griffin C E (2001) Dermatoses of Pet Rodents, Rabbits and Ferrets. In: Muller and Kirks Small Anim Derm. 6th edn. W B Saunders Company, Philadelphia. pp 1415-1458.
  • Emery D L, Vaughan J A, Clark B & Stewart J (1986) Virulence Determinants of Fusobacterium Necrophorum and their Prophylactic Potential in Animals. In: Foot Rot in Ruminants. Proc of a Workshop. Eds: Stewart D J, Peterson J E, McKern N M & Emery D L. CSIRO Division of Animal Health, Australian Wool Corp, Glebe, New South Wales, Australia. pp 267-274.

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