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Miyazaki M, Hattori H. Lemierre's Syndrome Caused by Streptococcus milleri Group. Intern Med 2024; 63:1289-1294. [PMID: 37743513 PMCID: PMC11116006 DOI: 10.2169/internalmedicine.2311-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/06/2023] [Indexed: 09/26/2023] Open
Abstract
A 64-year-old woman was transported to the emergency room with a headache and fever. She presented with a right ocular protrusion, hyperemia, and tenderness in the neck. Contrast-enhanced MRI of the head showed a high DWI signal in the bilateral sphenoid sinuses and contrast defects along the bilateral internal jugular and superior ophthalmic veins. Blood and CSF cultures revealed Streptococcus milleri group. Surgery was performed for Lemierre's syndrome secondary to sphenoid sinusitis. The patient was treated with antibiotics and anticoagulant therapy, but a duodenal ulcer and brain abscess thereafter developed. However, multidisciplinary endoscopic and surgical treatment saved her life.
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Bazarov AY, Sergeyev KS, Sidoryak NP. Polysegmental and multilevel lesions in hematogenous vertebral osteomyelitis: assessment of immediate and long-term results. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.75-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To analyze the results of treatment of disseminated (polysegmental and multilevel) forms of hematogenous vertebral osteomyelitis (HVO) as compared with those of monosegmental and monovertebral lesions.Material and Methods. A retrospective analysis of a monocenter cohort of 266 patients with hematogenous osteomyelitis of the spine for 2006 to 2019 was carried out. Patients were divided into two groups: Group A (polysegmental and multilevel lesions) included 33 (12.4 %) patients and Group B (monosegmental and monovertebral lesions) – 233 (87.6 %) patients. The main examination methods were: clinical, radiological (standardized roentgenography, CT), MRI, microbiological, histological and statistical ones.Results. Comparison revealed that involvement of the cervical (p < 0.001) and thoracic (p = 0.014) spine was more typical for polysegmental and multilevel lesions. There was a tendency to the predominance of type A lesions according to the Pola classification in patients with local forms (p = 0.078) and to the increase in type C lesions in polysegmental and multilevel processes (p = 0.035). The number of neurological complications was higher in polysegmental and multilevel lesions (p = 0.003). There were no significant differences in the treatment results, the number of relapses and mortality rate between the compared groups.Conclusion. Lesions of the cervical and thoracic spine and the presence of a neurological deterioration are typical for multilevel and polysegmental HVO. The formation of a multilevel lesion in different regions of the spine with a gap of 2–4 weeks or more requires a separate implementation of the diagnostic algorithm, defining of classification criteria and differentiated treatment tactics for each focus.
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Affiliation(s)
- A. Yu. Bazarov
- Tyumen Regional Clinical Hospital No. 2;
Tyumen State Medical University
75 Melnikaite str., Tyumen, 625039, Russia;
54 Odesskaya str., Tyumen, 625023, Russia
| | - K. S. Sergeyev
- Tyumen State Medical University
54 Odesskaya str., Tyumen, 625023, Russia
| | - N. P. Sidoryak
- Traumatology and Orthopedic Department No. 3
Regional Clinical Hospital No. 2
75 Melnikaite str., Tyumen, 625039, Russia
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McGovern M, Fried TB, Mangan J, Hilibrand AS. Paralysis: A Rare Presentation of Lemierre's Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00048. [PMID: 36099469 DOI: 10.2106/jbjs.cc.21.00682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A patient presented with acute paralysis in the setting of undiagnosed Lemierre's syndrome. Streptococcus pyogenes was the causative organism leading to internal jugular vein thrombosis, sternocleidomastoid abscess, vertebral osteomyelitis, and epidural phlegmon. The patient was treated both surgically, with abscess evacuation, hemicorpectomy, and fusion, and medically, with antibiotics and anticoagulation. Postoperatively, the patient regained upper extremity strength and lower extremity sensation, but the paraplegia remained. CONCLUSION Lemierre's syndrome is a rare complication of oropharyngeal infection with a constellation of findings including jugular thrombophlebitis, metastatic abscesses, and frequent involvement of anaerobic pathogens that may present acutely with paralysis.
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Affiliation(s)
- Madeline McGovern
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Linares CA, Ryan F, Hajat I, Glass S. Lemierre's syndrome involving milleri group streptococci: further insight into age and aetiology. BMJ Case Rep 2020; 13:13/11/e238062. [PMID: 33229487 DOI: 10.1136/bcr-2020-238062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lemierre's syndrome (LS) is a suppurative thrombophlebitis of the internal jugular vein secondary to otorhinolaryngologic infection. It is classically associated with the Gram-negative anaerobe Fusobacterium necrophorum (FN) and is thought to be a disease of young people. Here, we describe the case of a 56-year-old woman with LS involving milleri group streptococci (MGS), which has been reported only 13 times since it was first observed in 2003. Subgroup analysis of all published cases of LS involving MGS demonstrated these patients were significantly older than those involving FN (median age 49 years versus 18 years, p = 0.007, IQR 36-58 years), although this finding is limited by publication bias. This report clarifies a 2014 hypothesis regarding the relationship between age and aetiology in this rare disease. While FN remains the most common cause of LS overall, empiric antibiotic therapy should also cover oral streptococci such as MGS, even in younger adults.
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Affiliation(s)
- Christian A Linares
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Felicity Ryan
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Imran Hajat
- Otolaryngology Department, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
| | - Stephen Glass
- Medical Microbiology Service, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK
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Matsuo T, Mori N, Sakurai A, Mikami Y, Furukawa K. Vertebral osteomyelitis as a rare manifestation of Lemierre's syndrome. IDCases 2017; 10:46-48. [PMID: 28879094 PMCID: PMC5582373 DOI: 10.1016/j.idcr.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 10/25/2022] Open
Affiliation(s)
- Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Aki Sakurai
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Yumiko Mikami
- Department of Clinical and Laboratory Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Keiichi Furukawa
- Department of Infectious Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
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Johannesen KM, Bodtger U. Lemierre's syndrome: current perspectives on diagnosis and management. Infect Drug Resist 2016; 9:221-227. [PMID: 27695351 PMCID: PMC5028102 DOI: 10.2147/idr.s95050] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.
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Affiliation(s)
| | - Uffe Bodtger
- Department of Lung Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense; Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark
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He J, Lam JCL, Adlan T. Clival osteomyelitis and hypoglossal nerve palsy--rare complications of Lemierre's syndrome. BMJ Case Rep 2015; 2015:bcr-2015-209777. [PMID: 26323975 DOI: 10.1136/bcr-2015-209777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
An increasingly reported entity, Lemierre's syndrome classically presents with a recent oropharyngeal infection, internal jugular vein thrombosis and the presence of anaerobic organisms such as Fusobacterium necrophorum. The authors report a normally fit and well 17-year-old boy who presented with severe sepsis following a 5-day history of a sore throat, myalgia and neck stiffness requiring intensive care admission. Blood cultures grew F. necrophorum and radiological investigations demonstrated left internal jugular vein, cavernous sinus and sigmoid sinus thrombus, left vertebral artery dissection and thrombus within the left internal carotid artery. Imaging also revealed two areas of acute ischaemia in the brain, consistent with septic emboli, skull base (clival) osteomyelitis and an extensive epidural abscess. The patient improved on meropenem and metronidazole and was warfarinised for his cavernous sinus thrombosis. He has an on-going left-sided hypoglossal (XIIth) nerve palsy.
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Affiliation(s)
- Jingzhou He
- Department of Medicine, Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | | | - Tarig Adlan
- Department of Radiology, Royal Devon and Exeter Hospital, Exeter, Devon, UK
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Anaerobic Spondylodiscitis due to Fusobacterium Species: A Case Report Review of the Literature. Case Rep Infect Dis 2015; 2015:759539. [PMID: 26000181 PMCID: PMC4426655 DOI: 10.1155/2015/759539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022] Open
Abstract
Spondylodiscitis caused by Fusobacterium species is rare. Most cases of spontaneous spondylodiscitis are caused by Staphylococcus aureus and most postoperative cases are caused by Staphylococcus aureus or coagulase-negative staphylococci. Escherichia coli is the most common Gram-negative organism causing spondylodiscitis. Fusobacterium species are unusual causes for anaerobic spondylodiscitis. We report the case of a patient with spontaneous L2-L3 spondylodiscitis, vertebral osteomyelitis, and epidural abscess caused by Fusobacterium species and review the literature for patients with Fusobacterium spondylodiscitis.
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