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Shareef M, Ghosn Y, Khdhir M, El Annan T, Alam R, Hourani R. Critical infections in the head and neck: A pictorial review of acute presentations and complications. Neuroradiol J 2024; 37:402-417. [PMID: 35188822 PMCID: PMC11366201 DOI: 10.1177/19714009211059122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-traumatic head and neck emergencies include several disease processes such as infectious, inflammatory, and malignant. Infections are among the most common pathological processes that affect the head and neck, and are particularly important due to their acute, severe, and potentially life-threatening nature. Radiologists need to be well acquainted with these entities because any delay or misdiagnosis can lead to significant morbidity and mortality. Having a general understanding of such diseases is crucial, their prevalence, clinical presentation, common causative pathogens, route of spread, potential complications, and multimodality radiological appearance. Furthermore, understanding the relevant anatomy of the region, including the various fascial planes and spaces, is essential for radiologists for accurate image interpretation and assessment of potential complications. Our aim is to review the most common severe infections affecting the head and neck as well as other rare but potentially life-threatening infections. We will also describe their imaging features while focusing on the anatomy of the regions involved and describing their potential complications and treatment options.
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Affiliation(s)
| | - Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Raquelle Alam
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut, Lebanon
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Pan Y, Xing Y, Lai Y, Dong H, Sheng H, Xu W. Metagenomic next-generation sequencing reveals co-infection with Legionella pneumophila and Fusobacterium necrophorum in a patient with severe pneumonia: a case report. BMC Pulm Med 2024; 24:279. [PMID: 38867173 PMCID: PMC11170816 DOI: 10.1186/s12890-024-03097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/11/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Legionella pneumonia is one of the most severe types of atypical pneumonia, impairing multiple organ systems, posing a threat to life. Diagnosing Legionella pneumonia is challenging due to difficulties in culturing the bacteria and limitations in immunoassay sensitivity and specificity. CASE PRESENTATION This paper reports a rare case of sepsis caused by combined infection with Legionella pneumophila and Fusobacterium necrophorum, leading to respiratory failure, acute kidney injury, acute liver injury, myocardial damage, and electrolyte disorders. In addition, we systematically reviewed literature on patients with combined Legionella infections, analyzing their clinical features, laboratory results and diagnosis. CONCLUSIONS For pathogens that require prolonged incubation periods and are less sensitive to conventional culturing methods, metagenomic next-generation sequencing (mNGS) can be a powerful supplement to pathogen screening and plays a significant role in the auxiliary diagnosis of complex infectious diseases.
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Affiliation(s)
- Yunqi Pan
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yi Xing
- Department of Hospital Infection Management, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yanan Lai
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huixing Dong
- Department of Respiratory and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huiming Sheng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Weihong Xu
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Pagels J, Torisson G, Wasserstrom L, Hedin K, Holm K, Nygren D. Symptoms predictive of Fusobacterium necrophorum pharyngotonsillitis - an observational study of cases presenting to hospitals in Southern Sweden. Eur J Clin Microbiol Infect Dis 2024; 43:1099-1107. [PMID: 38609699 PMCID: PMC11178599 DOI: 10.1007/s10096-024-04827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Fusobacterium necrophorum is a common cause of pharyngotonsillitis. However, no guidelines exist on when to diagnose or treat it. We aimed to investigate associations between clinical criteria and F. necrophorum-positivity in pharyngotonsillitis and assess the predictive potential of a simple scoring system. METHODS Pharyngotonsillitis patients who were tested for F. necrophorum (PCR) and presented to hospitals in the Skåne Region, Sweden, between 2013-2020 were eligible. Data were retrieved from electronic chart reviews and registries. By logistic regression we investigated associations between F. necrophorum-positivity and pre-specified criteria: age 13-30 years, symptom duration ≤ 3 days, absence of viral symptoms (e.g. cough, coryza), fever, tonsillar swelling/exudate, lymphadenopathy and CRP ≥ 50 mg/L. In secondary analyses, associated variables were weighted by strength of association into a score and its predictive accuracy of F. necrophorum was assessed. RESULTS Among 561 cases included, 184 (33%) had F. necrophorum, which was associated with the following criteria: age 13-30, symptom duration ≤ 3 days, absence of viral symptoms, tonsillar swelling/exudate and CRP ≥ 50 mg/L. Age 13-30 had the strongest association (OR5.7 95%CI 3.7-8.8). After weighting, these five variables had a sensitivity and specificity of 68% and 71% respectively to predict F. necrophorum-positivity at the proposed cut-off. CONCLUSION Our results suggest that F. necrophorum cases presenting to hospitals might be better distinguished from other pharyngotonsillitis cases by a simple scoring system presented, with age 13-30 being the strongest predictor for F. necrophorum. Prospective studies, involving primary care settings, are needed to evaluate generalisability of findings beyond cases presenting to hospitals.
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Affiliation(s)
- Josefina Pagels
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden.
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lisa Wasserstrom
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital, Lund, Sweden
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Futurum, Jönköping, Region Jönköping County, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
| | - David Nygren
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
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Nygren D, Torisson G, Happonen L, Mellhammar L, Linder A, Elf J, Yan H, Welinder C, Holm K. Proteomic Characterization of Plasma in Lemierre's Syndrome. Thromb Haemost 2024; 124:432-440. [PMID: 37857346 PMCID: PMC11038868 DOI: 10.1055/a-2195-3927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The underlying mechanisms of thrombosis in Lemierre's syndrome and other septic thrombophlebitis are incompletely understood. Therefore, in this case control study we aimed to generate hypotheses on its pathogenesis by studying the plasma proteome in patients with these conditions. METHODS All patients with Lemierre's syndrome in the Skåne Region, Sweden, were enrolled prospectively during 2017 to 2021 as cases. Age-matched patients with other severe infections were enrolled as controls. Patient plasma samples were analyzed using label-free data-independent acquisition liquid chromatography tandem mass spectrometry. Differentially expressed proteins in Lemierre's syndrome versus other severe infections were highlighted. Functions of differentially expressed proteins were defined based on a literature search focused on previous associations with thrombosis. RESULTS Eight patients with Lemierre's syndrome and 15 with other severe infections were compared. Here, 20/449 identified proteins were differentially expressed between the groups. Of these, 14/20 had functions previously associated with thrombosis. Twelve of 14 had a suggested prothrombotic effect in Lemierre's syndrome, whereas 2/14 had a suggested antithrombotic effect. CONCLUSION Proteins involved in several thrombogenic pathways were differentially expressed in Lemierre's syndrome compared to other severe infections. Among identified proteins, several were associated with endothelial damage, platelet activation, and degranulation, and warrant further targeted studies.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Lotta Happonen
- Division of Infection Medicine, Lund University, Lund, Sweden
| | - Lisa Mellhammar
- Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
| | - Adam Linder
- Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
| | - Johan Elf
- Center of Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Hong Yan
- The Swedish National Infrastructure for Biological Mass Spectrometry (BioMS), Lund University, Lund, Sweden
| | - Charlotte Welinder
- The Swedish National Infrastructure for Biological Mass Spectrometry (BioMS), Lund University, Lund, Sweden
| | - Karin Holm
- Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
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Qi Q, Yang J, Yang L, Tian H, Wan C, Liu D. Diagnostic and Therapeutic Challenges in Lemierre Syndrome: A Case Report Using Metagenomic Next Generation Sequencing. Infect Drug Resist 2024; 17:1669-1673. [PMID: 38707986 PMCID: PMC11069072 DOI: 10.2147/idr.s455994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Lemierre syndrome (LS) is a rare and life-threatening condition predominantly caused by Fusobacterium necrophorum. Currently, there are no standardized clinical guidelines for LS management. Here, we describe the case of a 40-year-old male with fever, productive cough, and dyspnea but no sore throat. Diagnostic radiological examinations revealed multiple pulmonary cavitary nodules and an internal jugular vein occlusion. Metagenomic Next-Generation Sequencing (mNGS) of the alveolar lavage fluid identified Fusobacterium necrophorum, thereby confirming the diagnosis of LS. Intriguingly, the patient exhibited a delayed clinical response despite receiving the appropriate antibiotic. After integrating tigecycline into the treatment to address potential co-infecting bacteria, we observed a marked improvement in his clinical symptoms. Subsequent follow-up over 12 weeks post-discharge revealed complete alleviation of symptoms, and a chest CT scan showed marked regression of the lung lesions.
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Affiliation(s)
- Qi Qi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jun Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Linhui Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Huohuan Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Yu T. Minimally invasive treatment of uterine necrosis with favorable outcomes: an uncommon case presentation and literature review. BMC Womens Health 2024; 24:267. [PMID: 38678258 PMCID: PMC11055244 DOI: 10.1186/s12905-024-03089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Uterine necrosis is a rare condition and is considered a life-threatening complication. However, cases of uterine necrosis were rarely reported, particularly those caused by infection. In terms of treatment, no minimally invasive treatment for uterine necrosis has been reported, and total hysterectomy is mostly considered as the treatment option. OBJECTIVE The article specifically focuses on minimally invasive treatments and provides a summary of recent cases of uterine necrosis. CASE PRESENTATION We report the case of a 28-year-old patient gravid 1, para 0 underwent a cesarean section after unsuccessful induction due to fetal death. She presented with recurrent fever and vaginal discharge. The blood inflammation markers were elevated, and a CT scan revealed irregular lumps with low signal intensity in the uterine cavity. The gynecological examination revealed the presence of gray and white soft tissue, approximately 5 cm in length, exuding from the cervix. The secretions were found to contain Fusobacterium necrophorum, Escherichia coli, and Proteus upon culturing. Given the patient's sepsis and uterine necrosis caused by infection, laparoscopic exploration uncovered white pus and necrotic tissue openings in the anterior wall of the uterus. The necrotic tissue was removed during the operation, and the uterus was repaired. Postoperative pathological findings revealed complete degeneration and necrosis of fusiform cell-like tissue. Severe uterine necrosis caused by a multi-drug resistant bacterial infection was considered after the operation. She was treated with antibiotics for three weeks and was discharged after the infection was brought under control. The patient expressed satisfaction with the treatment plan, which preserved her uterus, maintained reproductive function, and minimized the extent of surgery. CONCLUSION Based on the literature review of uterine necrosis, we found that it presents a potential risk of death, emphasizing the importance of managing the progression of the condition. Most treatment options involve a total hysterectomy. A partial hysterectomy reduces the extent of the operation, preserves fertility function, and can also yield positive outcomes in the treatment of uterine necrosis, serving as a complement to the overall treatment of this condition.
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Affiliation(s)
- Tengge Yu
- Department of Gynecology and Obstetrics, West China Xiamen Hospital of Sichuan University, Xiamen, 361000, China.
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Burgdorf E, Jensen J, Grimm P, von Huth S. Atypical presentation of Lemierre's syndrome caused by penicillin-susceptible Staphylococcus aureus in a patient with chronic stomatitis and COVID-19. BMJ Case Rep 2024; 17:e258776. [PMID: 38569736 PMCID: PMC10989154 DOI: 10.1136/bcr-2023-258776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
A healthy man in his late 20s was admitted to the emergency department due to a flare-up in his severe chronic stomatitis, along with flu-like symptoms. CXR showed multiple bilateral consolidations and subsequent CT revealed thrombosis of the left facial and internal jugular vein, together with septic embolism in both lungs. Blood cultures showed penicillin-susceptible Staphylococcus aureus The patient was diagnosed with Lemierre's syndrome, despite atypical bacteria and clinical presentation. During hospitalisation, he developed pulmonary empyema as a complication and was admitted for 4 weeks. During hospitalisation and after discharge, the patient was examined for multiple rheumatic, immunological and dermatological diseases, but no underlying cause for Lemierre's syndrome has been found. We present this case due to the rarity of its nature, with atypical clinical presentation and pathogen for Lemierre's syndrome, but with classic radiological findings.
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Affiliation(s)
- Emma Burgdorf
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Janni Jensen
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Peter Grimm
- Department of Radiology, Odense Universitetshospital, Odense, Syddanmark, Denmark
| | - Sebastian von Huth
- Department of Infectious Diseases, Odense Universitetshospital, Odense, Syddanmark, Denmark
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Simsek B, Zhang R, Morton C, Villanueva MS. Lemierre syndrome with pulmonary empyema caused by Prevotella intermedia. BMJ Case Rep 2024; 17:e258158. [PMID: 38490705 PMCID: PMC10946344 DOI: 10.1136/bcr-2023-258158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Lemierre syndrome is a rare disease that is most often caused by Fusobacterium necrophorum We present a case caused by Prevotella intermedia in a young, healthy man, complicated by multiple cavitary lung lesions, loculated pleural effusions requiring chest tube placement and trapezius abscess. Our case highlights (a) P. intermedia as a rare cause of Lemierre syndrome and (b) clinical response to appropriate antimicrobial therapy may be protracted.
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Affiliation(s)
- Bahadir Simsek
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee Zhang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher Morton
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merceditas S Villanueva
- Department of Internal Medicine, Section of Infectious Disease, Yale University School of Medicine, New Haven, Connecticut, USA
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Jaber F, Alsakarneh S, Alsharaeh T, Salahat AJ, Elfert K, Beran A, Gangwani MK, Abboud Y, Al-sayyed L, Madi MY, Jaber M, Dahiya DS, Numan L, Duong N. Gastrointestinal Variant of Lemierre's Syndrome: A Systematic Review and Comprehensive Analysis of 36 Case Reports. J Clin Exp Hepatol 2024; 14:101319. [PMID: 38250215 PMCID: PMC10794926 DOI: 10.1016/j.jceh.2023.101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024] Open
Abstract
Background A gastrointestinal (GI) variant of Lemierre's syndrome (LS) involving Fusobacterium species causing pylephlebitis and possibly liver abscesses was recently identified. This systematic review aims to summarize the literature on this variant. Methods PubMed, Embase, Scopus, and Cochrane databases were searched up to November, 2nd, 2023 for case reports or case series detailing the GI variant of LS. Data regarding demographics, clinical features, and management were extracted. Descriptive statistics were used for analysis, including means, standard deviations, and percentages. Results The cohort included 36 patients (mean age 50.8 years; predominantly men 72%). Positive blood cultures were detected in 88.8% of cases, primarily growing Fusobacterium nucleatum (47.2%) and Fusobacterium necrophorum (33.3%). The GI tract was the primary infection source (58.3%), mostly related to diverticular disease (25%). Common manifestations were fever (86.1%), abdominal pain (72.2%), and leukocytosis (86.1%). Thrombosis involved the portal vein in 77.7%, with isolated portal vein thrombosis (PVT) (44.4%) and PVT extending to the superior mesenteric vein (30.5%). Liver abscesses were detected in 50% of cases, with positive aspirate cultures in 92.3%. Treatment included penicillin/penicillin-lactamase inhibitors alone (17%) and ertapenem alone (17%). Abscess drainage (13/18) resulted in complete/near-complete resolution in 83%. Long-term anticoagulation therapy was given in 75% of cases, commonly using vitamin K antagonists (59.2%). No deaths occurred. Conclusion The GI variant of LS should be considered in patients with abdominal pain, fever, leukocytosis, and portal/superior mesenteric vein thrombosis. Identifying Fusobacterium species in blood cultures and liver abscesses further supports the diagnosis. Management involves antibiotic therapy, abscess drainage, and long-term anticoagulation.
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Affiliation(s)
- Fouad Jaber
- Department of Internal Medicine, University of Missouri, Kansas City, MO, United States
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri, Kansas City, MO, United States
| | - Tala Alsharaeh
- Department of Medical Education, The University of Jordan – Faculty of Medicine, Amman, Jordan
| | - Ahmed-Jordan Salahat
- Department of Medical Education, The University of Jordan – Faculty of Medicine, Amman, Jordan
| | - Khaled Elfert
- Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, United States
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Manesh K. Gangwani
- Department of Internal Medicine, University of Toledo, Toledo, OH, United States
| | - Yazan Abboud
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Leen Al-sayyed
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mahmoud Y. Madi
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mohammad Jaber
- Department of Medical Education, Al-Azhar University-Faculty of Medicine, Gaza, Palestine
| | - Dushyant S. Dahiya
- Division of Gastroenterology Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, United States
| | - Laith Numan
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Nikki Duong
- Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Chaudhari P, Sawant R, Bedi GN, Desale R, Kumar S, Acharya S. Case Report on Mycobacterium tuberculosis Presenting As Lemierre's Syndrome: A Reemerging Catastrophe. Cureus 2024; 16:e56353. [PMID: 38633960 PMCID: PMC11021875 DOI: 10.7759/cureus.56353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Lemierre's syndrome is characterized by internal jugular vein thrombophlebitis and bacteremia, primarily from anaerobic organisms. The condition usually arises after a recent oropharyngeal infection. Young, healthy people with prolonged pharyngitis that progresses into septicemia, pneumonia, or lateral neck stiffness should be suspected of having Lemierre's syndrome. Identifying internal jugular vein thrombophlebitis and developing anaerobic bacterial growth on blood culture are frequently used to confirm the diagnosis. Treatment consists of long-term antibiotic treatment, sometimes in conjunction with anticoagulant medication. In this case report, we describe the unique case of a 29-year-old male with Mycobacterium tuberculosis with pulmonary tuberculosis, tubercular meningitis, tuberculosis-related acute ischemic stroke with septic thrombophlebitis. The patient presented with sudden onset altered sensorium for 4 hours. Magnetic resonance imaging of the brain was done, which suggested obstructive hydrocephalus with periventricular ooze. The patient was started on antibacillary treatment, antibiotics, anticoagulants, and systemic steroids. The patient was vitally stable when he was discharged. Therefore, it is crucial to consider the likelihood of such atypical tuberculosis presentations while providing a prompt and relevant diagnosis and recommending the right course of therapy.
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Affiliation(s)
| | - Rucha Sawant
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Gautam N Bedi
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Rahul Desale
- Interventional Radiology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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11
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Xie M, Liu J, Zheng J, Wang J, Han D. Lemierre Syndrome: Report of a Case with an Innovative Diagnostic Method and Literature Review. Infect Drug Resist 2024; 17:1-10. [PMID: 38192332 PMCID: PMC10771796 DOI: 10.2147/idr.s439069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
Objective To understand the clinical features, diagnosis and treatment of Lemierre syndrome (LS), a high-risk and low-prevalence infectious disease. Methods We present the severe LS case that was diagnosed using metagenomic next-generation sequencing (mNGS) in our hospital, and systematically summarized the diagnosis and treatment strategies of patients that reported LS from 2006 to 2022. Results The 24-year-old patient in our hospital suffered from cranial nerve paralysis, a neurological complication rarely seen in LS cases. The causative agent (Fusobacterium necrophorum, Fn) of this patient was only detected by mNGS tests, and the reads number of Fn detected by plasma mNGS tests was decrease as the patients gradually improved, indicating plasma mNGS is valuable in monitoring treatment efficacy. Although most of the cases retrieved from the literature showed typical symptoms, such as a history of sore throat, septic emboli, and internal jugular vein thrombosis, clinical manifestations were still relatively heterogeneous (eg, diversity of predisposing factors and pathogens, differences in pulmonary imaging features). Conclusion We summarized the clinical presentation, diagnosis, treatment, and regression of 17 symptomatic cases reported LS to provide clinicians with knowledge about this rare but fatal disease. mNGS assays should be considered as early as possible to identify the responsible pathogens for acute and critically ill patients with suspected infections in order to implement accurate and effective treatment.
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Affiliation(s)
- Mengxiao Xie
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jian Liu
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jieyuan Zheng
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jingchao Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Dongsheng Han
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical in vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
- Institute of Laboratory Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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12
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Dewdney CJ, Anderson JJ, Dewar S, Doubal F, Burgess FR, Subedi D, Lyall MJ. A case of Lemierre's syndrome causing panhypopituitarism, cavernous sinus thrombosis, ischaemic stroke and pulmonary embolism. J R Coll Physicians Edinb 2023; 53:258-262. [PMID: 37675957 DOI: 10.1177/14782715231198180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Infection is a rare cause of panhypopituitarism and has not been reported in the context of Lemierre's syndrome. We present the case of a previously well 19-year-old man, who presented acutely unwell with meningitis and sepsis. Fusobacterium necrophorum was isolated from peripheral blood cultures and identified on cerebrospinal fluid with 16S rDNA Polymerase Chain Reaction (PCR). Imaging demonstrated internal jugular vein thrombosis with subsequent cavernous venous sinus thrombosis. Pituitary function tests were suggestive of panhypopituitarism. The patient was diagnosed with Lemierre's syndrome complicated by meningitis, cavernous sinus thrombosis, base of skull osteomyelitis, ischaemic stroke and panhypopituitarism. He was treated with 13 weeks of intravenous antibiotics followed by 3 weeks of oral amoxicillin, and anticoagulated with dalteparin then apixaban. His panhypopituitarism was managed with hydrocortisone, levothyroxine and desmopressin.
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Affiliation(s)
| | | | - Simon Dewar
- Department of Medical Microbiology, NHS Lothian, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, Edinburgh Neuroscience, Edinburgh, UK
| | | | - Deepak Subedi
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK
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13
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Miura T, Fukuda H, Kawada H, Kaga T, Matsuo M, Sakai T, Yoshida S, Okada H, Ogura S, Tetsuka N. Delayed diagnosis of Lemierre's syndrome in a patient with severe coronavirus disease 2019: importance of comprehensive oral and neck examination - a case report. BMC Infect Dis 2023; 23:768. [PMID: 37936077 PMCID: PMC10629146 DOI: 10.1186/s12879-023-08755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre's syndrome, which involves symptoms resembling COVID-19-related throat manifestations. CASE PRESENTATION A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre's syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications. CONCLUSION This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
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Affiliation(s)
- Tomotaka Miura
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
- Department of Infection Control, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan
| | - Hirotsugu Fukuda
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | | | - Tetsuro Kaga
- Department of Radiology, Gifu University, Gifu, Japan
| | | | - Tsutomu Sakai
- Gastroenterology, Hashima City Hospital, Gifu, Japan
| | - Shozo Yoshida
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Hideshi Okada
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Shinji Ogura
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | - Nobuyuki Tetsuka
- Department of Infection Control, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-Shi, Gifu, 501-1194, Japan.
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14
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Fumagalli RM, Gloor E, Kaufmann PA, Frehner M, Voci D, Konstantinides SV, Kucher N, Nicoletti TF, Pecci A, Valerio L, Barco S. Common laboratory tests and their correlation with the clinical presentation and prognosis of Lemierre syndrome. Anaerobe 2023; 83:102773. [PMID: 37595866 DOI: 10.1016/j.anaerobe.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Lemierre syndrome is a thromboembolic complication following an acute bacterial infection of the head/neck area, often due to anaerobes. Data on the prognostic role of laboratory parameters is lacking. METHODS We analyzed individual-patient level data from a multinational cohort of patients with Lemierre-syndrome. Patients had an infection in the head/neck area, and contiguous vein thrombosis or septic embolism, irrespective of the causal pathogen. We studied the patterns of white blood cell count, platelet count, and C-reactive protein concentration investigating their association with baseline characteristics and in-hospital clinical outcomes (septic embolism, major bleeding, all-cause death). RESULTS A total of 447 (63%) patients had complete data for analysis. White blood cells were elevated across all subgroups (median 17 × 103/μL; Q1-Q3:12-21). Median platelet count was 61 × 103/μL (Q1-Q3:30-108) with decreasing levels with increasing age. Males, patients with renal failure or cardiopulmonary impairment, and those with typical Lemierre syndrome (tonsillitis, septic thromboembolism, positivity for Fusobacterium spp.) had the lowest platelet count. Median C-reactive protein was 122 (Q1-Q3:27-248) mg/L with higher values in patients who also had more severe thrombocytopenia. The overall risk of complications was similar across subgroups of patients stratified according to white blood cell and C-reactive protein levels. Patients in the lowest third of platelet count (<42 × 103/μL) had the highest rate of complications (26%), as opposed to those in the highest third (11%), notably septic embolic events. CONCLUSIONS Common laboratory tests correlate with the clinical presentation of Lemierre syndrome. However, extreme values did not appear to be prognostically relevant for in-hospital complications and potentially able to improve clinical management.
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Affiliation(s)
| | - Elvira Gloor
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | - Maurus Frehner
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stavros V Konstantinides
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | | | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Luca Valerio
- Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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15
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Pignatelli P, Nuccio F, Piattelli A, Curia MC. The Role of Fusobacterium nucleatum in Oral and Colorectal Carcinogenesis. Microorganisms 2023; 11:2358. [PMID: 37764202 PMCID: PMC10537357 DOI: 10.3390/microorganisms11092358] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/02/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
In recent years, several studies have suggested a strong association of microorganisms with several human cancers. Two periodontopathogenic species in particular have been mentioned frequently: Fusobacterium nucleatum (F. nucleatum) and Porphyromonas gingivalis. Chronic periodontal disease has been reported to be a risk factor for oral squamous cell carcinoma (OSCC), colorectal cancer (CRC) and pancreatic cancer. F. nucleatum is a Gram-negative anaerobic bacterium that lives in the oral cavity, urogenital, intestinal and upper digestive tract. It plays a significant role as a co-aggregation factor, with almost all bacterial species that participate in oral plaque formation acting as a bridge between early and late colonizers. F. nucleatum, gives an important inflammatory contribution to tumorigenesis progression and is associated with epithelial-derived malignancies, such as OSCC and CRC. F. nucleatum produces an adhesion protein, FadA, which binds to VE-cadherin on endothelial cells and to E-cadherins on epithelial cells. The last binding activates oncogenic pathways, such as Wnt/βcatenin, in oral and colorectal carcinogenesis. F. nucleatum also affects immune response because its Fap2 protein interacts with an immune receptor named TIGIT present on some T cells and natural killer cells inhibiting immune cells activities. Morover, F. nucleatum release outer membrane vesicles (OMVs), which induce the production of proinflammatory cytokines and initiating inflammation. F. nucleatum migrates from the oral cavity and reaches the colon hematogenously but it is not known if in the bloodstream it reaches the CRC as free, erythrocyte-bound bacteria or in OMV. F. nucleatum abundance in CRC tissue has been inversely correlated with overall survival (OS). The prevention and treatment of periodontal disease through the improvement of oral hygiene should be included in cancer prevention protocols. FadA virulence factors may also serve as novel targets for therapeutic intervention of oral and colorectal cancer.
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Affiliation(s)
- Pamela Pignatelli
- COMDINAV DUE, Nave Cavour, Italian Navy, Stazione Navale Mar Grande, 74122 Taranto, Italy;
| | - Federica Nuccio
- MARICENSELEZ ANCONA, Centro di Selezione M.M., Italian Navy, 60127 Ancona, Italy;
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University for Health Sciences, 00131 Rome, Italy;
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Maria Cristina Curia
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
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16
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Zhang Y, Zeng Y. Lemierre's Syndrome Under the Disguise of COVID-19 Pneumonia: A Case Report and Systematic Review. Cureus 2023; 15:e45827. [PMID: 37876396 PMCID: PMC10593421 DOI: 10.7759/cureus.45827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Lemierre's syndrome refers to septic thrombophlebitis caused by Fusobacterium necrophorum bacteremia. The incidence of Lemierre's syndrome has risen over the past two decades. This report describes a case of a 31-year-old woman presenting with multifocal pneumonia and uncomplicated parapneumonic effusion, considered as COVID-19 pneumonia initially, then found to have Lemierre's syndrome with Fusobacterium necrophorum bacteremia and right internal jugular vein thrombophlebitis. Her condition improved after four weeks of antibiotics without anticoagulation. The article summarized the history, epidemiology, clinical presentation, differential diagnosis, and treatment of Lemierre's syndrome, the rare but severe complication of bacterial infection. The article also summarized six reported Lemierre's syndrome cases during the COVID-19 pandemic to emphasize the significance of having a broad differential diagnosis for respiratory symptoms, especially in the COVID-19 era.
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Affiliation(s)
- Yani Zhang
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Yuhao Zeng
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
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17
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Venditto L, Ferrante G, Caccin A, Franchini G, Zaffanello M, Tenero L, Piazza M, Di Gioia S, Piacentini G, Pietrobelli A. Lung abscess as a complication of Lemierre Syndrome in adolescents: a single center case reports and review of the literature. Ital J Pediatr 2023; 49:96. [PMID: 37563612 PMCID: PMC10413500 DOI: 10.1186/s13052-023-01499-4] [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: 05/13/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fusobacterium necrophorum is an anaerobic, gram-negative, non-motile, filamentous, non-spore forming bacillus found in the oral cavity, gastrointestinal tract, and female genital tract, responsible of a rare disease named Lemierre Syndrome, characterized by septic thrombophlebitis of the internal jugular vein, which mainly affects previously healthy adolescents and young adults; some risk factors are reported, as smoking or primary viral or bacterial infection leading to the disruption of mucosa. The syndrome originates commonly from an upper respiratory infection such as pharyngotonsillitis, acute otitis media, cervical lymphadenitis, sinusitis, or odontogenic abscess, and may result in multiorgan metastasis, more frequently leading to pulmonary complications, especially lung abscesses. CASE PRESENTATION We describe two cases of adolescents with atypical Lemierre Syndrome evaluated in a tertiary care center, one with a confirmed infection by Fusobacterium necrophorum and one with a presumptive diagnosis based on clinical features, who developed lung abscesses needing a prolonged antibiotic course and hospitalization. Of interest, both were user of electronic cigarette, configuring a possible new risk factor. The proper diagnosis of Lemierre Syndrome is often difficult to establish, so a high degree of suspicion is needed, especially in the case of lung abscesses in otherwise healthy adolescents. CONCLUSION The current study will contribute to providing insight into Lemierre Syndrome clinical presentation and management in adolescents, promoting awareness for a rare but potentially fatal disease. Moreover, it suggests a possible relationship between Lemierre syndrome and the use of electronic cigarette, that should be investigated by future studies.
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Affiliation(s)
- Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Anna Caccin
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giulia Franchini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Laura Tenero
- Pediatric Division, University Hospital of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Stefano Di Gioia
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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18
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Tiwari A. Lemierre's Syndrome in the 21st Century: A Literature Review. Cureus 2023; 15:e43685. [PMID: 37724228 PMCID: PMC10505273 DOI: 10.7759/cureus.43685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Lemierre's syndrome is a rare, life-threatening complication of an acute oropharyngeal infection. It is generally characterised by pharyngitis secondary to Fusobacterium necrophorum, causing thrombophlebitis of the internal jugular vein and sepsis, with subsequent formation of septic emboli that can rapidly spread to different organ sites. The condition is associated with high mortality if treatment with antibiotics is delayed, and recent evidence suggests that patients are at significant risk of in-hospital morbidity and long-term neurological sequelae. Although it is agreed that antibiotics are the mainstay of treatment, there is currently no consensus on the use of anticoagulation in the condition. This review article aims to summarise our current understanding of Lemierre's syndrome with regard to its definition, epidemiology, microbiology, presentation, diagnosis, and treatment.
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Affiliation(s)
- Abhinav Tiwari
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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19
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AlAmer NA, AlMarzouq WF. Lemierre syndrome: a hidden complication of sore throats. Int J Emerg Med 2023; 16:45. [PMID: 37488492 PMCID: PMC10364365 DOI: 10.1186/s12245-023-00524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein, most commonly caused by Fusobacterium necrophorum. CASE PRESENTATION A 46-year-old woman with no significant medical history presented with generalized neck swelling and fever. Despite seeking medical attention at multiple outpatient clinics for upper respiratory symptoms lasting 10 days, she only received symptomatic treatment for acute viral pharyngitis. A computed tomography (CT) scan of her neck revealed thrombophlebitis in the left internal jugular vein, and subsequent cultures indicated the presence of Klebsiella pneumoniae. The patient's oxygen saturation levels suddenly dropped, and the CT scan identified bilateral peripheral consolidation areas in both lungs, consistent with septic emboli. These findings were consistent with a diagnosis of Lemierre syndrome. The patient was treated with 2 weeks of intravenous piperacillin/tazobactam and vancomycin, as well as anticoagulation therapy using heparin, and her symptoms resolved completely. CONCLUSION This report presents an unusual occurrence of Lemierre syndrome caused by K. pneumoniae, a less frequently encountered causative pathogen in patients without diabetes mellitus. The case highlights the significance of timely and appropriate antibiotic use to prevent potential complications.
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Affiliation(s)
- Naheel A AlAmer
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Wasan F AlMarzouq
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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20
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Someko H, Shiojiri T. Bilateral pterygoid abscesses in a patient with Lemierre's syndrome. BMJ Case Rep 2023; 16:e255398. [PMID: 37460247 PMCID: PMC10357689 DOI: 10.1136/bcr-2023-255398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Patients with Lemierre's syndrome may have complications such as lung lesions, large joint arthritis and central nervous system involvement. However, complications involving a pterygoid abscess have scarcely been reported. Here, we report a case of bilateral Lemierre's syndrome accompanied with an intracranial epidural abscess and bilateral pterygoid abscesses. A woman in her 70s presented to the emergency room with a decreased level of consciousness. Infection was suspected, and Slackia exigua and species of Fusobacterium were identified in blood cultures, which suggested that the origin of infection was odontogenic, particularly as the patient had poor oral hygiene. Head and neck CT with contrast enhancement revealed bilateral internal jugular vein thrombophlebitis, septic pulmonary embolism, frontal epidural abscess and bilateral pterygoid abscesses. After antibiotic treatment and drainage, her condition improved. Pterygoid abscesses should be recognised as a rare complication of Lemierre's syndrome, especially when the infection origin is odontogenic.
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Affiliation(s)
- Hidehiro Someko
- General Internal Medicine, Asahi General Hospital, Asahi, Japan
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21
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Kajihara T, Yahara K, Kitamura N, Hirabayashi A, Hosaka Y, Sugai M. Distribution, Trends, and Antimicrobial Susceptibility of Bacteroides, Clostridium, Fusobacterium, and Prevotella Species Causing Bacteremia in Japan During 2011-2020: A Retrospective Observational Study Based on National Surveillance Data. Open Forum Infect Dis 2023; 10:ofad334. [PMID: 37469615 PMCID: PMC10352651 DOI: 10.1093/ofid/ofad334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
Background The increasing prevalence of anaerobic bacteremia is a major concern worldwide and requires longitudinal monitoring. Methods We present one of the largest and longest longitudinal studies on the prevalence and antimicrobial resistance of Bacteroides, Clostridium, Fusobacterium, and Prevotella spp. isolated from blood culture samples using national comprehensive surveillance data in Japan during 2011-2020 as part of the Japan Nosocomial Infections Surveillance. Results Data for 41 949 Bacteroides spp., 40 603 Clostridium spp., 7013 Fusobacterium spp., and 5428 Prevotella spp. isolates were obtained. The incidences of bacteremia caused by Bacteroides fragilis, Clostridium perfringens, and Fusobacterium nucleatum significantly increased during the period (P < .0001). Among the 20 species analyzed, 18 showed no significant changes in susceptibility over time, including B. fragilis, C perfringens, and F. nucleatum. However, resistance to clindamycin increased in B. thetaiotaomicron (P = .0312), and resistance to ampicillin increased in B. ovatus (P = .0008). Conclusions Our comprehensive national surveillance data analysis demonstrated a continuous increase in the incidence of anaerobic bacteremia, particularly in B. fragilis, C. perfringens, and F. nucleatum. This may be linked to the increasing number of colorectal cancer cases or advancing methods for species identification and susceptibility testing, requiring cautious interpretation. The discovery of an upsurge in anaerobic bacteremia and potential alterations in susceptibility highlights the necessity for more extensive studies in this field.
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Affiliation(s)
- Toshiki Kajihara
- Correspondence: Toshiki Kajihara, MD, Phd, Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho Higashimurayama, Tokyo 189-0002, Japan ()
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norikazu Kitamura
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Aki Hirabayashi
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yumiko Hosaka
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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22
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Bourgeaud J, Delabays B, Van den Bogaart L, Ratano D. Complex Lemierre syndrome with multisystemic abscesses. BMJ Case Rep 2023; 16:16/4/e254638. [PMID: 37085282 PMCID: PMC10124225 DOI: 10.1136/bcr-2023-254638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for Fusobacterium necrophorum and a right lingual vein thrombosis was detected at a late stage when the patient developed a septic shock. Initial antimicrobial therapy with metronidazole and ceftriaxone was modified to meropenem due to progressive worsening. The patient underwent laparoscopy and neurosurgical drainage of a cerebral abscess. She spent many days in the intensive care unit and recovered fully after 6 weeks on meropenem therapy. Although considered rare, the incidence of Lemierre syndrome, a potentially life-threatening condition, is increasing. The clinician should promptly recognise and treat it while being aware of its potential atypical presentations.
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23
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Osifo SE, Umolu AG, Perera WR, Howlett DC. Lemierre’s Syndrome: A Cloaked Dagger. Cureus 2023; 15:e36087. [PMID: 37065315 PMCID: PMC10096120 DOI: 10.7759/cureus.36087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/14/2023] Open
Abstract
Lemierre's syndrome is a condition characterized by septicemia, with bacteremia, thrombophlebitis of the internal jugular vein (IJV), and septic embolization to distant organs following a recent upper respiratory infection (URI). Fusobacterium necrophorum, an anaerobic Gram-negative rod, has been mostly implicated as the causative organism of this condition that tends to affect healthy teenagers and young adults. While once regarded as a disease of old, it has seen a resurgence in recent times, possibly due to antibiotic stewardship and current trends of reduced antibiotic use for URIs. It is important that the modern physician has a high index of suspicion, as well as the characteristic presentation of this potentially fatal illness. Current treatment guidelines are centered on the use of appropriate antibiotics, drainage of purulent collections when possible, and, in some situations, anticoagulants have been utilized. This study describes a case of a young lady who presented with symptoms of chest pain and deteriorating oxygen saturations following recent treatment for acute tonsillitis.
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24
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Silverberg B, Sharon MJ, Makati D, Mott M, Rose WD. Forget-me-not: Lemierre's syndrome, a case report. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:343-347. [PMID: 33760711 DOI: 10.1080/07448481.2021.1899190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Background: Familiarity breeds complacency. One case of sore throat can start to sound like another. However, even common viral and bacterial infections can lead to serious sequelae. Clinicians cannot make a diagnosis if they do not consider it in their differential.Case: The presentation - and subsequent hospitalization - of a septic 19 year-old male college student is described. Despite brief interval improvement, he became hypoxic one week after developing a sore throat and was ultimately diagnosed with Lemierre's syndrome (septic thrombophlebitis of the internal jugular vein) via blood cultures and advanced imaging.Conclusions: Though rare, Lemierre's syndrome carries a high mortality rate. It should be considered an emergent complication of head and neck infections, particularly in young adults.
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Affiliation(s)
- Benjamin Silverberg
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Melinda J Sharon
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Devan Makati
- Section of Nephrology, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mariah Mott
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - William D Rose
- Division of Ambulatory Care, Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
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25
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Dayasiri K, Rao S. Fifteen-minute consultation: Evaluation of paediatric torticollis. Arch Dis Child Educ Pract Ed 2023; 108:17-21. [PMID: 34799417 DOI: 10.1136/archdischild-2020-319668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/28/2021] [Indexed: 02/05/2023]
Abstract
Torticollis refers to a state in which the neck is twisted due to excessive contraction or shortening of the muscles on one side. Congenital muscular torticollis, which is more common than acquired torticollis, has an incidence of 0.3%-1.9% among all live births. The clinical approach to torticollis depends on the age at presentation, duration of torticollis and presenting symptoms. The underlying aetiology for torticollis varies with the age of the child. Torticollis can be a presenting feature for life-threatening conditions and thus requires careful evaluation.
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Affiliation(s)
- Kavinda Dayasiri
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Paediatrics, Faculty of medicine, University of Kelaniya, Sri Lanka
| | - Sahana Rao
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Department of Paediatrics, University of Oxford, Oxford, UK
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26
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Sanivarapu RR, Rajamreddy RS, Nalla S, Shaik Masthan S, Mangu G. Lemierre's Syndrome in the External Jugular Vein Precipitated by COVID-19 Infection. Cureus 2023; 15:e34512. [PMID: 36874340 PMCID: PMC9984202 DOI: 10.7759/cureus.34512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Lemierre's syndrome is a condition when an oropharyngeal infection, typically from Fusobacterium necrophorum, causes thrombophlebitis of the internal jugular vein. There have been few case reports of Lemierre's syndrome affecting the external jugular vein, but to our knowledge, this is the first case report where COVID-19 infection is the prime suspect for causing this syndrome. SARS-CoV-2 infection, known to cause hypercoagulability and immunosuppression, increases the risk of deep venous thrombosis and secondary infections. We report a case of a young male with no known risk factors who developed Lemierre's syndrome as a complication of COVID infection.
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Affiliation(s)
- Raghavendra R Sanivarapu
- Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Odessa, USA.,Pulmonary and Critical Care Medicine, Nassau University Medical Center, East Meadow, USA
| | - Ramya Sruthi Rajamreddy
- Internal Medicine, People's Education Society Institute of Medical Sciences and Research (PESIMSR), Kuppam, IND
| | - Swetha Nalla
- Internal Medicine, Mamata Medical College, Khammam, IND
| | | | - Goutami Mangu
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
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High risk and low prevalence diseases: Lemierre's syndrome. Am J Emerg Med 2022; 61:98-104. [DOI: 10.1016/j.ajem.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
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Shah A, Moake MM. Diagnosis of Internal Jugular Vein Septic Thrombophlebitis by Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:568-571. [PMID: 35477931 DOI: 10.1097/pec.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Septic thrombophlebitis represents a rare but serious collection of diseases, which carry a high risk of morbidity and mortality requiring prompt and aggressive treatment. Diagnosis centers on identification of thrombus along with clinical and microbiologic data. We present a case where point-of-care ultrasound was used to diagnose septic thrombophlebitis of the internal jugular vein and expedite appropriate therapy. We further review the technique and literature for ultrasound diagnosis of venous thrombosis and associated thrombophlebitis.
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Affiliation(s)
- Aalap Shah
- From the Departments of Emergency Medicine
| | - Matthew M Moake
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
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Nygren D, Wasserstrom L, Holm K, Torisson G. Associations Between Findings of Fusobacterium necrophorum or β-Hemolytic Streptococci and Complications in Pharyngotonsillitis-A Registry-Based Study in Southern Sweden. Clin Infect Dis 2022; 76:e1428-e1435. [PMID: 36069108 PMCID: PMC9907503 DOI: 10.1093/cid/ciac736] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most pharyngotonsillitis guidelines focus on the identification of group A streptococci (GAS), guided by clinical scores determining whom to test with a rapid antigen detection test. Nevertheless, many patients testing negative with this test are evaluated for group C/G streptococci (GCS/GGS) and Fusobacterium necrophorum, yet their importance remains debated. Our primary aim was to evaluate associations between complications and findings of F. necrophorum, GAS, or GCS/GGS in pharyngotonsillitis. METHODS This was a retrospective, registry-based study of pharyngotonsillitis cases tested for F. necrophorum (polymerase chain reaction) and β-hemolytic streptococci (culture) in the Skåne Region, Sweden, in 2013-2020. Patients with prior complications or antibiotics (within 30 days) were excluded. Data were retrieved from registries and electronic charts. Logistic regression analyses were performed with a dichotomous composite outcome of complications as primary outcome, based on International Classification of Diseases, Tenth Revision, codes. Cases with negative results (polymerase chain reaction and culture) were set as reference category. Complications within 30 days were defined as peritonsillar or pharyngeal abscess, otitis, sinusitis, sepsis or septic complications, recurrence of pharyngotonsillitis (after 15-30 days) or hospitalization. RESULTS Of 3700 registered cases, 28% had F. necrophorum, 13% had GCS/GGS, 10% had GAS, and 54% had negative results. The 30-day complication rates were high (20%). F. necrophorum (odds ratio, 1.8; 95% confidence interval, 1.5-2.1) and GAS (1.9; 1.5-2.5) were positively associated with complications, whereas GCS/GGS were negatively associated (0.7; 0.4-0.98). CONCLUSIONS Our results indicate that F. necrophorum is a relevant pathogen in pharyngotonsillitis, whereas the relevance of testing for GCS/GGS is questioned. However, which patient to test and treat for F. necrophorum remains to be defined.
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Affiliation(s)
- David Nygren
- Correspondence: D. Nygren, Division of Infection Medicine, Department of Clinical Sciences, BMC, B14, Sölvegatan 19, 22362 Lund, Sweden ()
| | - Lisa Wasserstrom
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital, Lund, Sweden
| | - Karin Holm
- Division of Infection Medicine, Lund University, Lund, Sweden,Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
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Cervicofacial Cellulitis due to Staphylococcus aureus with Jugular Vein Thrombosis and Multiple Septic Pulmonary Embolism: A Lemierre-Like Syndrome. Case Rep Infect Dis 2022; 2022:7805523. [PMID: 36062238 PMCID: PMC9439926 DOI: 10.1155/2022/7805523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
This is the case of a 28-year-old male patient with no particular pathological history who presented with an inflammatory swelling of the right cheek with pus in an infectious context. Cervicofacial CT with contrast injection allowed the diagnosis of a right cervicofacial cellulitis, associated with a jugular venous thrombosis extending to the superior vena cava. It also revealed septic pulmonary metastases in the form of multiple excavated pulmonary nodules. The analysis of the pus sample allowed the isolation of Staphylococcus aureus as the causative germ. This led to the diagnosis of a Lemierre-like syndrome, which is a variant of the Lemierre syndrome. Despite appropriate antibiotic treatment and anticoagulation, the patient died after 16 days of hospitalization.
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Mohammadian M, Rath P, Dikhtyar A, Jesani S, Alyacoub R. Portal Vein Thrombosis Associated With Fusobacterium nucleatum Bacteremia: A Rare Abdominal Variant of Lemierre’s Syndrome. Cureus 2022; 14:e27918. [PMID: 36120206 PMCID: PMC9467494 DOI: 10.7759/cureus.27918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
Lemierre's syndrome is a rare but potentially severe complication of bacterial infections that usually affects previously healthy adolescents and young adults. It commonly presents as septic thrombophlebitis of the internal jugular vein and bacteremia following a recent oropharyngeal infection. The most commonly isolated organisms are Fusobacterium necrophorum, followed by Fusobacterium nucleatum and other anaerobes. Atypical Lemierre's syndrome is characterized by thrombophlebitis at sites distant from the head and neck veins and is far less encountered than typical Lemierre's syndrome. Here, we present a case of an elderly African American female with pylephlebitis, a rare abdominal variant of Lemierre's syndrome with extensive portal vein, splenic vein, and mesenteric vein thrombosis following perforated diverticulitis and resultant F. nucleatum bacteremia. She demonstrated complete recovery following appropriate long-term intravenous antibiotics and anticoagulation. This case calls attention to the re-emergence of the rare manifestation of this forgotten disease and highlights improved outcomes with prompt recognition and early treatment.
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Bugenhagen SM, Raptis DA, Bhalla S. Vascular Infections in the Thorax. Semin Roentgenol 2022; 57:380-394. [DOI: 10.1053/j.ro.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022]
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Hirschhorn A, Averbuch D, Michaan N, Adler A, Grisaru-Soen G. Invasive Fusobacterium Infections in Children: A Retrospective Multicenter Study. Pediatr Infect Dis J 2022; 41:517-523. [PMID: 35363651 DOI: 10.1097/inf.0000000000003514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Adi Hirschhorn
- From 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
| | - Diana Averbuch
- Paediatric Infectious Diseases, Paediatric Division, Hadassah Medical Center, Jerusalem, Israel, affiliated to the Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadav Michaan
- Microbiology Laboratory
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Galia Grisaru-Soen
- From 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
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Kaplan S, Grobler R, Chetty S. Post-traumatic Lemierres Syndrome: A rare presentation secondary to mandibular fracture. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221106854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lemierre’s Syndrome is a rare phenomenon with a low prevalence and is characteristically seen in patients with an oropharyngeal infection that is complicated by thrombophlebitis of the internal jugular vein and secondary septic emboli. We present the case of a 16 year old previously well male who was diagnosed with a rare case of Lemierre’s syndrome secondary to a mandibular fracture. Blood tests and radiological imaging confirmed the diagnosis, with CT scan of the patients head and neck revealing a right mandibular fracture with abscess formation, bilateral parapharyngeal abscesses, bilateral internal jugular vein thromboses, left sigmoid sinus thrombosis, cavernous sinus thrombosis, post septal orbital cellulitis with enhancing infraorbital collections and a subdural empyema overlying the left tentorium cerebelli. The treatment is usually non-operative with antibiotics and in some instances surgical drainage. In this case a combination of surgical drainage for source control and antibiotics were used. Unfortunately, despite an initial improvement in the patient’s clinical status the patient died. This is the first case of Lemierre’s syndrome secondary to blunt facial trauma reported in the scientific literature. This case highlights the importance of clinicians having a high degree of suspicion of Lemierre’s syndrome when a patient presents with typical clinical features following facial trauma.
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Affiliation(s)
- Saul Kaplan
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ruan Grobler
- Division of Neurosurgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sean Chetty
- Department of Anaesthesiology & Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Septic Thrombophlebitis of the Internal Jugular Vein in an Immunocompromised Patient with Lemierre Syndrome: A Case Report. Transplant Proc 2022; 54:1388-1390. [DOI: 10.1016/j.transproceed.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
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Newman N, Bantikassegn A, West TG, Peacock JE. An Unusual Etiology of Lemierre-Like Syndrome: Preseptal Cellulitis due to Methicillin-Resistant Staphylococcus aureus. Open Forum Infect Dis 2022; 9:ofac143. [PMID: 35531375 PMCID: PMC9070346 DOI: 10.1093/ofid/ofac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Lemierre’s syndrome (LS) is a rare and potentially fatal condition that predominantly affects young adults with oropharyngeal infection. Fusobacterium necrophorum is the usual etiology and classically causes internal jugular vein septic thrombophlebitis, frequently complicated by septic emboli to several organs (most classically to the lungs). Lemierre-like syndrome (LLS) describes the same constellation of symptoms and pathophysiology as Lemierre’s syndrome; however, Fusobacterium spp. are not the cause, and the source of infection may be nonoropharyngeal. We present a case with an unusual etiology of LLS: a patient with untreated preseptal cellulitis and associated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in the setting of injection drug use. Physical exam revealed tachypnea and rhonchi with severe periorbital and bilateral eyelid edema. Imaging demonstrated bilateral preseptal and orbital cellulitis with thrombosis of both internal jugular veins and bilateral pulmonary cavitary lesions consistent with septic pulmonary emboli. She was managed with anticoagulation and parenteral antibiotics. To our knowledge, this is the first case of LLS originating from preseptal cellulitis without evidence of preceding pharyngitis. While facial and orbital infections are rare etiologies of LLS, the potentially devastating sequelae of LLS warrant its inclusion in differential diagnoses.
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Affiliation(s)
- Noah Newman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amlak Bantikassegn
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas G West
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James E Peacock
- Division of Infectious Disease, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Factors Affecting Patients with Concurrent Deep Neck Infection and Lemierre's Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12040928. [PMID: 35453976 PMCID: PMC9029513 DOI: 10.3390/diagnostics12040928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
Deep neck infection (DNI) is a severe disease affecting the deep neck spaces, and is associated with an increased risk of airway obstruction. Lemierre’s syndrome (LS) refers to septic thrombophlebitis of the internal jugular vein after pharyngeal infection, and is linked with high morbidity and mortality. Both diseases begin with an oropharyngeal infection, and concurrence is possible. However, no studies have examined the risk factors associated with co-existence of LS and DNI. Accordingly, this study examined a patient population to investigate the risk factors associated with concurrent DNI and LS. We examined data from a total of 592 patients with DNI who were hospitalized between May 2016 and January 2022. Among these patients, 14 had concurrent DNI and LS. The relevant clinical variables were assessed. In a univariate analysis, C-reactive protein (odds ratio (OR) = 1.004, 95% CI: 1.000−1.009, p = 0.045), involvement of multiple spaces (OR = 23.12, 95% CI: 3.003−178.7, p = 0.002), involvement of the carotid space (OR = 179.6, 95% CI: 22.90−1409, p < 0.001), involvement of the posterior cervical space (OR = 42.60, 95% CI: 12.45−145.6, p < 0.001) and Fusobacterium necrophorum (F. necrophorum, OR = 288.0, 95% CI: 50.58−1639, p < 0.001) were significant risk factors for concurrent DNI and LS. In a multivariate analysis, involvement of the carotid space (OR = 94.37, 95% CI: 9.578−929.9, p < 0.001), that of the posterior cervical space (OR = 24.99, 95% CI: 2.888−216.3, p = 0.003), and F. necrophorum (OR = 156.6, 95% CI: 7.072−3469, p = 0.001) were significant independent risk factors for concurrent LS in patients with DNI. The length of hospitalization in patients with concurrent LS and DNI (27.57 ± 14.94 days) was significantly longer than that in patients with DNI alone (10.01 ± 8.26 days; p < 0.001), and the only pathogen found in significantly different levels between the two groups was F. necrophorum (p < 0.001). Involvement of the carotid space, that of the posterior cervical space and F. necrophorum were independent risk factors for the concurrence of DNI and LS. Patients with concurrent LS and DNI had longer hospitalization periods than patients with DNI alone. Furthermore, F. necrophorum was the only pathogen found in significantly different levels in DNI patients with versus those without LS.
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Case report of Lemierre's Syndrome associated with Fusobacterium nucleatum infection without internal or external jugular venous thrombophlebitis. Respir Med Case Rep 2022; 37:101651. [PMID: 35516791 PMCID: PMC9062341 DOI: 10.1016/j.rmcr.2022.101651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Fusobacterium nucleatum is an anaerobe that is commensal to the human oral cavity. It is usually a component of periodontal plaque that is emerging as a pathogen and quickly attracting attention of the medical and research communities. It has been even discovered in bronchoalveolar lavage of some patients with lung cancer. Lemierre's syndrome (LS) is characterized as septic thrombophlebitis of the internal jugular vein, which usually begins with oropharyngeal infection that worsens and leads to inflammation of the wall of the jugular vein. This is the hallmark of the disease. However, in this case, there was no thrombophlebitis of the internal jugular vein. There is one other case presentation where it was diagnosed without the internal jugular vein involvement. Most sequelae involve infected thrombus of the vein, soft tissue inflammation, persistent bacteremia, and septic emboli, often leading to metastatic infections. Interestingly enough, in the age of SARS-COV-2, LS has also been mistaken for multisystem inflammatory syndrome in children (MIS-C). We present a previously healthy 20-year-old female college student who was transferred from her local hospital to Bristol-Myers Squibb Children's Hospital (BMSCH) at Robert Wood Johnson University Hospital for suspected LS with loculated pleural effusions and necrotizing pneumonia with lung abscess secondary to Fusobacterium nucleatum, systemic and emphysematous osteomyelitis possibly secondary to septic emboli, thrombocytopenia, and palatine tonsil and thyroid abscesses.
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Cloutet A, Botta RK, Kulkarni SR, Ponna PK. A Complex Case of Lemierre’s Syndrome With Facial Vein Involvement. Cureus 2022; 14:e23420. [PMID: 35475072 PMCID: PMC9028854 DOI: 10.7759/cureus.23420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
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Yoshikawa S, Ueda T, Fujiwara T. Use of intravascular hypo- and hyper-attenuation on non-contrast-enhanced computed tomography in diagnosing acute septic thrombophlebitis. J Radiol Case Rep 2022; 16:1-14. [PMID: 35529424 PMCID: PMC9063837 DOI: 10.3941/jrcr.v16i3.4364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Septic thrombi, such as those observed in pylephlebitis and Lemierre's syndrome, are characterized by portal vein thrombosis and venous thrombosis with bacterial infection. Although radiographic findings of septic thrombus on contrast-enhanced computed tomography have been well described, no report has described the characteristics of non-contrast-enhanced computed tomography. We describe a case series of septic thrombophlebitis exhibiting intravascular hypo- and hyper-attenuation on non-contrast-enhanced computed tomography. These radiographic features reflect the pathophysiology of septic thrombus, and therefore, it is important and useful to evaluate thrombus attenuation on non-contrast-enhanced computed tomography.
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Affiliation(s)
- Satoshi Yoshikawa
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takeshi Ueda
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takuya Fujiwara
- Department of Radiology, National Hospital Organization/Osaka National Hospital, Osaka, Japan
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Fusobacterium necrophorum oral infections - A need for guidance. Anaerobe 2022; 75:102532. [PMID: 35122953 DOI: 10.1016/j.anaerobe.2022.102532] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022]
Abstract
F. necrophorum, a gram-negative obligate anaerobe, causes pharyngotonsillitis, peritonsillar abscess and the Lemierre Syndrome as well as other significant infections. Clinical information on this bacterium has increased dramatically over the past 20 years, yet no standard guidance exists for treating these infections. While data support F. necrophorum as a cause of pharyngotonsillitis, no consensus exists on the clinical importance of these findings especially in the 15-30 age group. Similarly, recent data find this bacterium the most frequent and most likely to recur in peritonsillar abscess for that age group. Should this impact how we treat these patients? Finally, we have no studies of either antibiotics or anticoagulation for the Lemierre Syndrome. Thus, each physician making the diagnosis of the Lemierre Syndrome chooses antibiotics (and their duration) and whether or not to anticoagulate without guidance. Infectious disease specialists and hospitalists would benefit from consensus expert opinions based on reviewing data on these infections.
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Giorelli M, Altomare S, Aniello MS, Leone R, Liuzzi D, Plasmati I, Sardaro M, Superbo M, Mennea G, Fioretto N, Guglielmi G, Balzano R, Scarabino T, Cuccorese G, Cialdella F, Campobasso G, Barbara M. Lemierre's syndrome complicated by cerebral venous sinus thrombosis: A life threatening and rare disease successfully treated with empiric antimicrobial therapy and conservative approach. Intractable Rare Dis Res 2022; 11:37-39. [PMID: 35261851 PMCID: PMC8898395 DOI: 10.5582/irdr.2021.01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/05/2022] Open
Abstract
Lemierre's syndrome (LS) is a "forgotten" condition characterized by septic thrombophlebitis of the jugular vein that follows an otolaryngological infection. Fusobacterium necrophorum is the aetiological agent responsible for the syndrome in adolescents and young adults whereas in older people even common bacteria are involved. Complications arise from spreading of septic emboli distally, i.e. to the brain, lungs, bones and internal organs everywhere in the body. We report a middle-aged woman who presented with headache and bilateral sixth cranial nerve palsy following a sphenoidal sinusitis and left mastoiditis. Imaging revealed thrombotic involvement of the left internal jugular vein as well as of several cerebral venous sinuses thrombosis (CVT). Currently, precise management protocols of LS with CVT complication do not exist although a combination of macrolides and second or third-generation cephalosporins, as well as anti-coagulants represent the mainstream of therapeutics. Surgical drainage is associated to remove septic foci but is burdened by severe complications and side effects. Complete recovery was achieved following pharmacological treatment in our patient. This report adds further evidence that LS complicated by CVT may be effectively treated adopting a conservative approach thus avoiding surgical drainage and severe complications.
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Affiliation(s)
- Maurizio Giorelli
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
- Address correspondence to:Maurizio Giorelli, Operative Unit of Neurology, "Dimiccoli" General Hospital, Viale Ippocrate 11, Barletta 76121, Italy. E-mail:
| | - Sergio Altomare
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Ruggiero Leone
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Daniele Liuzzi
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Michele Sardaro
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Maria Superbo
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Mennea
- Operative Unit of Internal Medicine, "Bonomo" General Hospital, Andria, Italy
| | - Nicola Fioretto
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Guglielmi
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Rosario Balzano
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Tommaso Scarabino
- Operative Unit of Radiology, "Bonomo" General Hospital, Andria, Italy
| | - Giuseppe Cuccorese
- Operative Unit of Internal Medicine, "Dimiccoli" General Hospital, Barletta, Italy
| | - Francesca Cialdella
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Campobasso
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Michele Barbara
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
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Recchia A, Cascella M, Altamura S, Borrelli F, De Nittis N, Dibenedetto E, Labonia M, Pavone G, Del Gaudio A. Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome. Antibiotics (Basel) 2021; 10:antibiotics10121526. [PMID: 34943737 PMCID: PMC8698451 DOI: 10.3390/antibiotics10121526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.
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Affiliation(s)
- Andreaserena Recchia
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Marco Cascella
- Anesthesia and Pain Medicine Istituto Nazionale Tumori-IRCCS, Fondazione G. Pascale, 80100 Napoli, Italy
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Sabrina Altamura
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Felice Borrelli
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Nazario De Nittis
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Elisabetta Dibenedetto
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Maria Labonia
- Microbiology and Virology, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giovanna Pavone
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Alfredo Del Gaudio
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
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Jaber TM, Saini V, Ogbebor O, Dumont T, Balaan M, Lega M, Cheema T. Lemierre's Syndrome: A Case Series. Cureus 2021; 13:e18436. [PMID: 34737904 PMCID: PMC8559581 DOI: 10.7759/cureus.18436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
Lemierre’s syndrome (LS) is a potentially fatal complication of oropharyngeal infection, resulting in contiguous suppurative thrombosis of the internal jugular vein (IJV) and septic emboli. It is most commonly associated with Fusobacterium necrophorum (F. necrophorum), though other pathogens have also been implicated in its pathogenesis. The incidence of LS had so significantly decreased that it was referred to as "the forgotten disease." However, cases of LS have shown a resurgence, which may be partly attributed to an overreliance on a negative group A beta-hemolytic streptococcal rapid antigen detection test (RADT), commonly referred to as "rapid strep test." Clinicians must maintain a very high index of suspicion for LS in patients with persistent sequelae from tonsillopharyngitis who have a negative RADT.
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Affiliation(s)
- Tariq M Jaber
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Vikram Saini
- Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Osakpolor Ogbebor
- Internal Medicine/Infectious Disease & Critical Care, Allegheny Health Network, Pittsburgh, USA
| | - Tiffany Dumont
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
| | - Marvin Balaan
- Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Mark Lega
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, USA
| | - Tariq Cheema
- Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, USA
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Nielsen NØ, Nørlinger C, Greve T, Klug TE. Cervical suppurative lymphadenitis in children: microbiology, primary sites of infection, and evaluation of antibiotic treatment. Eur Arch Otorhinolaryngol 2021; 279:3053-3062. [PMID: 34623496 DOI: 10.1007/s00405-021-07115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.
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Affiliation(s)
- Nicolai Østergaard Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Christian Nørlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Thomas Greve
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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Schwarz Y, Habashi N, Rosenfeld-Yehoshua N, Soikher E, Marom T, Tamir SO. Pediatric Patient with Lemierre Syndrome of the External Jugular Vein: Case Report and Literature Review. Int Arch Otorhinolaryngol 2021; 25:e633-e640. [PMID: 34737835 PMCID: PMC8558952 DOI: 10.1055/s-0040-1721337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/02/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Lemierre syndrome (LS) involving the external jugular vein (EJV) is rare, and only a few cases have been reported in the literature. Objectives To report a case of LS involving the external jugular vein as well as to make a review of the literature regarding both diagnosis and management strategies. Data Synthesis We describe a case of LS involving the EJV and review the literature of previously published articles to search for additional cases. A PubMed, Embase, Scopus, and Web of science-based search was performed to determine the scope of coverage in well-reported articles in English. Twenty-one papers were retrieved and documented for age, incidence, pathogen, presenting symptoms, imaging, treatment, and outcome, which were noted for each of these cases. In our literature review of 21 papers, there were 16 patients (61%) in their 2nd and 3rd decades of life. Lemierre syndrome was shown to affect females and males equally. The presenting symptoms were a sore throat and fever. Treatment requires intravenous antibiotics, and there is no consensus regarding treatment with anticoagulation. Conclusions The present case report and review of the literature emphasize the importance of history taking as well as physical examination in what seems to be a case of simple tonsillitis.
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Affiliation(s)
- Yehuda Schwarz
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Nadeem Habashi
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Noa Rosenfeld-Yehoshua
- Department of Pediatric Intensive Care Unit, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Eugene Soikher
- Department of Radiology, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
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Hwang SY, Shin SJ, Yoon HE. Lemierre's syndrome caused by Klebsiella pneumoniae: A case report. World J Nephrol 2021; 10:101-108. [PMID: 34631480 PMCID: PMC8477271 DOI: 10.5527/wjn.v10.i5.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/19/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lemierre's syndrome is a disease that causes anaerobic sepsis, internal jugular vein thrombosis, and septic embolism in the lungs and other organs after acute oropharyngeal infection. It was named after André-Alfred Lemierre in 1936.
CASE SUMMARY Here, we have reported a case of Lemierre’s syndrome in a 56-year-old female patient who presented with a sore throat. The patient had septic shock, had not voided, and had severe hyperglycemia at the time of her visit. Imaging tests revealed bilateral pneumonia, pleural effusion, pulmonary embolism, and renal vein thrombosis. The patient was admitted to the intensive care unit and placed on mechanical ventilation due to acute respiratory distress syndrome. Continuous renal replacement therapy was administered to treat renal failure with anuria. Klebsiella pneumoniae was cultured from blood and sputum samples. After reviewing various results, the patient was ultimately diagnosed with Lemierre’s syndrome. The patient was treated with appropriate antibiotics and thrombolytic agents. She was discharged from the hospital after recovery.
CONCLUSION Lemierre’s syndrome is associated with a high mortality rate. Therefore, clinicians should be familiar with the signs and symptoms of this disease as well as the preemptive examinations, procedures, and treatments.
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Affiliation(s)
- So Yeon Hwang
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, South Korea
| | - Seok Joon Shin
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, South Korea
| | - Hye Eun Yoon
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, South Korea
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Severiche-Bueno DF, Insignares-Niño DA, Severiche-Bueno DF, Vargas-Cuervo MT, Varón-Vega FA. Lemierre's syndrome by Bacillus circulans, Fusobacterium nucleatum and Staphylococcus aureus with involvement of the internal and external jugular vein. Germs 2021; 11:314-318. [PMID: 34422702 DOI: 10.18683/germs.2021.1267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/11/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
Introduction Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is Fusobacterium necrophorum. Case report A 27-year-old male, previously healthy, presented with a 7-day history of sore throat and fever. He was diagnosed with Lemierre's syndrome, coinfection by Bacillus circulans, F. nucleatum and Staphylococcus aureus with an atypical presentation due to the involvement of the external jugular vein and the internal jugular vein. Conclusions As far as we are aware, we present the first case of Lemierre's syndrome with these characteristics.
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Affiliation(s)
- Diego Fernando Severiche-Bueno
- MD, MSc, Fundación Neumológica Colombiana - Universidad de La Sabana, KM 7.5 Autopista Norte de Bogotá, Bogotá D.C, Colombia
| | | | | | | | - Fabio Andrés Varón-Vega
- MD, MSc, PhD, Fundación Neumológica Colombiana - Universidad de La Sabana, Fundación Cardioinfantil, Calle 163A # 13B - 85, Bogotá D.C, Colombia
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Moretti M, De Geyter D, Goethal L, Allard SD. Lemierre's syndrome in adulthood, a case report and systematic review. Acta Clin Belg 2021; 76:324-334. [PMID: 32116143 DOI: 10.1080/17843286.2020.1731661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Lemierre's syndrome is a septic thromboembolic complication of an oropharyngeal or neck infection, primarily caused by Fusobacterium species. Although it usually affects young healthy patients, some case reports describe this syndrome in older population.Methods: A case report and a systematic review of the literature were conducted to investigate the late onset of Lemierre's syndrome. Forty-one articles were selected for the qualitative analysis, 39 for the quantitative analysis.Results: The average age of the study population was 52 years old. Diabetes mellitus and upper gastro-intestinal malignancy, common comorbidities in the study population, might play a role in the development of late-onset Lemierre's syndrome. Empiric antibiotic treatment should cover Fusobacterium and Streptococcus species both, which may cooperate to induce purulent disease. Reported unfavourable outcome was more than expected.Conclusion: Lemierre's syndrome in adulthood may differ from the usual version. This disease may further pass unrecognized, if presented out of the expected age range. Nevertheless, early diagnosis and prompt treatment are a requisite to prevent morbidity and mortality, which may be higher in this older population.
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Affiliation(s)
- Marco Moretti
- Department of Internal Medicine and Infectious Disease, Vrije Universiteit Brussel, UZ Brussel, Belgium
| | - Deborah De Geyter
- Department of Microbiology, Vrije Universiteit Brussel, UZ Brussel, Belgium
| | - Lode Goethal
- Department of Radiology, Vrije Universiteit Brussel, UZ Brussel, Belgium
| | - Sabine D. Allard
- Department of Internal Medicine and Infectious Disease, Vrije Universiteit Brussel, UZ Brussel, Belgium
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An unusual case of Lemierre syndrome - One pathogen or two? IDCases 2021; 25:e01203. [PMID: 34221895 PMCID: PMC8243003 DOI: 10.1016/j.idcr.2021.e01203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/20/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
Lemierre Syndrome is characterized by thrombophlebitis of the internal jugular vein. The disease is rare, typically preceded by pharyngitis, and is caused usually by Fusobacterium necrophorum. In rare cases, Lemierre Syndrome is polymicrobial involving other oral microbes.
Lemierre syndrome, or septic thrombophlebitis of the internal jugular vein, is a rare disease that affects healthy young adults following an episode of pharyngitis or other upper respiratory disease. It most commonly involves the anaerobe Fusobacterium necrophorum, a component of normal oral flora. In this report, we present an unusual case of polymicrobial Lemierre syndrome involving both F. necrophorum and Group C streptococcus following an episode of pharyngitis and streptococcal toxic shock syndrome. Providers should consider the possibility of polymicrobial infection when there are imaging findings suggestive of Lemierre Syndrome and adjust antibiotic regimens accordingly.
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