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Shiran SI, Pratt LT, DeRowe A, Matot S, Neiderman NC, Wasserzug O. The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis. AJNR Am J Neuroradiol 2024; 45:761-768. [PMID: 38724201 PMCID: PMC11288586 DOI: 10.3174/ajnr.a8217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/05/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography. MATERIALS AND METHODS CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group). RESULTS Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly). CONCLUSIONS In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.
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Affiliation(s)
- Shelly I Shiran
- From the Department of Radiology (S.I.S., L.-t.P.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Li-Tal Pratt
- From the Department of Radiology (S.I.S., L.-t.P.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ari DeRowe
- Pediatric Otorhinolaryngology Unit, "Dana" Children's Hospital (A.D., O.W.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sophie Matot
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery (S.M., N.C.N.), Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin Carmel Neiderman
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery (S.M., N.C.N.), Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Pediatric Otorhinolaryngology Unit, "Dana" Children's Hospital (A.D., O.W.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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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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Pan Y, Shi Z, Ye B, Da Q, Wang C, Shen Y, Xiang M. Surgical intervention of Lemierre's syndrome: a case report and review of the literature. J Med Case Rep 2024; 18:265. [PMID: 38816729 PMCID: PMC11140976 DOI: 10.1186/s13256-024-04584-2] [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: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Lemierre's syndrome is a fatal and rare disease that is typically characterized by oropharyngeal infection and internal jugular vein thrombosis. Timely institution of appropriate antibiotics is the standard treatment. CASE PRESENTATION The authors report a case of Lemierre's syndrome. A 67-year-old male patient of Han ethnicity in China suffered from a large inflammatory neck mass involving left internal jugular vein thrombosis diagnosed as Lemierre's syndrome and finally cured by surgical treatment. In addition, a literature review was carried out through PubMed using the terms "Lemierre's syndrome/disease and review, meta-analysis or retrospective study" and "Lemierre's syndrome/disease and internal jugular vein". This search yielded six articles that recorded surgical methods such as drainage, craniotomy, tooth extraction, and ligation of the occluded vein to give clinicians more ideas about the treatment of the Lemierre's syndrome. CONCLUSION This is the first review to summarize the conditions under which surgical treatment are conducted. Additionally, this is the first report of such a large inflammatory neck mass that was completely cured by surgical resection and internal jugular vein ligation. The authors also offer several conclusions regarding surgical intervention in Lemierre's syndrome for the first time.
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Affiliation(s)
- Yiqi Pan
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Ye
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Da
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaofu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Shen
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mingliang Xiang
- Department of Otolaryngology and Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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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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Nygren D, Wasserstrom L, Torisson G, Holm K. Low usefulness of reporting tonsillar PCR Ct-values in pharyngeal infections with Fusobacterium necrophorum. Anaerobe 2024; 86:102831. [PMID: 38369049 DOI: 10.1016/j.anaerobe.2024.102831] [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: 10/23/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
Tonsillar Fusobacterium necrophorum PCR Ct-values were higher in participants with asymptomatic tonsillar carriage than patients with pharyngeal infections. However, Ct-values were not associated with severity of disease or predictive of development of complications and hence lacked clinical usefulness. The reporting of F. necrophorum Ct-values in clinical samples is not recommended.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden.
| | - Lisa Wasserstrom
- Clinical Microbiology Laboratory, Infection Control and Prevention, Laboratory Medicine, Lund, Sweden; Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden; Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Malmö, Sweden
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7
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Zhang H, Liu Z, Guan Y, Li D, Liu H, Ruan L. Case report: Metagenomics next-generation sequencing in the diagnosis of septic shock due to Fusobacterium necrophorum in a 6-year-old child. Front Cell Infect Microbiol 2024; 14:1236630. [PMID: 38435306 PMCID: PMC10904578 DOI: 10.3389/fcimb.2024.1236630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024] Open
Abstract
Fusobacterium necrophorum (F. necrophorum) infection is rare in pediatrics. In addition, the detection time of F. necrophorum by blood culture is long, and the positive rate is low. Infection with F. necrophorum bacilli usually follows rapid disease progression, resulting in high mortality. In previous reports of F. necrophorum-related cases, the most dangerous moment of the disease occurred after the appearance of Lemierre's syndrome. We report an atypical case of a 6-year-old female patient who developed septic shock within 24 h of admission due to F. necrophorum infection in the absence of Lemierre's syndrome. F. necrophorum was identified in a blood sample by metagenomics next-generation sequencing (mNGS) but not by standard blood culture. The patient was finally cured and discharged after receiving timely and effective targeted anti-infection treatment. In the present case study, it was observed that the heightened virulence and invasiveness of F. necrophorum contribute significantly to its role as a primary pathogen in pediatric septic shock. This can precipitate hemodynamic instability and multiple organ failure, even in the absence of Lemierre's syndrome. The use of mNGS can deeply and rapidly identify infectious pathogens, guide the use of targeted antibiotics, and greatly improve the survival rate of patients.
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Affiliation(s)
- Haiyang Zhang
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zhongqiang Liu
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yuanlin Guan
- Depertment of Bioinformation, Hugobiotech Co., Ltd., Beijing, China
| | - Deyuan Li
- Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingying Ruan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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8
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Khan A, Alzghoul H, Khan AA, Allada G, Gronquist JM, Pak J, Mukundan S, Zakhary B, Wusirika R, Sher N, Reddy R. Epidemiology and Clinical Outcomes of Fusobacterium Infections: A Six-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:248. [PMID: 38399536 PMCID: PMC10890494 DOI: 10.3390/medicina60020248] [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: 12/25/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Anaerobic bacteria like Fusobacterium can lead to severe and life-threatening infections. The inherent complexities in the isolation of these bacteria may result in diagnostic and therapeutic delays, thereby escalating both morbidity and mortality rates. We aimed to examine data from patients with infections due to Fusobacterium to gain insights into the epidemiology and clinical outcomes of patients with these infections. Methods and Results: We conducted a retrospective analysis of clinical data from a cohort of patients with cultures positive for Fusobacterium species at a tertiary care medical center in the United States. Between 2009 and 2015, we identified 96 patients with cultures positive for Fusobacterium. Patients could be categorized into three groups based on the site of primary infection. Patients with head and neck infections constituted 37% (n 36). Patients with infections of other soft tissue sites accounted for 38.5% (n 37). Patients with anaerobic bacteremia due to Fusobacterium formed 24% (n 23) of the cohort. Surgical intervention coupled with antibiotic therapy emerged as cornerstones of management for patients with head and neck or other soft tissue infections, who generally exhibited more favorable outcomes. Patients with bacteremia were older, more likely to have malignancy, and had a high mortality rate. When speciation was available, Fusobacterium necrophorum was the most frequently isolated species. Conclusions: Our retrospective analysis of epidemiology and clinical outcomes of Fusobacterium infections revealed three distinct cohorts. Patients with head, neck, or soft tissue infections had better outcomes than those with bacteremia. Our findings highlight the importance of employing management strategies based on infection site and underlying comorbidities in patients with Fusobacterium infections. Further research is needed to investigate the optimal therapeutic strategies and identify prognostic indicators to improve clinical outcomes for these complex infections.
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Affiliation(s)
- Akram Khan
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
| | - Hamza Alzghoul
- Graduate Medical Education, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
| | - Abdul Ahad Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Banner University Medical Center, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85721, USA; (A.A.K.)
| | - Gopal Allada
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
| | | | - Jonathan Pak
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
| | - Srini Mukundan
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR 97239-3098, USA;
| | - Bishoy Zakhary
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
| | - Raghav Wusirika
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
| | - Nehan Sher
- Division of Pulmonary, Critical Care and Sleep Medicine, Banner University Medical Center, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85721, USA; (A.A.K.)
| | - Raju Reddy
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA (B.Z.)
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Thomas M, Peterson CJ, Mazin LN, Rawlins J. Lemierre Syndrome With Streptococcus constellatus Bacteremia. Cureus 2023; 15:e50580. [PMID: 38222167 PMCID: PMC10788095 DOI: 10.7759/cureus.50580] [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: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has made this a rarer syndrome, it can nevertheless manifest in patients presenting with pharyngitis. Herein, we describe a 20-year-old male patient with no relevant medical history presenting with signs concerning for pneumonia and was ultimately diagnosed with Lemierre syndrome with Streptococcus constellatus bacteremia. Complications included IJV thrombus with presumed septic emboli to the lungs. The patient was discharged on ampicillin/sulbactam with plans to transition to amoxicillin/clavulanate.
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Affiliation(s)
- Miles Thomas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Lauren N Mazin
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Jonas Rawlins
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
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Abstract
Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, University Medical Center at the Johannes Gutenberg University, Mainz, Germany
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Division of Public Health, Infectious Diseases and Occupational Health, Rochester, Minnesota
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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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12
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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: 0] [Impact Index Per Article: 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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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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Mishima K, Aoki K, Shirai Y, Aritomo H, Iwasaka M, Katsura M, Tatsutani T, Ikeuchi H, Oryoji K, Mizuki S. Elderly onset atypical Lemierre's syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report. BMC Infect Dis 2023; 23:145. [PMID: 36890459 PMCID: PMC9993631 DOI: 10.1186/s12879-023-08089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Typical Lemierre's syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre's syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck. CASE PRESENTATION We describe an atypical Lemierre's syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre's syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day. CONCLUSION Clinicians should consider Lemierre's syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.
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Affiliation(s)
- Koji Mishima
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.
| | - Kazunobu Aoki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Yusuke Shirai
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan.,Department of Respiratory Medicine, Japanese Red Cross Ishinomaki Hospital, Miyagi Prefecture, Ishinomaki City, Japan
| | - Hiroshi Aritomo
- Department of Otorhinolaryngology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Maiko Iwasaka
- Division of Dermatology, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Masakazu Katsura
- Department of Thoracic Surgery, Matsuyama Red Cross Hospital, Matsuyama City, Ehime Prefecture, Japan
| | - Tomofumi Tatsutani
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Hiroko Ikeuchi
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Kensuke Oryoji
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
| | - Shinichi Mizuki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyomachi, Ehime Prefecture, 790-8524, Matsuyama City, Japan
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Constans S, Bosshard T, Petignat PA, Le Peillet D. Atypical involvement of the thyro-linguo-facial vein in Lemierre syndrome. BMJ Case Rep 2022; 15:e251722. [PMID: 36379635 PMCID: PMC9667992 DOI: 10.1136/bcr-2022-251722] [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: 11/16/2022] Open
Abstract
Fusobacterium necrophorum is a Gram-negative anaerobic bacterium that can lead to severe infection in young patients even without immunodeficiency. Due to the length of time for isolation and speciation of this Gram-negative bacillus (typically 5-8 days), and its potential mortality, broad-spectrum antibiotic therapy should be started without delay. With a cervical thrombosis, even on an unusual site and with a standard condition such as tonsillitis, Lemierre syndrome should be considered. We report a case of Lemierre syndrome in a previously healthy young woman.
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Affiliation(s)
- Sophie Constans
- Internal Medicine, Valais Hospital, Sion, Valais, Switzerland
| | - Thomas Bosshard
- Internal Medicine, Valais Hospital, Sion, Valais, Switzerland
| | - Pierre-Auguste Petignat
- Internal Medicine, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Valais, Switzerland
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16
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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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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: 6] [Impact Index Per Article: 3.0] [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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King JP, Matthews L, Ashai S. Atypical presentation of Lemierre syndrome in a young healthy man with acute jaundice. BMJ Case Rep 2022; 15:e249824. [PMID: 36129352 PMCID: PMC9438057 DOI: 10.1136/bcr-2022-249824] [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: 11/04/2022] Open
Abstract
This report presents a case of Lemierre syndrome caused by Fusobacterium necrophorum in a healthy young adult who presented atypically with shortness of breath and jaundice but no clinical or diagnostic evidence of thrombophlebitis. Due to this unusual presentation with jaundice, diagnosis was challenging and delayed. However, the patient was successfully initiated on a prolonged course of intravenous antibiotics; he required a period in the intensive care unit and was discharged without significant complications. This report aims to raise awareness of the diagnosis and treatment of this rare condition and to highlight both common and unusual presentations of the syndrome.
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Affiliation(s)
| | - Lauren Matthews
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
| | - Shanze Ashai
- Jack Steinberg Critical Care Unit, King's College Hospital, London, UK
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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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Thapa G, Jayal A, Sikazwe E, Perry T, Mohammed Al Balushi A, Livingstone P. A genome-led study on the pathogenesis of Fusobacterium necrophorum infections. Gene 2022; 840:146770. [PMID: 35905848 DOI: 10.1016/j.gene.2022.146770] [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: 05/24/2022] [Revised: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 11/04/2022]
Abstract
Fusobacterium necrophorum causes a range of mild to life threatening infections and there is uncertainty in terms of diagnosis and treatment due to the lack of knowledge on their pathogenic mechanisms. This study characterised genomes of F. necrophorum to compare their virulence factors and investigate potential infection markers. 27 isolates of F. necrophorum from patients with pharyngotonsillitis were subjected to whole genome sequencing and compared with 42 genomes published in the NCBI database. Phylogenomics, pangemome, pan-GWAS and virulome were analysed to study strain variations with reference to virulence factors. Core genome based phylogenomic tree exhibited three clades of which Clade A belonged to F. necrophorum subsp necrophorum, clades B and C were F. necrophorum subsp funduliforme. Pan-GWAS and Pan-Virulome suggest some marker genes associated with clinical sources of isolation that needs further validation. Our study highlights some interesting features of the pathogenesis of F. necrophorum infections. Although the animal isolate genomes had some marker genes, the genomes of human isolates did not exhibit clear correlation to their clinical sources of isolation. This prompts to think of other mechanisms such as co-infections or host factors that can be involved in the pathogenesis.
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Affiliation(s)
- Gary Thapa
- Public Health Wales Microbiology Aberystwyth, Bronglais General Hospital, Aberystwyth
| | - Ambikesh Jayal
- School of Information Systems and Technology, University of Canberra, Australia
| | - Elvis Sikazwe
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Thomas Perry
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Ali Mohammed Al Balushi
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Paul Livingstone
- School of Sports and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.
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21
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Cao P, Chen Q, Shi C, Wang L, Gong Z. Fusobacterium nucleatum promotes the development of acute liver failure by inhibiting the NAD + salvage metabolic pathway. Gut Pathog 2022; 14:29. [PMID: 35765030 PMCID: PMC9238040 DOI: 10.1186/s13099-022-00503-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute liver failure (ALF) patients are often accompanied by severe energy metabolism abnormalities and intestinal microecological imbalance. The intestinal mucosal barrier is severely damaged. Intestinal endotoxin can induce intestinal endotoxemia through the "Gut-Liver axis". More and more evidence shows that members of the gut microbiota, especially Fusobacterium nucleatum (F. nucleatum), are related to inflammatory bowel disease, but whether F. nucleatum is involved in the development of ALF and whether it affects the liver energy metabolism is unclear. METHODS This study first detected the abundance of F. nucleatum and its effect on ALF disease, and explored whether F. nucleatum aggravated liver inflammation in vitro and in vivo. RESULTS Our data showed that liver tissues of ALF patients contained different abundances of F. nucleatum, which were related to the degree of liver inflammation. In addition, we found that F. nucleatum infection affected the energy metabolism of the liver during the development of ALF, inhibited the synthesis pathway of nicotinamide adenine dinucleotide (NAD+)'s salvage metabolism, and promoted inflammatory damage in the liver. In terms of mechanism, F. nucleatum inhibited NAD+ and the NAD+-dependent SIRT1/AMPK signaling pathway, and promoted liver damage of ALF. CONCLUSIONS Fusobacterium nucleatum coordinates a molecular network including NAD+ and SIRT1 to control the progress of ALF. Detection and targeting of F. nucleatum and its related pathways may provide valuable insights for the treatment of ALF.
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Affiliation(s)
- Pan Cao
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jie Fang Road, Wuhan, 430060, People's Republic of China
| | - Qian Chen
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jie Fang Road, Wuhan, 430060, People's Republic of China
| | - Chunxia Shi
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jie Fang Road, Wuhan, 430060, People's Republic of China
| | - Luwen Wang
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jie Fang Road, Wuhan, 430060, People's Republic of China
| | - Zuojiong Gong
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jie Fang Road, Wuhan, 430060, People's Republic of China.
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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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Lee SJ, Baek YJ, Kim JN, Lee KH, Lee EH, Yeom JS, Choi JY, Ku NS, Ahn JY, Kim JH, Jeong SJ. Increasing Fusobacterium infections with Fusobacterium varium, an emerging pathogen. PLoS One 2022; 17:e0266610. [PMID: 35421136 PMCID: PMC9009667 DOI: 10.1371/journal.pone.0266610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Infections caused by Fusobacterium species are rare; however serious infections with complications or mortality may occur occasionally. We conducted a retrospective study to investigate the clinical features of patients with Fusobacterium infections and the differences between infections caused by the species F. necrophorum, F. nucleatum, and F. varium. Additionally, we attempted to identify risk factors for Fusobacterium-associated mortality. This study included all patients at a large tertiary care teaching hospital in South Korea with Fusobacterium infections from January 2006 to April 2021. Demographic, clinical, laboratory, and outcome data were analyzed. Multiple logistic regression analysis was performed to assess the risk factors for in-hospital mortality associated with F. nucleatum and F. varium infections. We identified 272 patients with Fusobacterium infections during the study period. The number of Fusobacterium cases has increased recently, with F. varium infections markedly increasing since 2016 and causing a significant proportion of infections. Patients with F. varium infections were older and had a higher proportion of nosocomial infections than the other groups. The F. nucleatum and F. varium groups showed higher in-hospital mortality than the F. necrophorum group. Through logistic regression analysis, APACHE II score and serum albumin level were considered risk factors for in-hospital mortality. APACHE II score was positively correlated with age, red cell distribution width, and serum blood urea nitrogen, and negatively correlated with serum albumin level. Infections caused by Fusobacterium species are increasing. F. varium causes a significant proportion of severe infections.
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Affiliation(s)
- Se Ju Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Yae Jee Baek
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Jin Nam Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Ki Hyun Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Eun Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Joon Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Nam Su Ku
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Jin Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Seoul, South Korea
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24
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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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Kreuzpointner R, Valerio L, Corsi G, Zane F, Sacco C, Holm K, Righini C, Pecci A, Zweifel S, Barco S. Ophthalmic complications of Lemierre syndrome. Acta Ophthalmol 2022; 100:e314-e320. [PMID: 33829646 DOI: 10.1111/aos.14871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. METHODS We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). RESULTS Nine (33%) patients were women; the median age was 20 (Q1-Q3: 15-33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. CONCLUSION Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.
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Affiliation(s)
| | - Luca Valerio
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES) Alma Mater Studiorum University of Bologna Bologna Italy
- Department of Pneumology and Respiratory Intensive Therapy Unit St Orsola University Hospital Bologna Italy
| | - Federica Zane
- Department of General Medicine Hospital of Sondrio Sondrio Italy
| | - Clara Sacco
- Thrombosis and Haemorrhagic Diseases Center Humanitas Clinical and Research Center‐IRCCS Milan Italy
| | - Karin Holm
- Department of Clinical Sciences Division of Infection Medicine Skåne University Hospital Lund University Lund Sweden
| | - Christian Righini
- Department of ENT, Head and Neck Surgery University Hospital of Grenoble Grenoble France
| | - Alessandro Pecci
- Department of Internal Medicine IRCCS Policlinico San Matteo Foundation and University of Pavia Pavia Italy
| | - Sandrine Zweifel
- Department of Ophthalmology University Hospital Zurich Zurich Switzerland
- University of Zurich Zurich Switzerland
| | - Stefano Barco
- Clinic of Angiology University Hospital Zurich Zurich Switzerland
- Center for Thrombosis and Hemostasis University Medical Center Mainz Mainz Germany
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Ling JM, Wang ZH, Yan L. Severe thrombocytopenia and jaundice associated with Lemierre's syndrome: A case report. World J Emerg Med 2022; 13:75-77. [PMID: 35003423 PMCID: PMC8677911 DOI: 10.5847/wjem.j.1920-8642.2022.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jian-Min Ling
- Emergency and Intensive Care Unit, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhao-Hua Wang
- Emergency and Intensive Care Unit, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li Yan
- Emergency and Intensive Care Unit, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Xiao J, Jiang J, He X, Zhang S, Wang Z, Wang F, Wang L, Guo D. Evaluation of Immunoprotective Effects of Fusobacterium necrophorum Outer Membrane Proteins 43K OMP, Leukotoxin and Hemolysin Multi-Component Recombinant Subunit Vaccine in Mice. Front Vet Sci 2021; 8:780377. [PMID: 34938794 PMCID: PMC8685265 DOI: 10.3389/fvets.2021.780377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022] Open
Abstract
We evaluated the efficacy of three vaccine formulations containing different combinations of proteins (43K OMP, leukotoxin recombinant protein PL4 and hemolysin recombinant protein H2) and killed whole cell Fusobacterium necrophorum in preventing liver abscess. Four subcutaneous vaccines were formulated: vaccine 1 (43K OMP), vaccine 2 (PL4 and H2), vaccine 3 (43K OMP, PL4 and H2), and vaccine 4 (killed whole bacterial cell). 43K OMP, PL4, and H2 proteins were produced by using recombinant protein expression. To evaluate vaccine efficacy, we randomly allocated 50 BALB/c female mice to one of five different treatment groups: PBS control group, vaccine 1, vaccine 2, vaccine 3, and vaccine 4. Mice were vaccinated three times, with 14 days between each immunization. After immunization, the mice were challenged with F. necrophorum. The three key findings of this study are as follows: (1) Vaccine 3 has enabled mice to produce higher antibody titer following bacterial challenge, (2) in the liver pathology of mice, the vaccine 3 liver showed the least pathology, and (3) all four vaccines produced high levels of antibodies and cytokines in mice, but the level of vaccine 3 was the highest. Based on our results, it has been demonstrated that a mixture of F. necrophorum 43K OMP, PL4, and H2 proteins inoculated with mice can achieve protection against liver abscess in mice. Our research may therefore provide the basis for the development of a vaccine against F. necrophorum bovine infections.
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Nygren D, Oldberg K, Holm K. Short blood culture time-to-positivity in Fusobacterium necrophorum bacteremia is associated with Lemierre's syndrome. Anaerobe 2021; 73:102474. [PMID: 34758377 DOI: 10.1016/j.anaerobe.2021.102474] [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] [Received: 03/09/2021] [Revised: 09/29/2021] [Accepted: 11/02/2021] [Indexed: 11/01/2022]
Abstract
The usefulness of blood culture time-to-positivity (TTP) in the diagnosis of endovascular infections has previously been shown. Here, we investigated TTP in 41 patients with F. necrophorum bacteraemia and found an association between short TTP and Lemierre's syndrome (p = 0.026).
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Medical Faculty, Lund University, Lund, Sweden.
| | - Karl Oldberg
- Division of Infection Medicine, Department for Clinical Sciences Lund, Medical Faculty, Lund University, Lund, Sweden; Clinical Microbiology, Labmedicin, Region Skåne, Lund, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Medical Faculty, Lund University, Lund, Sweden
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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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Abstract
Lemierre syndrome is a rare form of septic thrombophlebitis of the head and neck veins, most typically the internal jugular vein, which affects otherwise healthy adolescents and young adults after an oropharyngitis or other local infection and is characterized by multiple septic embolization. Despite treatment, Lemierre syndrome displays a high rate of in-hospital complications that include thrombus progression and new peripheral septic embolization, and it can be fatal or cause disabling sequelae. The mainstay of treatment is antibiotic therapy; anticoagulation is often used, but its role is controversial. Surgical treatment is often necessary in case of peripheral septic lesions. In the absence of prospective studies, what little guidance exists on its management is based on case series or on analogy with similar conditions such as other forms of septic thrombophlebitis or non-septic venous thrombosis. Over the last few years, new observational evidence has improved our knowledge of the clinical epidemiology of this condition and highlighted a number of promising management strategies. We provide an overview of the treatment patterns observed in the contemporary era, summarise the arguments proposed so far against or in favour of alternative treatments as well as possible decision rules on the use of anticoagulation, and outline the priorities of ongoing and future observational and interventional research.
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Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center, University of Mainz, Mainz, Germany -
| | - William Pleming
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Nygren D, Brorson E, Musonda M, Wasserstrom L, Johansson Å, Holm K. Geographical differences in tonsillar carriage rates of Fusobacterium necrophorum - A cross-sectional study in Sweden and Zambia. Anaerobe 2021; 69:102360. [PMID: 33757851 DOI: 10.1016/j.anaerobe.2021.102360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022]
Abstract
While Fusobacterium necrophorum historically has been considered normal tonsillar flora, recent studies from Europe and the US have suggested that carriage occur transiently in adolescence and young adulthood. However, no studies originating from Africa exist. In this cross-sectional study of tonsillar carriage of F. necrophorum, we aimed to investigate geographical differences in tonsillar carriage rates of F. necrophorum in healthy participants aged 15-25 years in Sweden and Zambia and further investigate the age distribution of tonsillar carriage in Zambia. Specimens were obtained by tonsillar swabs and analyzed with real-time PCR for F. necrophorum. In participants aged 15-25 years, tonsillar carriage was more common in Sweden 21/100 (21%) than in Zambia 6/192 (3%), p < 0.001. In Zambian participants aged above 25 years tonsillar carriage was rare 1/76 (1%). In conclusion, the high rate of tonsillar carriage in participants aged 15-25 years in Sweden has implications on the interpretation of tonsillar findings in patients with pharyngotonsillitis. Interestingly, a geographical difference was found with tonsillar carriage rarely identified in Zambia.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Ellen Brorson
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Lisa Wasserstrom
- Clinical Microbiology Laboratory, Skåne University Hospital, Lund, Sweden
| | | | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
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Valerio L, Corsi G, Granziera S, Holm K, Hotz MA, Jankowski M, Konstantinides SV, Kucher N, Nicoletti T, Reinhardt C, Righini C, Sacco C, Trinchero A, Zane F, Pecci A, Barco S. Sex differences in Lemierre syndrome: Individual patient-level analysis. Thromb Res 2021; 202:36-39. [PMID: 33713865 DOI: 10.1016/j.thromres.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Luca Valerio
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
| | - Gabriele Corsi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Serena Granziera
- Department of Geriatrics, San Giovanni e Paolo Hospital, Venice, Italy
| | - Karin Holm
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
| | - Michel-André Hotz
- Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
| | - Marius Jankowski
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
| | - Tommaso Nicoletti
- Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy; Institute of Neurology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Christoph Reinhardt
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
| | - Christian Righini
- Department of ENT, Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France.
| | - Clara Sacco
- Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Alice Trinchero
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
| | - Federica Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
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Valerio L, Zane F, Sacco C, Granziera S, Nicoletti T, Russo M, Corsi G, Holm K, Hotz MA, Righini C, Karkos PD, Mahmoudpour SH, Kucher N, Verhamme P, Di Nisio M, Centor RM, Konstantinides SV, Pecci A, Barco S. Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases. J Intern Med 2021; 289:325-339. [PMID: 32445216 DOI: 10.1111/joim.13114] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. METHODS In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. RESULTS The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26 died (4.0%; 2.7-5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2-13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). CONCLUSIONS Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.
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Affiliation(s)
- L Valerio
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - F Zane
- Department of General Medicine, Hospital of Sondrio, Sondrio, Italy
| | - C Sacco
- Thrombosis and Hemostasis Center, Humanitas Research Hospital and Humanitas University, Rozzano, Italy
| | - S Granziera
- Department of Physical and Rehabilitation Medicine, "Villa Salus" Hospital, Mestre, Italy
| | - T Nicoletti
- Institute of Neurology, Catholic University of the Sacred Heart and Institute of Neurology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - M Russo
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - G Corsi
- Department of Emergency Medicine, San Giovanni Calibita Fatebenefratelli Hospital, AFAR, Rome, Italy
| | - K Holm
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
| | - M-A Hotz
- Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - C Righini
- Department of ENT, Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France
| | - P D Karkos
- Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S H Mahmoudpour
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Institute for Medical Biostatistics, Epidemiology, and Informatics (IMBEI), Department of Biometry and Bioinformatics, University Medical Center Mainz, Mainz, Germany
| | - N Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - P Verhamme
- Department of Vascular Medicine and Hemostasis, University Hospitals Leuven, Leuven, Belgium
| | - M Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - R M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - S V Konstantinides
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - S Barco
- From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Valerio L, Corsi G, Sebastian T, Barco S. Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry. Thromb Res 2020; 196:494-499. [DOI: 10.1016/j.thromres.2020.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/24/2023]
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Nygren D, Elf J, Torisson G, Holm K. Jugular Vein Thrombosis and Anticoagulation Therapy in Lemierre's Syndrome -A Post Hoc Observational and Population-Based Study of 82 Patients. Open Forum Infect Dis 2020; 8:ofaa585. [PMID: 33447643 PMCID: PMC7793455 DOI: 10.1093/ofid/ofaa585] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Lemierre’s syndrome is typically caused by Fusobacterium necrophorum where an oropharyngeal infection is followed by septic internal jugular vein thrombophlebitis with subsequent septic embolization. Yet, the pathogenesis of septic thrombophlebitis, differences dependent on the presence of jugular vein thrombosis, and the role of anticoagulant therapy are insufficiently understood. Methods Patients with invasive infection with F. necrophorum and Lemierre’s syndrome who had been investigated for jugular vein thrombosis were included from a previous population-based observational study in Sweden. Medical records were reviewed and compared in patients with and without jugular vein thrombosis. Then, patients with jugular vein thrombosis were compared by exposure to therapeutic, prophylactic, or no anticoagulation. Outcomes examined were thrombosis progression, early or late peripheral septic complications, chronic major sequelae, 30-day mortality, and major bleeding. Results Fifty-one of 82 (62%) radiologically investigated patients with Lemierre’s syndrome had jugular vein thrombosis. Patients with jugular vein thrombosis had lower platelet levels (median, 76 vs 112 ×109/L; P = .04) on presentation and more days to defervesence (12 vs 7 days; P = .03) yet similar rates of major sequelae and 30-day mortality. No significant differences in outcomes were seen between patients with jugular vein thrombosis exposed to therapeutic, prophylactic, or no anticoagulation therapy, yet study outcomes were rare. Conclusions Patients with Lemierre’s syndrome with jugular vein thrombosis were more severely affected, yet had similar prognosis. Most patients with jugular vein thrombosis recovered well without therapeutic anticoagulation therapy, though adverse events were similarly rare in anticoagulated patients. The observational design and rarity of study outcomes require cautious interpretation.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johan Elf
- Center of Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department for Clinical Sciences Lund, Lund University, Lund, Sweden
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Dasari SP, Gill H, Bodette H, Brandes E, Jha P. A Challenging Case of Lemierre’s Syndrome With Central Nervous System Involvement and a Comprehensive Review. Cureus 2020; 12:e10131. [PMID: 32879837 PMCID: PMC7456631 DOI: 10.7759/cureus.10131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lemierre’s syndrome (LS) is a complex medical condition that is characterized by an acute oropharyngeal infection leading to thrombophlebitis of the internal jugular vein and an eventual metastatic spread to distant vital organs. This metastatic spread is from septic emboli and is most frequently seen in the lungs, kidneys, and large joints. Central nervous system (CNS) involvement in LS is extremely rare, and only a few cases of CNS involvement have been reported in the literature. For all cases of LS, early diagnosis and treatment are crucial, yet due to the rarity of CNS complications in LS, diagnostic patterns and treatment algorithms are not fully understood for this subset of presentations. In this report, we present a case of 19-year-old immune-competent female who presented with a Fusobacterium oropharyngeal infection that was complicated by suppurative sinusitis, cavernous sinus thrombosis, meningitis, and an abducens nerve palsy. Our patient was treated with broad-spectrum antibiotics, anticoagulation, and multiple surgical interventions. This case highlights the importance of an early diagnosis and a multidisciplinary approach in managing LS to minimize the mortality and long-term morbidity of this relatively rare and complicated multisystem disease.
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