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Alhalabi M, Nasri D, Aji W. Portal vein thrombosis as extraintestinal complications of Crohn's disease: a case report and review of literature. J Med Case Rep 2024; 18:246. [PMID: 38741148 DOI: 10.1186/s13256-024-04560-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: 10/10/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Thrombotic events are more than twice as common in inflammatory bowel disease patients as in the general population. We report an interesting and rare case of portal vein thrombosis as a venous thromboembolic event in the context of extraintestinal manifestations of Crohn's disease. We also conducted a literature review on portal vein thrombosis associated with inflammatory bowel disease, with the following concepts: inflammatory bowel diseases, ulcerative colitis, Crohn's disease, portal vein, and thrombosis. CASE PRESENTATION A 24-year-old Syrian female with active chronic Crohn's disease was diagnosed 11 years ago and classified as A1L3B1P according to the Montreal classification. She had no prior surgical history. Her previous medications included azathioprine and prednisolone. Her Crohn's disease activity index was 390 points. Gastroduodenoscopy revealed grade I esophageal varices, a complication of portal hypertension. Meanwhile, a colonoscopy revealed several deep ulcers in the sigmoid, rectum, and descending colon. An investigation of portal vein hypertension revealed portal vein thrombosis. We used corticosteroids to induce remission, followed by tapering; additionally she received ustekinumab to induce and maintain remission. She began on low-molecular-weight heparin for 1 week, warfarin for 3 months, and then apixaban, a novel oral anticoagulant, after excluding antiphospholipid syndrome. Primary prophylaxis for esophageal varices was not required. After 1 year, she achieved clinical, biochemical, and endoscopic remission. Despite 1 year of treatment, a computed tomography scan revealed no improvement in portal vein recanalization. CONCLUSION Portal vein thrombosis is a rare and poorly defined complication of inflammatory bowel disease. It is usually exacerbated by inflammatory bowel disease. The symptoms are nonspecific and may mimic a flare-up of inflammatory bowel disease, making the diagnosis difficult. Portal vein Doppler ultrasound for hospital-admitted inflammatory bowel disease patients may contribute to the diagnosis and management of this complication.
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Affiliation(s)
- Marouf Alhalabi
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria.
| | - Duaa Nasri
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria
| | - Widad Aji
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria
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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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Liu C, Zhang H, Li T, Jiang Z, Yuan Y, Chen X. Fusobacterium nucleatum Promotes Megakaryocyte Maturation in Patients with Gastric Cancer via Inducing the Production of Extracellular Vesicles Containing 14-3-3ε. Infect Immun 2023; 91:e0010223. [PMID: 37404144 PMCID: PMC10429653 DOI: 10.1128/iai.00102-23] [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: 03/16/2023] [Accepted: 06/11/2023] [Indexed: 07/06/2023] Open
Abstract
Fusobacterium nucleatum colonization contributes to the occurrence of portal vein thrombosis in patients with gastric cancer (GC). However, the underlying mechanism by which F. nucleatum promotes thrombosis remains unclear. In this study, we recruited a total of 91 patients with GC and examined the presence of F. nucleatum in tumor and adjacent non-tumor tissues by fluorescence in situ hybridization and quantitative PCR. Neutrophil extracellular traps (NETs) were detected by immunohistochemistry. Extracellular vesicles (EVs) were extracted from the peripheral blood and proteins in the EVs were identified by mass spectrometry (MS). HL-60 cells differentiated into neutrophils were used to package engineered EVs to imitate the EVs released from NETs. Hematopoietic progenitor cells (HPCs) and K562 cells were used for megakaryocyte (MK) in vitro differentiation and maturation to examine the function of EVs. We observed that F. nucleatum-positive patients had increased NET and platelet counts. EVs from F. nucleatum-positive patients could promote the differentiation and maturation of MKs and had upregulated 14-3-3 proteins, especially 14-3-3ε. 14-3-3ε upregulation promoted MK differentiation and maturation in vitro. HPCs and K562 cells could receive 14-3-3ε from the EVs, which interacted with GP1BA and 14-3-3ζ to trigger PI3K-Akt signaling. In conclusion, we identified for the first time that F. nucleatum infection promotes NET formation, which releases EVs containing 14-3-3ε. These EVs could deliver 14-3-3ε to HPCs and promote their differentiation into MKs via activation of PI3K-Akt signaling.
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Affiliation(s)
- Chang Liu
- Department of Critical Care Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
- Department of Cardiovascular Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - He Zhang
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Tiepeng Li
- Department of Immunology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Zhiqiang Jiang
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Yiqiang Yuan
- Department of Cardiovascular Medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiovascular Medicine, The 7th People’s Hospital of Zhengzhou, Henan Cardiovascular Hospital Affiliated to Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Zhengzhou, Henan, China
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou, Henan, China
| | - Xiaobing Chen
- Department of Gastrointestinal Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
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A Rare Twist of the Forgotten Disease: A Case of Fusobacterium necrophorum Sepsis with Portomesenteric Thrombosis and a Review of the Literature. Case Rep Gastrointest Med 2021; 2021:6699867. [PMID: 34136289 PMCID: PMC8177980 DOI: 10.1155/2021/6699867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/22/2021] [Indexed: 01/16/2023] Open
Abstract
Abdominal variants of Lemierre's syndrome presenting with pylephlebitis are rare, and the role of anticoagulation in treatment is controversial. We hereby report a case of pylephlebitis secondary to F. necrophorum bacteremia in a 57-year-old female originating from bacterial translocation secondary to colitis, who developed a favorable outcome with prompt treatment with antibiotics and anticoagulation. We also perform a literature review on similar cases in the literature and discuss management options of this rare but potentially fatal complication.
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Tharu B, Nigussie B, Woredekal D, Abaleka FI, Gizaw M. A Sporadic Case of Disseminated Fusobacterium Causing Pylephlebitis and Intracranial and Hepatic Abscesses in a Healthy Young Patient. Cureus 2020; 12:e9229. [PMID: 32742883 PMCID: PMC7384457 DOI: 10.7759/cureus.9229] [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] [Indexed: 11/28/2022] Open
Abstract
Fusobacterium species is known for being a causative agent for Lemierre’s syndrome, which is characterized by thrombophlebitis of the jugular vein. However, Fusobacterium species causing Lemierre’s variant gastrointestinal syndrome has only been reported in case reports. We present a case of Fusobacterium causing hepatic vein pylephlebitis, multiple brain abscesses, and hepatic abscess. To the best of our knowledge, there have only been four other case reports of Fusobacterium causing hepatic abscesses with associated septic pylephlebitis in the literature.
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Affiliation(s)
- Biswaraj Tharu
- Internal Medicine, Western Reserve Health Education/NEOMED, Youngstown, USA
| | - Bisrat Nigussie
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Daniel Woredekal
- Department of Medicine, Trumbull Regional Medical Center, Youngstown, USA
| | - Fuad I Abaleka
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
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Almohaya AM, Almutairy TS, Alqahtani A, Binkhamis K, Almajid FM. Fusobacterium bloodstream infections: A literature review and hospital-based case series. Anaerobe 2020; 62:102165. [PMID: 32004686 DOI: 10.1016/j.anaerobe.2020.102165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infections with Fusobacterium, an anaerobic bacterium, have various clinical presentations, including bacteremia and Lemierre syndrome. Here, we report a case series of Fusobacterium bacteremia (FBB) from the largest academic center in Riyadh, Saudi Arabia, and provide a review of cases in the available literature. METHOD Records were retrospectively reviewed for all patients with at least one blood culture positive for Fusobacterium spp. admitted at King Khalid University Hospital, Riyadh, Saudi Arabia, between May 2015 to April 2019. LITERATURE REVIEW We conducted a MeSH Search on MedLine using the following terms: ("Bacteremia"[Mesh]) AND "Fusobacterium"[Mesh] for studies conducted from January 1, 1990, until March 30, 2019, excluding articles that lacked adequate clinical or microbiological details for individuals patients. Odds ratios and results of Chi-Square testing obtained in SPSS (Version 23.0, SPSS, Inc., Chicago, IL, USA) were considered statistically significant at p-values < 0.05. RESULTS Seven cases from our center and 205 cases from the literature were reviewed in this first reported case series for the region. Our patient series was similar to previous ones in terms of median age (45 vs. 45.5 years) and male predominance (85% vs. 65.9%). The species of Fusobacterium cultured from our cases were F. nucleatum (4 cases), F. varium (1 case), F. mortiferum (1 case), and one that could not be identified to the species level (1 case). We also report one case of FBB with renal vein thrombosis resembling that of atypical Lemierre syndrome. Analysis of literature cases revealed that bacteremia caused by the species most commonly associated with FBB, F. necrophorum, tended to be present in patients less than 40 years of age and be associated with head and neck infections and other complications, whereas F. nucleatum tended to affect people more than 40 years of age and be associated with mortality. CONCLUSION Although FBB is rarely reported in the literature, this case series and review of the literature suggests it is associated with morbidity and mortality. The type and duration of therapy used in these cases are underreported. Further research is needed to determine the most appropriate screening approach for FBB-associated complications and explore the relationship between FBB and specific malignancies, as well as optimal treatment type and duration.
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Affiliation(s)
- Abdulellah Musaid Almohaya
- Infectious Diseases Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Talal Saad Almutairy
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pathology and Clinical Laboratory Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulah Alqahtani
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Microbiology and Immunology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Khalifa Binkhamis
- Microbiology Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Mohammed Almajid
- Infectious Diseases Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Fusobacterium-Associated Pylephlebitis Complicated by Hepatic Abscess Following Roux-en-Y Gastric Bypass Surgery–Gastrointestinal Variant of Lemierre Syndrome. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Schweigart JH, Klotsas A, Schelenz S, Dhatariya K. Portal Vein Thrombosis despite Anticoagulation in a Person with Diabetes. J R Soc Med 2017; 98:161-3. [PMID: 15805557 PMCID: PMC1079440 DOI: 10.1177/014107680509800406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- J H Schweigart
- Department of Diabetes, Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY, UK
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Rahmati E, She RC, Kazmierski B, Geiseler PJ, Wong D. A case of liver abscess and fusobacterium septicemia. IDCases 2017; 9:98-100. [PMID: 28736715 PMCID: PMC5510492 DOI: 10.1016/j.idcr.2017.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022] Open
Abstract
Fusobacterium species are well described as the causative pathogen in Lemierre’s syndrome, a suppurative thrombophlebitis of the jugular vein. However, they are less recognized for a unique variant of Lemierre’s syndrome presenting with invasive intraabdominal infection and associated portal vein thrombosis. We describe a case of Fusobacterium nucleatum with hepatic abscess and septic pylephlebitis.
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Affiliation(s)
- Elham Rahmati
- Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the USC- LAC, United States
| | - Rosemary C She
- Department of Pathology, Keck School of Medicine of the University of Southern California, United States
| | - Brittany Kazmierski
- Department of Radiology, Keck School of Medicine of the University of Southern California, United States
| | - P Jan Geiseler
- Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the USC- LAC, United States
| | - Darren Wong
- Department of Medicine, Division of Infectious Diseases, Keck School of Medicine of the USC- LAC, United States
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Fusobacterium nucleatum Bacteremia Presenting with Portal Vein Thrombosis: An Abdominal Lemierre Syndrome? Am J Med 2017; 130:e255-e256. [PMID: 28163049 DOI: 10.1016/j.amjmed.2016.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/22/2022]
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Gastrointestinal Variant of Lemierre Syndrome: Fusobacterium nucleatum Bacteremia-Associated Hepatic Vein Thrombosis: a Case Report and Literature Review. Am J Ther 2017; 23:e933-6. [PMID: 24942004 DOI: 10.1097/mjt.0000000000000084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fusobacterium nucleatum is a gram-negative bacillius commonly found in oropharynx and is traditionally associated with Lemierre syndrome, which is characterized by history of recent oropharyngeal infection, internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly Fuosobacterium necrophorum. However, recent evidence indicated that F. nucleatum is also a normal resident of human gut. Less than a dozen of case reports had linked F. nucleatum to gastrointestinal variant of Lemierre syndrome with portal vein thrombosis. However, F. nucleatum bacteremia-associated hepatic vein thrombosis is very rare. We report a case of a 73-year-old man who had hepatic vein thrombosis associated with F. nucleatum bacteremia, most likely from subclinical primary infection affecting the lower gastrointestinal tract. The underlying pathophysiology and treatment options are discussed here. With rapid increase in reporting of Lemierre syndrome, this case deserves particular attention from clinicians.
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Choi SJ, Min JW, Yun JM, Ahn HS, Han DJ, Lee HJ, Kim YO. [Portal vein thrombosis with sepsis caused by inflammation at colonic stent insertion site]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:316-20. [PMID: 25998979 DOI: 10.4166/kjg.2015.65.5.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Portal vein thrombosis is an uncommon but an important cause of portal hypertension. The most common etiological factors of portal vein thrombosis are liver cirrhosis and malignancy. Albeit rare, portal vein thrombosis can also occur in the presence of local infection and inflammation such as pancreatitis or cholecystitis. A 52-year-old male was admitted because of general weakness and poor oral intake. He had an operation for colon cancer 18 months ago. However, colonic stent had to be inserted afterwards because stricture developed at anastomosis site. Computed tomography taken at admission revealed portal vein thrombosis and inflammation at colonic stent insertion site. Blood culture was positive for Escherichia coli. After antibiotic therapy, portal vein thrombosis resolved. Herein, we report a case of portal vein thrombosis with sepsis caused by inflammation at colonic stent insertion site which was successfully treated with antibiotics.
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Affiliation(s)
- Su Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Won Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Yun
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Shin Ahn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Deok Jae Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Jeong Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ok Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Leclercia adecarboxylata Bacteremia in a Patient with Ulcerative Colitis. Case Rep Gastrointest Med 2014; 2014:457687. [PMID: 25405041 PMCID: PMC4227368 DOI: 10.1155/2014/457687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/13/2014] [Indexed: 12/22/2022] Open
Abstract
Patients with inflammatory bowel disease (IBD) are a high risk population for bacteremia. Derangement in the mucosal architecture of the gastrointestinal (GI) tract and frequent endoscopic interventions in immunocompromised individuals are considered primary causes. Isolation of opportunistic microorganisms from the bloodstream of IBD patients has been increasingly reported in recent years. Leclercia adecarboxylata is a ubiquitous, aerobic, motile, gram-negative bacillus. The human GI tract is known to harbor this rarely pathogenic microorganism. There are only a few case reports of bacteremia with this microorganism; the majority are either polymicrobial or associated with immunocompromised patients. We describe a case of monomicrobial L. adecarboxylata bacteremia in a 43-year-old female who presented with bloody diarrhea. Colonoscopy revealed diffuse colonic mucosal inflammation with numerous ulcers, and histopathology revealed crypt abscesses. Following an episode of rectal bleeding, two sets of blood cultures grew L. adecarboxylata, which was treated with intravenous ceftriaxone. After a complicated hospital course, she was eventually diagnosed with ulcerative colitis and enteropathic arthritis, treated with intravenous methylprednisolone, mesalamine, and infliximab which resulted in resolution of her symptoms. In our previously immunocompetent patient, derangement of the gut mucosal barrier was the likely cause of bacteremia, yet performing endoscopic intervention may have contributed to bacterial translocation.
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Afra K, Laupland K, Leal J, Lloyd T, Gregson D. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC Infect Dis 2013; 14:264. [PMID: 24886502 PMCID: PMC4029911 DOI: 10.1186/1471-2334-14-264] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/07/2014] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to assess the epidemiology of intestinal parasitoses during a 5-year period in patients attending a tertiary-care hospital in a non-endemic setting. Methods In the period 2006–2010, 15,752 samples from 8,886 patients with clinically suspected parasitosis were subjected to macroscopic and microscopic examination, to parasitic antigen detection assays, and to cultures for protozoa and nematodes. Real-time PCR assays for the differentiation of Entamoeba histolytica and E. dispar and for the detection of Dientamoeba fragilis were also used. A statistical analysis evaluating the demographic data of the patients with intestinal parasitic infections was performed. Results Intestinal parasitic infections were diagnosed in 1,477 patients (16.6% prevalence), mainly adults and immigrants from endemic areas for faecal-oral infections; protozoa were detected in 93.4% and helminths in 6.6% of the cases, the latter especially in immigrants. Blastocystis hominis was the most common intestinal protozoan, and G. intestinalis was the most frequently detected among pathogenic protozoa, prevalent in immigrants, males, and pediatric patients. Both single (77.9%) and mixed (22.1%) parasitic infections were observed, the latter prevalent in immigrants. Conclusions Despite the importance of the knowledge about the epidemiology of intestinal parasitoses in order to adopt appropriate control measures and adequate patient care all over the world, data regarding industrialized countries are rarely reported in the literature. The data presented in this study indicate that intestinal parasitic infections are frequently diagnosed in our laboratory and could make a contribution to stimulate the attention by physicians working in non-endemic areas on the importance of suspecting intestinal parasitoses.
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Afra K, Laupland K, Leal J, Lloyd T, Gregson D. Incidence, risk factors, and outcomes of Fusobacterium species bacteremia. BMC Infect Dis 2013; 13:264. [PMID: 23734900 PMCID: PMC3679863 DOI: 10.1186/1471-2334-13-264] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 05/10/2013] [Indexed: 01/06/2023] Open
Abstract
Background Fusobacterium species (spp.) bacteremia is uncommon and has been associated with a variety of clinical presentations. We conducted a retrospective, population based study to determine the relative proportion of species in this genus causing bacteremia and the risk factors for infection and adverse clinical outcomes. Methods All cases of Fusobacterium spp. bacteremia detected at a regional microbiology laboratory serving outpatient and acute care for a population of approximately 1.3 million people over 11 years were identified from a computerized database. Clinical data on these cases was extracted from an administrative database and analyzed to determine underlying risk factors for and outcomes of infection. Results There were 72 incident cases of Fusobacterium spp. bacteremia over the study period (0.55 cases/100,000 population per annum). F. nucleatum was the most frequent species (61%), followed by F. necrophorum (25%). F. necrophorum bacteremia occurred in a younger population without underlying comorbidities and was not associated with mortality. F. nucleatum bacteremia was found in an older population and was associated with underlying malignancy or receiving dialysis. Death occurred in approximately 10% of F. nucleatum cases but causality was not established in this study. Conclusions Fusobacterium spp. bacteremia in our community is uncommon and occurs in approximately 5.5 cases per million population per annum. F. necrophorum occurred in an otherwise young healthy population and was not associated with any mortality. F. nucleatum was found primarily in older patients with chronic medical conditions and was associated with a mortality of approximately 10%. Bacteremias from other Fusobacterium spp. were rare.
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Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a high risk of deep venous thromboembolism. However, few data are available so far on portomesenteric vein thrombosis (PMVT). The aim of this study was to describe the characteristics of PMVT in patients with IBD. METHODS A retrospective study was conducted at 13 GETAID (Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif) centers from January 1995 to June 2010. The following data were collected, using a standardized questionnaire: characteristics of IBD, disease status at the time of PMVT, PMVT characteristics and mode of discovery, concomitant prothrombotic disorders, anticoagulant therapy, and evolution of PMVT. RESULTS Fifty cases (29 men and 21 women; median age, 41 years) were identified, including 14 patients with ulcerative colitis and 36 with Crohn's disease. Thirty-one patients (62%) presented with acute PMVT. Twenty-four patients had previously undergone surgical treatment, and IBD was active in 23 cases (77%) of acute thrombosis. The discovery of PMVT was fortuitous in 40% of our cases. Among the 43 patients screened for a prothrombotic disorder, abnormalities were observed in 17 patients (40%) (mainly hyperhomocysteinemia, n = 12). Forty-four patients (88%) were treated with anticoagulants. Recanalization of the vein was significantly more successful in patients with acute thrombosis (65% versus 37%, P = 0.05). CONCLUSIONS PMVT can occur when IBD is inactive, and its diagnosis was fortuitous in 40% of our cases. Screening for prothrombotic disorders is essential because it is positive in more than one third of cases.
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Maconi G, Bolzacchini E, Dell'Era A, Russo U, Ardizzone S, de Franchis R. Portal vein thrombosis in inflammatory bowel diseases: a single-center case series. J Crohns Colitis 2012; 6:362-7. [PMID: 22405175 DOI: 10.1016/j.crohns.2011.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/25/2011] [Accepted: 10/11/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND METHODS Portal vein thrombosis (PVT) has been reported as a complication of IBD in some case reports. We describe the presentation, diagnostic approaches, underlying risks factors and clinical outcome of 8 IBD patients with PVT. CASE-SERIES: The patients presented with partial PVT (4 patients) or portal cavernoma. Five patients had undergone surgery. In 2 patients portal biliopathy was diagnosed after detection of PVT. In 4 patients, the diagnosis of PVT was made while IBD was in remission. Five patients showed at least one risk factor for hypercoagulability: lupus anti-coagulant (one patient), increased von Willebrand factor (2 patients) or homocysteine levels (4 patients). Four patients received anticoagulant therapy for 6 months. None experienced other thrombotic events during a median of 5 years (range 2-8 years). CONCLUSION PVT is a potential complication of IBD, usually associated with acquired or inherited risks factors for hypercoagulability and with a benign outcome.
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Affiliation(s)
- Giovanni Maconi
- Gastrointestinal Unit, Department of Clinical Sciences, L.Sacco University Hospital, Milan, Italy.
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18
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Shahani L, Khardori N. Fusobacterium necrophorum--beyond Lemierres syndrome. BMJ Case Rep 2011; 2011:bcr.07.2011.4527. [PMID: 22674593 DOI: 10.1136/bcr.07.2011.4527] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fusobacterium necrophorum is a non-sporulating anaerobic gram negative bacillus and has traditionally been associated with Lemierre's syndrome. The authors report a 34-year-old male who presented to the emergency department with a week's history of dull epigastirc pain. Significant medical history included chronic pancreatitis secondary to alcohol use. The patient had radiological evidence of acute on chronic pancreatitis with thrombosis of the portal vein and multiple intrahepatic abscesses. CT-guided drainage of left upper quadrant revealed fluid collection in the pancreatic bed. The fluid culture grew F necrophorum and the patient was treated with tigecycline for 4 weeks. The patient improved symptomatically and his follow-up computerised axial tomography scan 2 months later showed resolving liver abscess, cavernous transformation of the portal vein and stable findings of chronic pancreatitis. This could represent an infection of the peripancreatic tissue with F necrophorum further leading to pylephlebitis.
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Affiliation(s)
- Lokesh Shahani
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, United States.
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Di Fabio F, Obrand D, Satin R, Gordon PH. Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease. Dis Colon Rectum 2009; 52:336-42. [PMID: 19279432 DOI: 10.1007/dcr.0b013e31819a235d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Venous and arterial thromboembolism constitutes a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The most common thrombotic manifestations are lower extremity deep vein thromboses with or without pulmonary embolism. Occasionally, thromboembolic events occur in the main abdominal vessels, such as the portal and superior mesenteric veins, vena cava and hepatic vein, aorta, splanchnic and iliac arteries, or in the limb arteries. The decision-making process for the treatment of these uncommon thromboembolic complications in inflammatory bowel disease may be very challenging for several reasons: 1) no standardized therapies are available; 2) the decision of starting anticoagulant therapy implies the potential risk of intestinal bleeding; 3) thromboembolic events may recur and be life-threatening if inadequately treated. The literature was searched by using MEDLINE, Embase, and the Cochrane library database. Studies published between 1970 and 2007 were reviewed. We discuss the medical and surgical therapeutic options that should be considered to optimize the outcome and reduce the risk of complications in abdominal thromboembolisms associated with inflammatory bowel disease.
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Affiliation(s)
- Francesco Di Fabio
- Division of Colon and Rectal Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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20
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Hamidi K, Pauwels A, Bingen M, Simo AC, Medini A, Jarjous N, Delafolie A, Barraud D. [Recent portal and mesenteric venous thrombosis associated with Fusobacterium bacteremia]. ACTA ACUST UNITED AC 2008; 32:734-9. [PMID: 18774251 DOI: 10.1016/j.gcb.2008.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/04/2008] [Accepted: 06/22/2008] [Indexed: 12/12/2022]
Abstract
SUMMARY Septic pylephlebitis is usually a complication of intraabdominal infection in the region drained by the portal venous system. We report two cases of portal and mesenteric venous thrombosis associated with Fusobacterium necrophorum bacteremia, which did not show any obvious intra-abdominal source of infection with noninvasive imaging procedures. In one case, early anticoagulation treatment was associated with repermeation of the portal vein and its right branch. As in Bacteroides bacteremia, portal and/or mesenteric venous thrombosis should be searched for in case of Fusobacterium bacteremia of unknown origin. Repermeation of the portal vein and relief of extrahepatic portal hypertension can be achieved in these cases with early anticoagulation.
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Affiliation(s)
- K Hamidi
- Service d'Hépato-Gastroentérologie, Centre Hospitalier de Gonesse, Gonesse cedex, France
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21
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Le Roux K, Sève P, Gomard E, Boibieux A, Beziat C, Stankovic K, Broussolle C. [Lemierre syndrome variant: Hepatic abscesses and hepatic venous thrombosis due to Fusobacterium nucleatum septicemia]. Rev Med Interne 2006; 27:482-6. [PMID: 16516355 DOI: 10.1016/j.revmed.2005.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 12/14/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Like Fusobacterium necrophorum, Fusobacterium nucleatum is capable causing Lemierre's syndrome. Various locations of venous thrombosis have been described associated with Fusobacterium sp. septicemia. EXEGESIS We describe a 43-year old alcoholic patient with F.nucleatum septicemia complicated with hepatic abscesses, middle hepatic venous thrombosis, osteomyelitis and infiltrative pneumonia. A pancreatic prosthesis was the only potentially identified infectious entrance. CONCLUSION Our patient showed an alternative presentation of Lemierre's syndrome, a "digestive variant". To the best of our knowledge, this is the first report of Fusobacterium septicemia associated with hepatic venous thrombosis. This report is close to the cases of portal thrombosis and opens the clinical sphere of the lemierre's syndrome, whose incidence is increasing.
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Affiliation(s)
- K Le Roux
- Service de médecine interne, Hôtel-Dieu, 1, place de l'hôpital, 69288 Lyon cedex 02, France
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Schweigart JH, Klotsas A, Schelenz S, Dhatariya K. Portal vein thrombosis despite anticoagulation in a person with diabetes. J R Soc Med 2005. [PMID: 15805557 DOI: 10.1258/jrsm.98.4.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- J H Schweigart
- Department of Diabetes, Norfolk and Norwich University Hospital NHS Trust, Norwich NR4 7UY, UK
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