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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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Raghavan S, Gonakoti S, Parra-Rodriguez L. Intracranial thrombosis associated with MSSA bacteraemia in the setting of influenza A. BMJ Case Rep 2021; 14:14/4/e239359. [PMID: 33888474 PMCID: PMC8070873 DOI: 10.1136/bcr-2020-239359] [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: 11/04/2022] Open
Abstract
The authors present a case of a 42-year-old previously healthy man who presented in sepsis, with right lateral gaze palsy. He was found to have bilateral cavernous sinus thrombosis (CST) and bilateral internal jugular thrombosis in the setting of Staphylococcus aureus bacteraemia. The patient was successfully treated and recovered from his illness after a protracted stay in the medical intensive care unit. We go over the treatment course and follow-up of this patient and discuss the need to have a high degree of clinical suspicion for CST and suppurative thrombophlebitis of the internal jugular veins. We also discuss the possible role of the Panton-Valentine leukocidin in causing thrombotic complications of S. aureus bacteraemia.
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Affiliation(s)
- Sairam Raghavan
- Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Sriram Gonakoti
- Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Luis Parra-Rodriguez
- Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
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Elhakeem IA, Al Shokri SD, Elzouki ANY, Danjuma MI. An Unusual Case of Modified Lemierre's Syndrome Caused by Staphylococcus aureus Cellulitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e916575. [PMID: 32008035 PMCID: PMC7017838 DOI: 10.12659/ajcr.916575] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lemierre's syndrome is a potential life-threatening disease commonly occurring in young, healthy individuals. It is often preceded by an oropharyngeal infection causing bacteremia. This may rapidly progress into thrombophlebitis of the internal jugular venous system, its branches, and septic embolization and often fulminant organ failure. CASE REPORT A previously healthy 31-year-old male with recent history of facial herpes zoster infection, presented with 1-week history of increasingly painful nasal, and periorbital swelling. Imaging confirmed superior ophthalmic vein thrombosis. Staphylococcus aureus was isolated in blood cultures and had an uncomplicated hospital course with full recovery. CONCLUSIONS Early recognition of Lemierre's syndrome contributes significantly in reducing morbidity and mortality associated with it. Staphylococcus aureus skin infection is a very rare cause of Lemierre's syndrome, and its association with superior ophthalmic vein thrombosis has not yet been reported in literature.
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Affiliation(s)
- Israa A Elhakeem
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdul-Naser Y Elzouki
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| | - Mohammed I Danjuma
- Clinical Pharmacology and Therapeutics Department of General Medicine, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
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Van Hoecke F, Lamont B, Van Leemput A, Vervaeke S. A Lemierre-like syndrome caused by Staphylococcus aureus: an emerging disease. Infect Dis (Lond) 2019; 52:143-151. [DOI: 10.1080/23744235.2019.1691255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Frederik Van Hoecke
- Department of Laboratory Medicine, Sint Andries Hospital, Tielt, Belgium
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Bart Lamont
- Department of Neurology, Sint Andries Hospital, Tielt, Belgium
| | - Ann Van Leemput
- Department of Radiology, Sint Andries Hospital, Tielt, Belgium
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
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Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature. Ophthalmic Plast Reconstr Surg 2019; 35:272-280. [DOI: 10.1097/iop.0000000000001231] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Little M, Renny N. Panton-Valentine leukocidin-producing Staphylococcus aureus infection of the neck that mimicked disseminated malignancy. Br J Oral Maxillofac Surg 2017; 55:862-863. [PMID: 28662921 DOI: 10.1016/j.bjoms.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Little
- Oral and Maxillofacial Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS3 4BW.
| | - N Renny
- Oral and Maxillofacial Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS3 4BW.
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Momtaz H, Hafezi L. Meticillin-resistant Staphylococcus aureus isolated from Iranian hospitals: virulence factors and antibiotic resistance properties. Bosn J Basic Med Sci 2014; 14:219-26. [PMID: 25428674 DOI: 10.17305/bjbms.2014.4.34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/03/2014] [Accepted: 09/06/2014] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus aureus is an important opportunistic pathogen responsible for a variety of diseases. Indiscriminate prescription of antibiotics caused severe antibiotic resistance especially against commonly used drugs. The present investigation was carried out to study the distribution of Panton-Valentine Leukocidin gene, SCCmec types and antibiotic resistance properties of meticillin-resistant Staphylococcus aureus isolated from Iranian hospitals. A total of 132 clinical specimens were collected from two major Iranian hospitals. Samples were cultured and their positive results were subjected to several PCR methods. The patterns of antibiotic resistance were studied using the disk diffusion method. We found that 66 out of 132 samples (50%) were positive for Staphylococcus aureus. The most commonly infected samples were superficial and surgical wounds (66.12%). The incidence of mecA, tetK, ermA, ermC, tetM, aacA-D, linA, msrA, vatA, vatC and vatB antibiotic resistance genes were 80.30%, 34.84%, 30.30%, 25.75%, 24.24%, 19.69%, 7.57%, 7.57%, 6.06%, 3.03% and 1.51%, respectively. Totally, 40.90% of isolates harbored the Panton-Valentine Leukocidin gene. Of 53 mec positive strains, the distribution of SCCmec V, SCCmec III, SCCmec IVa, SCCmec IVc and SCCmec IVb were 28 (52.83%), 13 (24.52%), 6 (11.32%), 4 (7.54%) and 2 (3.77%), respectively. All isolates were resistant to penicillin, cephalothin, cefazoline and ceftriaxone. The high levels of Staphylococcus aureus resistance against commonly used antibiotics as well as high presence of SCCmec types of meticillin-resistant virulent strains of Staphylococcus aureus suggest that infections with these strains require more advanced hospital care with emerging demand for novel antibiotics.
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Affiliation(s)
- Hassan Momtaz
- Department of Microbiology, Shahrekord Branch, Islamic Azad University.
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Sina H, Ahoyo TA, Moussaoui W, Keller D, Bankolé HS, Barogui Y, Stienstra Y, Kotchoni SO, Prévost G, Baba-Moussa L. Variability of antibiotic susceptibility and toxin production of Staphylococcus aureus strains isolated from skin, soft tissue, and bone related infections. BMC Microbiol 2013; 13:188. [PMID: 23924370 PMCID: PMC3750628 DOI: 10.1186/1471-2180-13-188] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022] Open
Abstract
Background Staphylococcus aureus is an opportunistic commensal bacterium that mostly colonizes the skin and soft tissues. The pathogenicity of S. aureus is due to both its ability to resist antibiotics, and the production of toxins. Here, we characterize a group of genes responsible for toxin production and antibiotic resistance of S. aureus strains isolated from skin, soft tissue, and bone related infections. Results A total of 136 S. aureus strains were collected from five different types of infection: furuncles, pyomyositis, abscesses, Buruli ulcers, and osteomyelitis, from hospital admissions and out-patients in Benin. All strains were resistant to benzyl penicillin, while 25% were resistant to methicillin, and all showed sensitivity to vancomycin. Panton-Valentine leukocidin (PVL) was the most commonly produced virulence factor (70%), followed by staphylococcal enterotoxin B (44%). Exfoliative toxin B was produced by 1.3% of the strains, and was only found in isolates from Buruli ulcers. The tsst-1, sec, and seh genes were rarely detected (≤1%). Conclusions This study provides new insight into the prevalence of toxin and antibiotic resistance genes in S. aureus strains responsible for skin, soft tissue, and bone infections. Our results showed that PVL was strongly associated with pyomyositis and osteomyelitis, and that there is a high prevalence of PVL-MRSA skin infections in Benin.
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Affiliation(s)
- Haziz Sina
- Laboratoire de Biologie et de Typage Moléculaire en Microbiologie, Faculté des Sciences et Techniques/Université d'Abomey-Calavi, Cotonou, Benin
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Keynan Y, Rubinstein E. Staphylococcus aureus Bacteremia, Risk Factors, Complications, and Management. Crit Care Clin 2013; 29:547-62. [DOI: 10.1016/j.ccc.2013.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Katayama W, Fujita K, Onuma K, Kamezaki T, Sakashita S, Sugita S. Cerebral venous thrombosis associated with micro-abscesses: case report. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 118:321-324. [PMID: 23564158 DOI: 10.1007/978-3-7091-1434-6_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case that is most likely Lemierre's syndrome. A 19-year-old man presented to us with -common-cold-like symptoms, which he had had for 2 days, such as slight fever, general malaise, anorexia, sore throat, and headache. Eight days after the onset of these symptoms, he died of brain herniation due to cerebral venous thrombosis associated with micro-abscesses detected in pathological examination.
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Affiliation(s)
- Wataru Katayama
- Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan.
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The first case of fatal pneumonia caused by Panton–Valentine leukocidin-producing Staphylococcus aureus in an infant in the Czech Republic. Folia Microbiol (Praha) 2012; 58:225-8. [DOI: 10.1007/s12223-012-0200-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
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The changing face of an old disease: case report of nonclassical Lemierre's syndrome caused by a Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus isolate. J Clin Microbiol 2012; 50:3144-5. [PMID: 22760040 DOI: 10.1128/jcm.00939-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brenes JA, Goswami U, Williams DN. The association of septic thrombophlebitis with septic pulmonary embolism in adults. Open Respir Med J 2012; 6:14-9. [PMID: 22611460 PMCID: PMC3355351 DOI: 10.2174/1874306401206010014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/15/2012] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
Background:
There have been an increasing number of pediatric reports of septic pulmonary embolism in the setting of septic thrombophlebitis adjacent to a primary infectious source. Methods:
Retrospective review at an urban hospital. A total of five adults with a documented primary infectious source, adjacent septic thrombophlebitis and septic pulmonary embolism were identified between 2000 and 2011. Results:
The predominant symptoms on presentation were fever and pleuritic chest pain, followed by chills and cough. S. aureus was the pathogen in 4 patients. Only one case had echocardiographic evidence of endocarditis. All patients received IV antibiotics and anticoagulation therapy. No new embolic events or central nervous system complications were noted. Conclusions:
The triad of extrapulmonary infection, contiguous septic thrombophlebitis and septic pulmonary embolism is present in adult as well as pediatric populations. The use of systemic anticoagulation with appropriate antibiotics resulted in clinical and radiologic improvement but no significant complications.
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Affiliation(s)
- Jorge A Brenes
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, MN 55415, USA
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Methicillin-resistant Staphylococcus aureus USA300 clone as a cause of Lemierre's syndrome. J Clin Microbiol 2011; 49:2063-6. [PMID: 21430106 DOI: 10.1128/jcm.02507-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a case of a young woman who had methicillin-resistant Staphylococcus aureus USA300 clone (MRSA-USA300)-associated Lemierre's syndrome and secondary necrotizing pneumonia and cerebral infarcts. We also review 11 cases of S. aureus-associated Lemierre's syndrome reported in the literature from 1965 to 2010. Recognition of S. aureus as an emergent cause of Lemierre's syndrome informs the initial empirical antibiotic choice for this life-threatening condition and may positively impact patient outcomes.
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Community-Acquired Methicillin-Resistant Staphylococcus aureus and Lemierre Syndrome. Am J Med Sci 2009; 338:326-7. [DOI: 10.1097/maj.0b013e3181a9302b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clark J. A brief review of Panton-Valentine leukocidin producing staphylococcal infections in the intensive therapy unit. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cacc.2008.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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