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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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Panchani D, Nair D. Not always as simple as a UTI: An atypical case of Lemierre's syndrome, the forgotten disease. Clin Med (Lond) 2021; 21:e664-e666. [PMID: 34862229 DOI: 10.7861/clinmed.2021-0579] [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: 11/27/2022]
Abstract
A 65-year-old man, who was previously fit and well with no known medical comorbidities, was admitted with symptoms of dysuria, urinary frequency, pyrexia, chills and lethargy. His vitals showed that he was hypotensive, tachycardic and pyrexial. Urine dip was heavily positive for leukocytes and nitrites and had markedly elevated inflammatory markers and mild acute kidney injury. He was commenced on piperacillin/tazobactam. He went on to develop severe left-sided neck swelling and erythema. Ultrasound of the neck with subsequent computed tomography revealed extensive internal jugular vein thrombosis with abscess collection around the vein. Microbiology grew Gram-negative bacilli, later identified as Fusobacterium necrophorum A diagnosis of Lemierre's syndrome was made. The patient was continued on intravenous piperacillin/tazobactam and metronidazole as per sensitivities and later switched to oral metronidazole. He was initiated on warfarin anticoagulation. He made a remarkable recovery and was discharged with outpatient ear, nose and throat and haematology follow-up.
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Marques TM, Almeida A, Cruz L, Ferreira T. Rapidly progressing incomplete Lemierre syndrome. J Postgrad Med 2021; 67:249-250. [PMID: 34528513 PMCID: PMC8706543 DOI: 10.4103/jpgm.jpgm_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- T M Marques
- Internal Medicine Department, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - A Almeida
- Internal Medicine Department, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - L Cruz
- Internal Medicine Department, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - T Ferreira
- Internal Medicine Department, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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Yalim H, Eveillard M, Apaire-Marchais V. Dépistage de l’angine à streptocoque du groupe A à l’officine. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Habib S, Rajdev K, Siddiqui A, Azam M, Memon A, Chalhoub M. Septic emboli of the lung due to Fusobacterium necrophorum, a case of Lemierre's syndrome. Respir Med Case Rep 2019; 28:100867. [PMID: 31211045 PMCID: PMC6562267 DOI: 10.1016/j.rmcr.2019.100867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Fusobacterium necrophorum plays a causal role in a rare and life-threatening condition, Lemierre's syndrome. It is characterized by infection involving the posterior compartment of the lateral pharyngeal space complicated by septic suppurative thrombophlebitis of the internal jugular vein with F. necrophorum bacteremia and metastatic abscesses, primarily to the lung and pulmonary septic emboli. Herein, we present a very rare case of oropharyngeal infection complicated by Lemierre's syndrome with characteristic septic emboli to the lungs presenting as sore throat in a previously healthy patient. A 23-year-old woman presented with sore throat and was found to be in sepsis and acute kidney injury. She was found to have septic emboli in lung and Streptococcus anginosus and F. necrophorum in blood. She was diagnosed with Lemierre's syndrome and successfully treated with antibiotics. Lemierre's syndrome should be included in the differential diagnosis in young patients who deteriorate in the setting of a sore throat. If the suspicion is high, throat swabs from young patients with nonstreptococcal group A tonsillitis should be cultured anaerobically on selective medium to detect the presence of F. necrophorum. While clinicians of the infectious disease team may be familiar with this condition other departments including internal medicine and critical care team may less so. Unless clinicians are aware of this syndrome, diagnosis and treatment can be delayed leading to higher morbidity and mortality.
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Affiliation(s)
- Saad Habib
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Kartikeya Rajdev
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - A.H. Siddiqui
- Department of Pulmonary & Critical Care, Staten Island University Hospital, USA
| | - Mohammed Azam
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Asma Memon
- Department of Internal Medicine, Staten Island University Hospital, USA
| | - Michel Chalhoub
- Department of Pulmonary & Critical Care, Staten Island University Hospital, USA
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