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Lemierre Syndrome

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81. Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study. Full Text available with Trip Pro

of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices.The research was based on electronic health records that may not always provide complete data. The number of practices included in the trial

2019 Health technology assessment (Winchester, England) Controlled trial quality: predicted high

82. Just a simple case of tonsillitis? Lemierre’s Syndrome and thrombosis of the external jugular vein. Full Text available with Trip Pro

Just a simple case of tonsillitis? Lemierre’s Syndrome and thrombosis of the external jugular vein. Oropharyngeal infections are routinely encountered within general practice and accident and emergency departments. Most settle with simple analgesia and antibiotics; occasionally such patients may develop Lemierre's syndrome (LS) a rare and potentially fatal sequela that can be easily overlooked. We aim to highlight the main symptoms, pathology, investigations and management. © JSCR.

2011 Journal of surgical case reports

83. Severe Pneumonia and Jaundice in a Young Man: An Atypical Presentation of an Uncommon Disease. Full Text available with Trip Pro

Severe Pneumonia and Jaundice in a Young Man: An Atypical Presentation of an Uncommon Disease. We present a patient with an atypical presentation of Fusobacterium infection, the genus responsible for Lemierre's syndrome. This syndrome, which often affects healthy, young people and can be fatal if not recognized and treated early, is defined as a history of recent oropharyngeal infection with clinical or radiological evidence of internal jugular vein thrombosis and isolation of anaerobic (...) pathogens, mainly Fusobacterium necrophorum. The history, presentation, investigations and management of the patient are described and then contrasted with the existing literature surrounding Lemierre's syndrome, once termed the 'forgotten disease'.

2011 Journal of Medical Microbiology

84. Facial vein thrombophlebitis: A case report and literature review. (Abstract)

Facial vein thrombophlebitis: A case report and literature review. Septic thrombophlebitis of the facial vein (STFN) commonly presents with facial erythema, tenderness, and swelling above the involved vessel. Due to its rarity, diagnosis and treatment remain a challenge. Lemierre syndrome (LS), which consists of a triad of internal jugular vein thrombophlebitis, septicemia, and distant septic emboli, is a more common entity of which physicians are more familiar. Whether tonsillitis-related STFN

2018 International Journal of Pediatric Otorhinolaryngology

85. Complicated Fusobacterium Sinusitis: A Case Report. (Abstract)

Complicated Fusobacterium Sinusitis: A Case Report. Fusobacterium infections and Lemierre syndrome are traditionally associated with pharyngitis. We report 3 cases of Fusobacterium sinusitis that resulted in Pott puffy tumor. One of these cases also had Lemierre Syndrome. We encourage expansion of the clinical spectrum of Lemierre syndrome to include complicated Fusobacterium sinusitis.

2018 Pediatric Infectious Dsease Journal

86. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. (Abstract)

is recommended if antibiotics are used for this indication. Oral analgesics and topical anesthetics are important for symptom management. Physicians should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome, Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and viral pharyngitis. A focused history and physical examination can help differentiate (...) Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. Pharyngitis is a common disease in the emergency department (ED). Despite a relatively low incidence of complications, there are many dangerous conditions that can mimic this disease and are essential for the emergency physician to consider.This article provides a review of the evaluation and management of group A β-hemolytic Streptococcal (GABHS) pharyngitis, as well as important medical conditions

2018 Journal of Emergency Medicine

87. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis Full Text available with Trip Pro

diphtheriae Diphtheria Mixed anaerobes Vincent's angina Fusobacterium necrophorum Lemierre's syndrome, peritonsillar abscess Francisella tularensis Tularemia (oropharyngeal) Yersinia pestis Plague Yersinia enterocolitica Enterocolitis, pharyngitis Viral Adenovirus Pharyngoconjunctival fever Herpes simplex virus 1 and 2 Gingivostomatitis Coxsackievirus Herpangina Rhinovirus Common cold Coronavirus Common cold Influenza A and B Influenza Parainfluenza Cold, croup EBV Infectious mononucleosis Cytomegalovirus (...) anaerobes Vincent's angina Fusobacterium necrophorum Lemierre's syndrome, peritonsillar abscess Francisella tularensis Tularemia (oropharyngeal) Yersinia pestis Plague Yersinia enterocolitica Enterocolitis, pharyngitis Viral Adenovirus Pharyngoconjunctival fever Herpes simplex virus 1 and 2 Gingivostomatitis Coxsackievirus Herpangina Rhinovirus Common cold Coronavirus Common cold Influenza A and B Influenza Parainfluenza Cold, croup EBV Infectious mononucleosis Cytomegalovirus CMV mononucleosis HIV

2012 Infectious Diseases Society of America

88. A case of liver abscess and fusobacterium septicemia Full Text available with Trip Pro

A case of liver abscess and fusobacterium septicemia 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.

2017 IDCases

89. Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis Full Text available with Trip Pro

Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis Fusobacterium necrophorum, an obligate anaerobic bacterium, was recently reported to be an important cause of bacterial pharyngitis with a prevalence as high as that of group A Streptococcus (GAS) in adolescents and young adults. Importantly, F. necrophorum is the primary causative agent of the life-threatening Lemierre's syndrome, and screening of pharyngeal samples may be warranted for its early detection

2017 Journal of clinical microbiology

90. Fusobacterial liver abscess: a case report and review of the literature. Full Text available with Trip Pro

search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre's Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged

2017 BMC Infectious Diseases

91. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. Full Text available with Trip Pro

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records.  To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs). Cohort study. 610 UK general practices from the UK Clinical Practice (...) Research Datalink. Registered patients with 45.5 million person years of follow-up from 2005 to 2014. Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients. Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre's syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice

2016 BMJ

92. More evidence on suppurative complications from Fusobacterium necrophorum tonsillitis

suppurative complications. We know from the Cochrane analysis that antibiotics decrease the risk of PTA independent of group A strep testing. This article adds to our growing concern about how to diagnosis and treat Fusobacterium necrophorum pharyngitis. This article does not address the Lemierre Syndrome. We do know that this syndrome most often follows FN pharyngitis. We cannot prove that appropriate antibiotics would prevent the syndrome, but neither can you provide any evidence that antibiotics would (...) not decrease the syndrome. As the article documents, the epidemiology of FN pharyngitis, PTA and Lemierre Syndrome overlap almost perfectly. These infections occur primarily in adolescents and young adults. While different articles have differing specific age ranges, one can easily generalize to around 15-30 year old patients. This large age group deserves a different approach to sore throats. One can only hope that the IDSA and CDC will study the growing evidence and develop new guidelines for diagnosing

2018 db's Medical Rants blog

93. If I were writing sore throat guidelines

for peritonsillar abscess or Lemierre Syndrome a limited CT of the neck should provide excellent diagnostic information. If you suspect the Lemierre Syndrome, bedside ultrasound of the internal jugular vein should show the clot. Share this: Like this: Like Loading... Comments (2) stephen friel said on 03-01-2019 Hi, as a GP(primary care physician ) in the UK with a 4000 patient list size,1000 under 24yrs, how many cases of lemierre’s syndrome would i expect to see in a 40 year career? I see lots of sore throats (...) bacterial infection and using rapid tests with backup cultures makes sense. I would change the guidelines for adolescents and young adults. I would treat patients having Centor scores of 3 or 4 with either penicillin or amoxicillin (augmentin would be fine). I would probably treat some 2s if they looked very ill. I would never use macrolides. If the patient is truly penicillin allergic and looked sick then I would use clindamycin. I would have a printed sheet for all adolescent/young adults. I will do

2018 db's Medical Rants blog

94. My approach to acute pharyngitis 2018

collaboration found that antibiotics decrease peritonsillar abscess regardless of pharyngitis etiology. My big concern is Lemierre syndrome. We have no PROOF that timely antibiotics will prevent the syndrome, but we must remember that lack of proof does not equal proof against that hypothesis. Many who study Fusobacterium necrophorum pharyngitis believe that appropriate antibiotics would decrease the probability of this severe complication. I believe Lemierre syndrome is the most important reason to treat (...) exudates actually are both a predictor of empiric antibiotics and significant infection. Please, please never use macrolides for adolescent/adult pharyngitis. They do not cover Fusobacterium necrophorum . While we do not have full proof, a significant number of patients who develop the Lemierre syndrome received macrolides empirically. Macrolides are never the correct antibiotics for empiric treatment of adolescent/adult pharyngitis. I hope that this post makes clear my current thoughts. Please ask me

2018 db's Medical Rants blog

95. The Fusobacterium story as of 2018 – a very long post

, articles about sore throats attracted my attention. An article in the BBC news health section stimulated this post – The BBC article, which reported an increase in the Lemierre Syndrome in England, stimulated a new interest – Fusobacterium necrophorum . Over the next several years, I would read about this bacteria and this important suppurative complication. I subscribed to PubMed and searched for Fusobacterium and pharyngitis. By 2007, 4 separate articles – 2 from Great Britain and 2 from Denmark (...) – documented Fusobacterium pharyngitis. Two studies used anaerobic culture and two used PCR identification. Unfortunately, these studies had no clinical information other than a presentation for a sore throat. One study showed clearly that they diagnosed Fusobacterium pharyngitis much more often in adolescents and young adults than in childhood. In 2008, a Danish article made me question strongly all the previous assumptions about sore throats. This article documented the Lemierre Syndrome and gave some

2018 db's Medical Rants blog

96. FeverPAIN vs the Centor Score

a careful evaluation for either suppurative complications (peritonsillar abscess or Lemierre syndrome) or one should consider significant viral infections in adults – infectious mononucleosis and acute HIV. The other problem that I have with the FeverPAIN analysis is the lack of distinction between preadolescents and adolescent/young adults. We have written about this problem, both in MEDRANTS and in this article – The streptococcal carrier rates for pre-adolescents are MUCH higher than for adolescents

2017 db's Medical Rants blog

97. The challenge of “evidence based” sore throat guidelines Full Text available with Trip Pro

against treating these sore throat patients and perhaps preventing suppurative complications. What makes me so passionate? Why is my bias for antibiotics for adolescent/young adults with Centor scores of 3 or 4? Imagine an infectious disease that responds to standard antibiotics. Like endocarditis it causes septic emboli. This infection often causes diagnostic errors, because few physicians see a patient while in training, or have the disease even discussed. The Lemierre Syndrome is that devastating (...) contagious. It occasionally causes streptococcal shock syndrome with the rare death. Treatment probably decreases duration of symptoms in adolescents and young adults, but not significantly in childhood. Some Europeans now consider GAS sore throat a self-limited disease that we need not treat. They discount the ARF risk and thus view the potential negative side effects from antibiotics a greater problem. We know that in adolescents and young adults, group C/G streptococcus and Fusobacterium necrophorum

2017 db's Medical Rants blog

98. My developing thoughts on adult pharyngitis

in a conversation I had yesterday at the University of Nebraska where I am this week as a visiting professor. A clinician educator asked me about “red flags” in sore throat patients. While I have written this previously, repetition helps all learners remember. Adult sore throats generally last around 3-5 days. The patient no longer has a routine sore throat when: It continues feeling worse – most Lemierre syndrome patients complain that they precedent sore throat was the worst they ever had The patient develops (...) rigors – Lemierre included this in his classic article, and we have found this in our clinical experience. Lemierre syndrome patients have bacteremia and the body responds with rigors (and somewhat less often drenching sweats) Unilateral neck swelling – requires imaging looking for either peritonsillar abscess or internal jugular suppurative thrombophlebitis. Most sore throats are totally benign – either with or without antibiotic treatment. But, our job is to be aware of the unusual presentations

2017 db's Medical Rants blog

99. Fusobacterium infections in children Full Text available with Trip Pro

antimicrobial agent (metronidazole, clindamycin). At times surgical involvement is required for mastoiditis such as drainage of abscesses or insertion of a ventilation tube. Delayed treatment of an infection caused by Fusobacterium can lead to serious complications, including Lemierre syndrome. Children should be seen in a hospital for close monitoring.Copyright© the College of Family Physicians of Canada.

2016 Canadian Family Physician

100. Coexisting pulmonary haemorrhage and venous thrombosis: a tricky but novel case Full Text available with Trip Pro

Coexisting pulmonary haemorrhage and venous thrombosis: a tricky but novel case We present a case of Lemierre's disease complicated by pulmonary artery pseudoaneurysm. A previously well woman aged 43 years presented with a history of a sore throat and worsening dyspnoea. She was diagnosed with a severe cavitating bilateral pneumonia complicated by internal jugular vein thrombosis consistent with a diagnosis of Lemierre's disease. She had an episode of massive haemoptysis which was confirmed

2016 BMJ case reports

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