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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. Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity. Full Text available with Trip Pro

Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity. Fusobacterium necrophorum (Fn), a gram-negative anaerobe, is increasingly implicated as an etiologic agent in older adolescents and young adults with sore throat. Inadequately treated Fn pharyngitis may result in suppurative complications such as peritonsillar abscess and Lemierre's syndrome. Data from the literature suggest that the incidence (...) of life-threating complications in these age groups from Fn pharyngitis (Lemierre's syndrome) in the United States exceeds those associated with group A beta-hemolytic streptococcal (GAS) pharyngitis (acute rheumatic fever). Using real-time PCR, we previously reported about a 10% prevalence of Fn in asymptomatic medical students and about 20% in students complaining of sore throat at a university student health clinic (p = 0.009). In this study, a comprehensive microbiome analysis of the same study

2018 PLoS ONE

83. 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

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. 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

86. 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

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. 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

89. 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

90. 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

91. 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

92. 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

93. 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

94. 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

95. 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

96. 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

97. A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures Full Text available with Trip Pro

. Additionally, the enlarged lymph node was compressing the internal jugular vein in the setting of oral contraceptive use by the patient, raising concern for Lemierre's syndrome or internal jugular vein thrombosis. This report shows how, in the appropriate clinical context, and especially with the involvement of adjacent respiratory or neurovascular structures, aggressive diagnostic testing can be indicated.

2016 Case reports in otolaryngology

98. To anticoagulate? Controversy in the management of thrombotic complications of head & neck infections. (Abstract)

To anticoagulate? Controversy in the management of thrombotic complications of head & neck infections. To review the thrombotic complications of head and neck infections, including Lemierre's syndrome, and their management.A retrospective review of pediatric patients presenting to McMaster Children's Hospital from 2009 to 2013 was undertaken. The literature was reviewed for evidence regarding the use of anticoagulation therapy in this population.Eleven cases (6 males, 5 females) were identified (...) within a median of 3.4 months (range 1.0-13.9). Adverse sequelae from the thrombi were MCA infarct (n = 1), septic pulmonary emboli (n = 4), cranial nerve palsies (n = 3) and Horner's syndrome (n = 2). There were no adverse effects from anti-coagulation therapy. Review of the literature revealed anticoagulant use in 63.7% of pediatric cases reported since 2002.Anticoagulation remains controversial in the management of thrombotic complications from head and neck infections. Based on this case series

2016 International Journal of Pediatric Otorhinolaryngology

99. Funtabulously Frivolous Friday Five 149

folds of skin around the neck and jaw. [ ] Question 2 Which subgroup of the working populous is affected by foam mattress-back syndrome? Medical Residents Back pain from sleeping on cheap hospital mattresses instead of their home finely sprung cotton mattress. [ ] Question 3 What is the forgotten disease? Lemierre’s syndrome Septic thrombophlebitis of the internal jugular vein from an oropharyngeal infection. Typically the patient will have pain, swelling and induration at the angle of the mandible (...) and is of high importance to NASA. Anthropologist John Moore believed 160 breeding individuals with no major genetic disorders could populate other planets but would need new genetic material within 200 years. [ ] …and over on Capitol Hill Last update: [last-modified] Share this: Filed Under: Tagged With: , , , , , , About Neil Long Emergency Physician working in Vancouver. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, tox, sim, ultrasound and any other project

2016 Life in the Fast Lane Blog

100. Primary Care Corner with Geoffrey Modest MD: Antibiotic Overprescribing and Acute Respiratory Infections

(as in, billion)​ in 2009, with $6.5 b in the community setting 41% of prescriptions are for respiratory conditions There are >2M antibiotic-resistant illnesses and 23K deaths in US/yr, with cost of $30 b Higher rates of multi-drug resistant pneumococcal disease occur in places where there is more prescribing of broad-spectrum antibiotics, esp extended-spectrum cephalosporins and macrolides And, antibiotics as a group are responsible for the largest number of medication-related adverse events, including 20 (...) anterior cervical nodes, absence of cough), BUT because the positive predictive value for group A strep is so low, the IDSA (Infectious Diseases Society of America) only suggests using these as a means to do no further testing or prescribing antibiotics if there are <3 criteria. Some patients present with severe signs/symptoms, such as difficulty swallowing, drooling, neck tenderness or swelling, and should be evaluated for peritonsillar abscess, parapharyngeal abscess, epiglottitis, Lemierre syndrome

2016 Evidence-Based Medicine blog

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