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Lemierre Syndrome

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81. CRACKCast E176 – Pediatric Musculoskeletal Disorders

blood cultures be obtained in all patients in whom bacterial arthritis is a consideration. Blood cultures are positive in approximately 40 percent of cases and sometimes yield the pathogen when joint fluid cultures are negative. Anaerobic cultures should be obtained if anaerobic infection is a concern (eg, direct inoculation or in jugular vein suppurative thrombophlebitis [also known as Lemierre’s syndrome] caused by Fusobacterium infection. – uptodate. [7] What the mechanism of a lateral elbow (...) ] The growth plate is the weakest part of the bone and is more likely to separate before the adjacent tendon or ligament tears, thereby making sprains uncommon. Of supracondylar fractures, 95% are of the extension type. Displaced fractures are at risk for neurovascular injury and compartment syndrome; the anterior interosseous branch of the median nerve (“A-OK sign”) and the brachial artery are most commonly involved. Developmental dysplasia of the hip affects 1% of children ; all children who are not yet

2018 CandiEM

82. CRACKCast E075 – Upper Respiratory Tract Infections

albicans [6] What are the potential complications of deep space neck/face infections? List 5. Airway Obstruction Trismus Lemierre’s syndrome Carotid aneurysm Cavernous sinus thrombosis Retropharyngeal abscess Empyema/pneumonia Sepsis/ acute respiratory distress syndrome Necrotizing fasciitis Mediastinitis Peri-myocarditis Osteomyelitis of the mandible, cervicothoracic necrotizing fasciitis [7] When do the sinuses typically develop? Fully develop by age 10. [8] What the pathophysiology of sinusitis (...) this “danger” space, which extends from the base of the skull to the diaphragm The prevertebral space extends from the base of the skull to the coccyx [5] What are the typical bacterial causes of deep space infections? What are the different syndromes called? Most frequently isolated organisms are streptococci, staphylococci, and Bacteroides species. β-Lactamase– producing organisms are isolated in ⅔ of cases. Other organisms include H. influenzae, Pseudomonas aeruginosa, Klebsiella species, and Candida

2017 CandiEM

83. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention

that they can be used to identify patients who have a low probability of group A streptococcal pharyngitis and do not warrant further testing ( ). Patients who meet fewer than 3 Centor criteria do not need to be tested. Those who present with unusually severe signs and symptoms, such as difficulty swallowing, drooling, neck tenderness, or swelling, should be evaluated for rare throat infections (such as peritonsillar abscess, parapharyngeal abscess, epiglottitis, or Lemierre syndrome). Recent data suggest (...) that Fusobacterium necrophorum is implicated in approximately 10% to 20% of endemic pharyngitis cases in adolescents ( , ). It has also been implicated as a cause of Lemierre syndrome ( ), which is a rare and life-threatening condition. The role of F necrophorum in pharyngitis and subsequent development of Lemierre syndrome warrant further study. Routine testing for F necrophorum is not recommended, but clinicians should remain vigilant and suspect Lemierre syndrome in adolescent and young adult patients

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2016 American College of Physicians

84. Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity. (PubMed)

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

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2018 PLoS ONE

85. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. (PubMed)

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

2018 Journal of Emergency Medicine

86. Complicated Fusobacterium Sinusitis: A Case Report. (PubMed)

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

87. 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

88. 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

89. Facial vein thrombophlebitis: A case report and literature review. (PubMed)

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

90. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. (PubMed)

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

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2016 BMJ

91. 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

2018 db's Medical Rants blog

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. The challenge of “evidence based” sore throat guidelines

causes suppurative complications. In Zwart’s study of patients 15 and older, penicillin decreased symptom duration by 1 day. F. necrophorum causes high percentage of peritonsillar abscess (PTA) in the 15-30 age group (the age group with the highest percentage of PTA). This organism causes the great majority of the Lemierre syndrome (sore throat followed by internal jugular septic thrombophlebitis and septic emboli). Again this devastating syndrome occurs primarily in the 15-30 age group. What (...) 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

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2017 db's Medical Rants blog

94. 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

95. Fusobacterial liver abscess: a case report and review of the literature. (PubMed)

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

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2017 BMC Infectious Diseases

96. 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

97. 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

2016 Life in the Fast Lane Blog

98. Fusobacterium necrophorum otitis and mastoiditis in infants and young toddlers.

Fusobacterium necrophorum otitis and mastoiditis in infants and young toddlers. There is an increased recovery of Fusobacterium necrophorum from cases of otitis media and mastoiditis in the pediatric population. These infections may be highly severe, causing local osteomyelitis, bacteremia, and Lemierre's syndrome. The severity and difficulties in providing optimal treatment for these infections may be especially difficult in this age group due to immunological immaturity and delayed (...) with antimicrobial agents (beta lactams plus metronidazole) and mastoidectomy. Lemierre's syndrome and Lemierre's syndrome variants developed in 60 % of the patients. Dissemination of the infection as distal osteomyelitis and septic shock were also reported. The outcome was favorable in all the cases. Otitis and mastoiditis infections in children less then 2 years old are invasive infections, and severe complications can occur.

2017 European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology

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

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

100. Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis (PubMed)

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

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2017 Journal of clinical microbiology

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