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Lemierre Syndrome

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101. Chromobacterium violaceum infection in chronic granulomatous disease: a case report and review of the literature (PubMed)

thrombosis, following travel to the rural Solomon Islands. C. violaceum was recovered from his blood. The patient recovered after treatment with meropenem and trimethoprim/sulfamethoxazole. Conclusion. To the best of our knowledge, this is the first case report of internal jugular vein thrombophlebitis (Lemierre's syndrome) caused by C. violaceum in a patient with CGD. A review of the literature demonstrated that the diagnosis of C. violaceum preceded the diagnosis of CGD in the majority of cases

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2017 JMM Case Reports

102. A case of liver abscess and fusobacterium septicemia (PubMed)

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.

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2017 IDCases

103. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis

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

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2012 Infectious Diseases Society of America

104. A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures (PubMed)

. 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.

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2016 Case reports in otolaryngology

105. Why I oppose home strep testing

” but rather something more complicated. (infectious mono, early HIV, peritonsillar abscess, Lemierre syndrome, Still’s disease, leukemia, etc.) Share this: Like this: Like Loading... Comments (1) pcb said on 20-09-2016 DB, You’re still stuck in “individual patient mode.” get with the times. it’s about “population health” now, and this approach gets us the most bang for the buck for most people when it comes to sore throats. ’cause it’s just a sore throat most of the time. And this is good enough. Post

2016 db's Medical Rants blog

106. The conundrum of clinical medicine is what makes it difficult

clinical passion — the Lemierre syndrome — has no evidence for prevention or treatment. We must make decisions about empiric antibiotics for severe sore throats in adolescents and young adults, and we must choose antibiotics in a patient diagnosed with the syndrome. We do not have, and likely will not have randomized controlled trials (RCTs) to guide our management. Rather we must use clinical judgment. Believing in EBM does not and should not eschew faith in clinical judgment. Many clinical situations

2016 KevinMD blog

107. Fusobacterium infections in children (PubMed)

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.

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2016 Canadian Family Physician

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

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

109. Evidence and clinical judgment should complement each other

many clinical questions lack such specificity. My recent clinical passion – the Lemierre syndrome – has no evidence for prevention or treatment. Yet we must make decisions about empiric antibiotics for severe sore throats in adolescents and young adults, and we must choose antibiotics in a patient diagnosed with the syndrome. We do not have, and likely will not have an RCTs to guide our management. Rather we must use clinical judgment. Believing in EBM does not and should not eschew faith

2016 db's Medical Rants blog

110. Microbiology of Para- og Retropharyngeal Abscess

findings in concomitant peritonsillar and parapharyngeal abscesses. Characterize patients with para- and retropharyngeal abscess. Compare the concentration of amylase in para- and retropharyngeal abscesses and neck abscesses without relation to the pharynx or salivary glands. Perform gene-sequencing of F. Necrophorum strains, and compare these with strains recovered from patients with acute tonsillitis, peritonsillar abscess, and Lemierre´s syndrome. Condition or disease Intervention/treatment

2015 Clinical Trials

111. Diagnostic accuracy – not a simple computer problem

... Comments (3) oncodoc said on 20-07-2015 Don’t you think that this is just a matter of time? Right now, computers can land a 747 safely, beat any human at chess, and beat any human at Jeopardy. I think that a metallosilicate brain could be educated to remember relatively rare things better than a protoplasmic brain. For example, when evaluating the “sore throat” chief complaint the computer could assess the risk factors for Lemierre syndrome quite rapidly and beat a human who can’t recall the syndrome

2015 db's Medical Rants blog

112. Thoughts from #SGIM15 & #ProudtobeGIM

Syndrome still warrants posters and oral presentations. More internists have become aware of the devastating syndrome, but few understand the true incidence. One presentation quoted the old incidence of 1 in 1 million. They had not absorbed this important paragraph from: Hagelskjaer Kristensen L, Prag J. Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey. Eur J Clin Microbiol Infect Dis. 2008;27:779-89. [PMID (...) : 18330604] doi:10.1007/s10096-008-0496-4 With a total population of 5.33 million in Denmark, the 58 cases of Lemierre’s syndrome corresponded to an incidence of 3.6 cases per million inhabitants per year (95% confidence interval [CI] 2.8–4.7). The incidence was 14.4 cases per million per year (95% CI 9.5–21.1) in youngsters 15–24 years of age. Lemierre’s syndrome was rare in adults over 40 years of age, with an incidence of 1.4 cases per million per year (95% CI 0.7–2.6). The detection rates varied

2015 db's Medical Rants blog

113. Why does sore throat diagnosis and management cause controversy?

. But sometimes serious consequences follow these routines complaints. Talk to any college health physician and they will tell you that they worry about sore throats; they worry about missing something more serious. What could they miss? Obviously, I am obsessed with the Lemierre Syndrome – relatively rare (I estimated in 2009 one in 70,000 adolescents or young adults each year) but often devastating. They could miss a peritonsillar abscess (or at least delay diagnosing it). Sore throats can precede acute (...) some procedure. Lemierre syndrome is the example used here, but with a 1 in 70,000 rate it is quite likely that a physician seeing twenty adolescent sore throats a week, or a thousand a year, will go their entire life without seeing a case. Nevertheless, it has to be looked for. In my field, the incidence of actual cancers in screening mammography populations is less than 1%. I used to joke that it would take a clinical trial of thousands to show that a sighted radiologist was better than a blind

2015 db's Medical Rants blog

114. How to teach clinical medicine – lessons learned by studying sore throats for 35 years

this: Like Loading... Comments (4) Cory said on 07-06-2015 Dr. C: Your expert opinion: Do you think widespread childhood use of antibiotics has made young adults more susceptible to Fusobacterium necrophorom because they have not “seen” it before and have not acquired earlier resistance? rcentor said on 08-06-2015 I do not think so. Lemierre syndrome was well known in the 20s-50s. It seemed to have almost disappeared in the 60s-80s. Many have speculated that empiric antibiotics (especially penicillin (...) ) held the syndrome at bay. Since the 80s we have seen some decrease in empiric antibiotics and even worse the wrong empiric antibiotics – especially macrolides. Fusobacterium necrophorum likely has been a major cause of adolescent/young adult pharyngitis for many years and likely not related to “immunity”. Adam said on 10-07-2015 What is the probability of a patient having Lemierre syndrome if presenting with only one risk factor? I am not a doctor, but a pharmacist and had a young man come

2015 db's Medical Rants blog

115. Fusobacterial head and neck infections in children. (PubMed)

Fusobacterial head and neck infections in children. Fusobacterium species are increasingly recognized as a cause of head and neck infections in children. These infections include acute and chronic otitis, sinusitis, mastoiditis, and tonsillitis; peritonsillar and retropharyngeal abscesses; Lemierre syndrome; post-anginal cervical lymphadenitis; and periodontitis. They can also be involved in brain abscess and bacteremia associated with head and neck infections. This review describes

2015 International Journal of Pediatric Otorhinolaryngology

116. A 28-year-old pregnant woman with a very rare cause of jugular vein thrombosis. (PubMed)

A 28-year-old pregnant woman with a very rare cause of jugular vein thrombosis. During pregnancy, venous thrombosis of the distal extremities is not uncommon. However, thrombosis in the upper part of the body, such as jugular vein thrombosis, is rare. If underlying causes such as ovarian hyperstimulation syndrome (OHSS) or septic thrombophlebitis (Lemierre's syndrome) are excluded, a serous borderline ovary tumour (BOT) must be considered and MR imaging of the abdomen could be performed to find

2014 Netherlands Journal of Medicine

117. Sore throat - acute

(glandular fever). Fusobacterium necrophorum , which may cause pharyngitis or tonsillitis, and can (very rarely) lead to Lemierre syndrome (septic phlebitis of the internal jugular vein). Rarer infectious causes include [ ; ; ]: Haemophilus influenza type b — can cause epiglottitis. Enteroviruses — can cause herpangina and hand, foot, and mouth disease. Measles virus. Candida albicans — causes candidal pharyngitis. Neisseria gonorrhoeae — can cause gonococcal pharyngitis. Corynebacterium diphtheria, C (...) , a displaced uvula, and an enlarged, displaced tonsil, with swelling of the peri-tonsillar region. It is most common in children 2 to 4 years of age. Retropharyngeal abscess — suggested by severe sore throat that does not resolve after a few days. There may be trismus or visible neck swelling. Lemierre syndrome — thrombophlebitis of the jugular vein. Typically seen in people with systemic inflammatory response syndrome (SIRS) or sepsis. Basis for recommendation Basis for recommendation Information

2012 NICE Clinical Knowledge Summaries

118. Upper Respiratory Tract Infection (Diagnosis)

subglottic stenosis. The work of breathing during epiglottitis or laryngotracheitis may lead to respiratory failure. Sleep apnea may occur from hypertrophied tonsils. Deep tissue infection may occur by extension of the infection into the orbit, middle ear, cranium, or other areas. Peritonsillar abscess (quinsy) may complicate bacterial pharyngitis, leading to difficulty swallowing and pain radiating to the ear. Retropharyngeal abscess may also complicate pharyngitis. Lemierre syndrome is an extension (...) > Upper Respiratory Tract Infection Updated: Jun 21, 2018 Author: Anne Meneghetti, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP Share Email Print Feedback Close Sections Sections Upper Respiratory Tract Infection Overview Practice Essentials Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx—to life-threatening illnesses

2014 eMedicine.com

119. Peritonsillar Abscess (Follow-up)

):23-6. . da Silva PS, Waisberg DR. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection. Pediatr Emerg Care . 2011 May. 27 (5):422-4. . Roccia F, Pecorari GC, Oliaro A, Passet E, Rossi P, Nadalin J, et al. Ten years of descending necrotizing mediastinitis: management of 23 cases. J Oral Maxillofac Surg . 2007 Sep. 65 (9):1716-24. . Ehrenfried Berthelsen R, Hein L. [Lemierre's syndrome following peritonsillar abscess]. Ugeskr Laeger

2014 eMedicine Surgery

120. Pleural Effusion (Overview)

include hypoalbuminemia, nephrosis, hepatic cirrhosis, and iatrogenic causes (eg, a misplaced central line or a complication of ventriculopleural shunt). Other, rare causes of pleural effusion include pancreatitis (effusions are usually hemorrhagic, unilateral and left sided), rupture of a pulmonary hydatid cyst into the pleural space, and Lemierre syndrome (postpharyngitis anaerobic sepsis with thrombophlebitis of the internal jugular vein). Previous Next: Epidemiology Parapneumonic effusions (...) ), Actinomyces species, and fungi. Group A beta-hemolytic S pneumoniae with pleural effusion and streptococcal toxic shock syndrome has been described in association with varicella infections in children. [ ] Anaerobes, including Bacteroides and Fusobacterium species, have been found, particularly in empyema associated with aspiration pneumonia in neurologically impaired children. [ ] Anaerobes have also been found in empyema associated with intraoral and subdiaphragmatic abscesses. [ ] Pneumocystis jiroveci

2014 eMedicine Pediatrics

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