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Lemierre Syndrome

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121. Pharyngitis (Overview)

, Fusobacterium necrophorum causes at least 10% of cases of pharyngitis. The study also observed that F. necrophorum was the primary cause of Lemierre syndrome in this age group. [ , ] Viruses that may cause acute viral pharyngitis include the following: EBV (mononucleosis) - Produces a shaggy white membrane Rhinovirus Adenovirus Parainfluenza virus Coxsackievirus Coronavirus Echovirus Cytomegalovirus (CMV) Causes of chronic pharyngitis (usually noninfectious) include the following: Irritation from postnasal

2014 eMedicine Pediatrics

122. Peritonsillar Abscess (Diagnosis)

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 . 2012 May 28. 174 (22):1534-5. . Ramirez-Schrempp D, Dorfman DH, Baker WE, Liteplo AS. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain?. Pediatr Emerg Care . 2009 Jan. 25 (1):44-8

2014 eMedicine Surgery

123. Internal Jugular Vein Thrombosis (Diagnosis)

to as Lemierre syndrome; this has also been termed necrobacillosis or postanginal septicemia. The diagnosis often is highly challenging and requires, first and foremost, a high degree of clinical suspicion. The best approach to making the diagnosis once suspicion is raised has not been definitively established. The morbidity and mortality of IJ vein thrombosis are comparable to those of upper-extremity deep vein thrombosis (DVT); accordingly, consideration should be given to treating these two entities (...) itself acts as the nidus for clot formation, despite being bonded and flushed with heparin. Additionally, the catheter tip itself may produce damage to the vessel wall and disrupt venous flow, further augmenting clot formation. Various oropharyngeal infections (eg, odontogenic infections and infections of the tonsils, peritonsillar tissue, pharynx, sinuses, middle ear, and parotids) may lead to Lemierre syndrome. The primary infection spreads to the posterior compartment of the lateral pharyngeal

2014 eMedicine Surgery

124. Internal Jugular Vein Thrombosis (Follow-up)

, and axillary deep venous thrombosis and the risk of pulmonary embolism. Vascular . 2008 Mar-Apr. 16 (2):73-9. . Righini CA, Karkas A, Tourniaire R, N'Gouan JM, Schmerber S, Reyt E, et al. Lemierre syndrome: study of 11 cases and literature review. Head Neck . 2014 Jul. 36 (7):1044-51. . Ascher E, Salles-Cunha S, Hingorani A. Morbidity and mortality associated with internal jugular vein thromboses. Vasc Endovascular Surg . 2005 Jul-Aug. 39 (4):335-9. . Tovi F, Fliss DM, Gatot A, Hertzanu Y. Septic jugular (...) thrombosis with abscess formation. Ann Otol Rhinol Laryngol . 1991 Aug. 100 (8):682-4. . Fuhrman T, Balatbat J, Frakes J, Metz R. Internal jugular thrombosis causing increased intracranial pressure and upper airway edema. Internet J Anesthesiol . 1999. 4 (3):1-5. . Kim BY, Yoon DY, Kim HC, Kim ES, Baek S, Lim KJ, et al. Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol . 2013 Jul. 54 (6):622-7. . Sheikh MA, Topoulos AP, Deitcher SR. Isolated internal

2014 eMedicine Surgery

125. Lung Abscess (Diagnosis)

necrosis 7-14 days later, resulting in formation of lung abscess. Other mechanisms for lung abscess formation include bacteremia or tricuspid valve endocarditis causing septic emboli (usually multiple) to the lung. Lemierre syndrome, an acute oropharyngeal infection followed by of the internal jugular vein, is a rare cause of lung abscesses. The oral anaerobe F necrophorum is the most common pathogen. Microbiology Because of the difficulty obtaining material uncontaminated by nonpathogenic bacteria

2014 eMedicine.com

126. Infectious Mononucleosis (Treatment)

and chemistry of Epstein-Barr virus. J Infect Dis . 1982 Oct. 146(4):506-17. . Kitazawa Y, Saito F, Nomura S, et al. A case of hemophagocytic lymphohistiocytosis after the primary Epstein-Barr virus infection. Clin Appl Thromb Hemost . 2007 Jul. 13(3):323-8. . Klein E, Masucci MG. Cell-mediated immunity against Epstein-Barr virus infected B lymphocytes. Springer Semin Immunopathol . 1982. 5(1):63-73. . Klein NC, Petelin A, Cunha BA. Mycoplasma pneumoniae preceding Lemierre's syndrome due to Fusobacterium (...) . . Akashi K, Eizuru Y, Sumiyoshi Y, et al. Brief report: severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult. N Engl J Med . 1993 Jul 15. 329(3):168-71. . Al-Jitawi SA, Hakooz BA, Kazimi SM. False positive Monospot test in systemic lupus erythematosus. Br J Rheumatol . 1987 Feb. 26(1):71. . Ali J. Spontaneous rupture of the spleen in patients with infectious mononucleosis. Can J Surg . 1993 Feb. 36(1):49-52. . Allday MJ, Crawford DH. Role of epithelium

2014 eMedicine.com

127. Thrombophlebitis (Treatment)

a sore throat to the intensive care unit: the Lemierre syndrome. Wien Klin Wochenschr . 2006 May. 118(7-8):243-6. . Brinsuk M, Tank J, Luft FC, Busjahn A, Jordan J. Heritability of venous function in humans. Arterioscler Thromb Vasc Biol . 2004 Jan. 24(1):207-11. . Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor's disease of the chest wall. Phys Ther Sport . 2017 Jan. 23:133-135. . Amano M, Shimizu T. Mondor's Disease: A Review of the Literature. Intern Med . 2018 May 18. . Belcaro G (...) thrombosis. Sydney views. Cardiovasc Surg . 2001 Apr. 9(2):149-50; discussion 153-6. . Parsi KA, McGrath MA, Lord RS. Traveller's venous thromboembolism. Cardiovasc Surg . 2001 Apr. 9(2):157-8. . McQuillan AD, Eikelboom JW, Baker RI. Venous thromboembolism in travellers: can we identify those at risk?. Blood Coagul Fibrinolysis . 2003 Oct. 14(7):671-5. . Varki A. Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood . 2007. 110:1723-1729. Kanaan AO, Silva MA, Donovan JL, Roy T, Al

2014 eMedicine.com

128. Pharyngitis, Bacterial (Treatment)

, Havlichek D, Laird-Fick H. Lemierre's syndrome and 2016 American College of Physician guidelines for pharyngitis: no to empiric coverage for bacterial pharyngitis. While no role for routine Fusobacterium PCR, keep suspicion for this pathogen. BMJ Case Rep . 2018 Jul 19. 2018: . Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med . 1954 Dec. 17(6):749-56. . American Academy of Pediatrics. Group A Streptococcal Infections. Red Book

2014 eMedicine.com

129. Pharyngitis, Bacterial (Overview)

. Clin Microbiol Infect . 2007 Jul. 13(7):695-701. . Lundin MS, Bastakoti S, Havlichek D, Laird-Fick H. Lemierre's syndrome and 2016 American College of Physician guidelines for pharyngitis: no to empiric coverage for bacterial pharyngitis. While no role for routine Fusobacterium PCR, keep suspicion for this pathogen. BMJ Case Rep . 2018 Jul 19. 2018: . Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med . 1954 Dec. 17(6):749-56

2014 eMedicine.com

130. Thrombophlebitis (Overview)

(11):2189-96. . Hochmair M, Valipour A, Oschatz E, Hollaus P, Huber M, Chris Burghuber O. From a sore throat to the intensive care unit: the Lemierre syndrome. Wien Klin Wochenschr . 2006 May. 118(7-8):243-6. . Brinsuk M, Tank J, Luft FC, Busjahn A, Jordan J. Heritability of venous function in humans. Arterioscler Thromb Vasc Biol . 2004 Jan. 24(1):207-11. . Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor's disease of the chest wall. Phys Ther Sport . 2017 Jan. 23:133-135. . Amano M (...) Author: Padma Chitnavis, MD; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Thrombophlebitis Overview Background Thrombophlebitis involves the formation of a blood clot in the presence of venous inflammation or injury. Many innate conditions may predispose patients to thrombophlebitis by means of a variety of hypercoagulopathy syndromes. [ ] Traumatic events can also initiate a thrombophlebitic reaction. In addition, the persistence of significant reflux

2014 eMedicine.com

131. Upper Respiratory Tract Infection (Overview)

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

132. Lung Abscess (Overview)

necrosis 7-14 days later, resulting in formation of lung abscess. Other mechanisms for lung abscess formation include bacteremia or tricuspid valve endocarditis causing septic emboli (usually multiple) to the lung. Lemierre syndrome, an acute oropharyngeal infection followed by of the internal jugular vein, is a rare cause of lung abscesses. The oral anaerobe F necrophorum is the most common pathogen. Microbiology Because of the difficulty obtaining material uncontaminated by nonpathogenic bacteria

2014 eMedicine.com

133. Infectious Mononucleosis (Overview)

pneumoniae preceding Lemierre's syndrome due to Fusobacterium nucleatum complicated by acute Epstein-Barr virus (EBV) infectious mononucleosis in an immunocompetent host. Heart Lung . 2013 Jan. 42(1):74-6. . Klemola E, Von Essen R, Henle G, et al. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis . 1970 Jun. 121(6):608-14. . Koj IG, Cunha BA. EBV infectious mononucleosis (...) . At the time, their article was entitled "Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis)," because the causative organism, EBV, had yet to be described. Since the 1800s, infectious mononucleosis has been recognized as a clinical syndrome consisting of fever, , and adenopathy. The term glandular fever was first used in 1889 by German physicians and was termed Drüsenfieber. The association between infectious mononucleosis and EBV was described in the late 1960s. Next

2014 eMedicine.com

134. Pharyngitis, Bacterial (Follow-up)

, Havlichek D, Laird-Fick H. Lemierre's syndrome and 2016 American College of Physician guidelines for pharyngitis: no to empiric coverage for bacterial pharyngitis. While no role for routine Fusobacterium PCR, keep suspicion for this pathogen. BMJ Case Rep . 2018 Jul 19. 2018: . Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med . 1954 Dec. 17(6):749-56. . American Academy of Pediatrics. Group A Streptococcal Infections. Red Book

2014 eMedicine.com

135. Thrombophlebitis (Follow-up)

a sore throat to the intensive care unit: the Lemierre syndrome. Wien Klin Wochenschr . 2006 May. 118(7-8):243-6. . Brinsuk M, Tank J, Luft FC, Busjahn A, Jordan J. Heritability of venous function in humans. Arterioscler Thromb Vasc Biol . 2004 Jan. 24(1):207-11. . Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor's disease of the chest wall. Phys Ther Sport . 2017 Jan. 23:133-135. . Amano M, Shimizu T. Mondor's Disease: A Review of the Literature. Intern Med . 2018 May 18. . Belcaro G (...) thrombosis. Sydney views. Cardiovasc Surg . 2001 Apr. 9(2):149-50; discussion 153-6. . Parsi KA, McGrath MA, Lord RS. Traveller's venous thromboembolism. Cardiovasc Surg . 2001 Apr. 9(2):157-8. . McQuillan AD, Eikelboom JW, Baker RI. Venous thromboembolism in travellers: can we identify those at risk?. Blood Coagul Fibrinolysis . 2003 Oct. 14(7):671-5. . Varki A. Trousseau’s syndrome: multiple definitions and multiple mechanisms. Blood . 2007. 110:1723-1729. Kanaan AO, Silva MA, Donovan JL, Roy T, Al

2014 eMedicine.com

136. Infectious Mononucleosis (Follow-up)

, Saito F, Nomura S, et al. A case of hemophagocytic lymphohistiocytosis after the primary Epstein-Barr virus infection. Clin Appl Thromb Hemost . 2007 Jul. 13(3):323-8. . Klein E, Masucci MG. Cell-mediated immunity against Epstein-Barr virus infected B lymphocytes. Springer Semin Immunopathol . 1982. 5(1):63-73. . Klein NC, Petelin A, Cunha BA. Mycoplasma pneumoniae preceding Lemierre's syndrome due to Fusobacterium nucleatum complicated by acute Epstein-Barr virus (EBV) infectious mononucleosis (...) patient education articles and . Previous References Sprunt TPV, Evans FA. Mononuclear leukocytosis in reaction to acute infection (infectious mononucleosis). Bulletin of the Johns Hopkins Hospital . Baltimore, 1920. 31:410-417. Aalto SM, Linnavuori K, Peltola H, et al. Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primaryinfection. J Med Virol . 1998 Nov. 56(3):186-91. . Akashi K, Eizuru Y, Sumiyoshi Y, et al. Brief report: severe infectious mononucleosis-like syndrome and primary

2014 eMedicine.com

137. Retropharyngeal Abscess (Diagnosis)

species. Other causative agents include Haemophilus parainfluenzae, Veillonella, Peptostreptococcus, Fusobacterium, and Eikenella species. Mycobacterium tuberculosis, Bartonella henselae , and Coccidia s hould be suspected in patients who may be predisposed (immunosuppressed individuals or recent immigrants), especially if they are not responding to conventional therapies. Finally, another consideration in the evaluation of these patients is the possibility of Lemierre syndrome (septic (...) thrombophlebitis of the internal jugular vein secondary to RPA). This infection is classically associated with Fusobacterium necrophorum , an anaerobic gram-negative rod. [ ] Surgical intervention, with adjunctive medical treatment that includes antibiotic therapy and anticoagulation, may be warranted in complicated RPA secondary to Lemierre syndrome. Previous Next: Epidemiology United States statistics In an analysis of a large national database of pediatric admissions in the United States, [ ] Lander et al

2014 eMedicine Pediatrics

138. Retropharyngeal Abscess (Overview)

species. Other causative agents include Haemophilus parainfluenzae, Veillonella, Peptostreptococcus, Fusobacterium, and Eikenella species. Mycobacterium tuberculosis, Bartonella henselae , and Coccidia s hould be suspected in patients who may be predisposed (immunosuppressed individuals or recent immigrants), especially if they are not responding to conventional therapies. Finally, another consideration in the evaluation of these patients is the possibility of Lemierre syndrome (septic (...) thrombophlebitis of the internal jugular vein secondary to RPA). This infection is classically associated with Fusobacterium necrophorum , an anaerobic gram-negative rod. [ ] Surgical intervention, with adjunctive medical treatment that includes antibiotic therapy and anticoagulation, may be warranted in complicated RPA secondary to Lemierre syndrome. Previous Next: Epidemiology United States statistics In an analysis of a large national database of pediatric admissions in the United States, [ ] Lander et al

2014 eMedicine Pediatrics

139. Infections of the Lung, Pleura and Mediastinum: Surgical Perspective (Diagnosis)

contains fat and lymphoid tissue. The middle mediastinum comprises the heart, pericardium, aorta, carina, mainstem bronchi, and lymph nodes. The posterior mediastinum includes the esophagus, descending aorta, vagus nerve, and thoracic duct. Chest radiographs and computed tomography images of patients with mediastinitis follow. CT scan of the thorax of a sixteen-year-old with Lemierre's syndrome and anterior mediastinitis revealing pneumomediastinum posterior to and to the left of the trachea, free (...) fluid surrounding the trachea, and left pleural effusion. CT scan of the thorax with intravenous contrast of a sixteen-year-old with Lemierre's syndrome and anterior mediastinitis revealing development of ring-enhancing fluid collections in the anterior mediastinum just posterior to the sternum. CT scan of the thorax with intravenous contrast of a sixteen-year-old with Lemierre's syndrome and anterior mediastinitis revealing a right pleural ring-enhancing abscess which persisted following drainage

2014 eMedicine Pediatrics

140. Pleural Effusion (Diagnosis)

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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