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Lemierre Syndrome

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121. Upper Respiratory Tract Infection (Overview)

syndrome (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). Hemoptysis suggests the possibility of tuberculosis. A tuberculin skin test, chest radiography, or both are appropriate in these patients. Complications of specific conditions Complications of group A streptococcal disease Group A streptococcal pharyngitis is of special concern because its complications include streptococcal toxic shock syndrome, acute rheumatic fever (ARF), acute glomerulonephritis (...) > 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

122. 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

123. Infectious Mononucleosis (Follow-up)

colonization versus infection. Infect Dis Pract . 1994. 18:16. Glaser SL, Lin RJ, Stewart SL, Ambinder RF, Jarrett RF, Brousset P, et al. Epstein-Barr virus-associated Hodgkin's disease: epidemiologic characteristics in international data. Int J Cancer . 1997 Feb 7. 70(4):375-82. . Godshall SE, Kirchner JT. Infectious mononucleosis. Complexities of a common syndrome. Postgrad Med . 2000 Jun. 107(7):175-9, 183-4, 186. . Gold WL, Kapral MK, Witmer MR, et al. Postanginal septicemia as a life-threatening (...) , 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

2014 eMedicine.com

124. Pharyngitis, Bacterial (Follow-up)

bacterial infection, antibiotics should not be prescribed. In contrast, a steroid may be prescribed to relieve symptoms in patients with infectious mononucleosis. Previous Next: Consultations An otolaryngologist should be consulted for local suppurative complications such as peritonsillar abscess and . may be considered in recurrent GABHS infection. [ , ] An infectious diseases expert may be consulted for patients with immunocompromising conditions or when an agent other than GABHS (eg, HIV (...) ) is suspected or confirmed. Previous Next: Diet Allow a regular diet as tolerated in patients with bacterial pharyngitis. Warm liquids may provide symptomatic relief. Previous Next: Activity Encourage rest during the acute illness. Previous Next: Prevention Patients with bacterial pharyngitis should be kept out of daycare, school, or work until 24 hours after the initiation of antibiotics. Vaccination Despite the massive disease burden caused by S pyogenes (GAS) infection, no licensed vaccine is available

2014 eMedicine.com

125. Arcanobacterium Haemolyticum (Overview)

presenting with a deep ulcer. [ ] Diabetic patients are more vulnerable to infection by A haemolyticum , and wound and blood cultures are appropriate if the patient appears septic. Multiple wound cultures may be required before A haemolyticum is identified. A haemolyticum is sometimes a copathogen with other bacteria, including with Fusobacterium necrophorum in one case of Lemierre disease. [ ] Although A haemolyticum has been implicated in a wide spectrum of diseases, it has been most commonly (...) . . Balakrishnan D. Arcanobacterium Hemolyticum Chorioamnionitis Leading to Preterm Labour – A Case Report. Basic Sci Med . 2017. 6(1):1-4. Smith HM, Arul I. Wound Infection and Sepsis Caused by Arcanobacterium haemolyticum. Clin Microbiol News . 2016. 38(6):49-50. Younus F, Chua A, Tortora G, Jimenez VE. Lemierre's disease caused by co-infection of Arcanobacterium haemolyticum and Fusobacterium necrophorum: a case report. J Infect . 2002 Aug. 45(2):114-7. . Nyman M, Alugupalli KR, Strömberg S, Forsgren

2014 eMedicine.com

126. Peritonsillar Abscess (Diagnosis)

are available internationally. Although tonsillitis is a disease of childhood, only one third of PTA cases are found in this age group. The age of patients with the condition is variable, ranging from 1 to 76 years, with the highest incidence in persons aged 15-35 years. No sexual or racial predilection has been established. In a retrospective cohort study of 427 patients with PTA, Marom et al investigated how the characteristics of PTA may have changed over time. [ ] The results led the authors to conclude (...) 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

127. Thrombophlebitis, Septic (Treatment)

in central catheter–associated thrombophlebitis, particularly in patients receiving total parenteral nutrition (TPN), and can usually be covered by the addition of intravenous fluconazole. Anticoagulation is often favored in deep vein disease, although no controlled studies have been performed to date. Studies of central venous thrombophlebitis report success with streptokinase, heparin, and enoxaparin. [ ] Internal jugular thrombophlebitis In the case of Lemierre syndrome, particular attention should (...) ):653-8. . . Verghese A, Widrich WC, Arbeit RD. Central venous septic thrombophlebitis--the role of medical therapy. Medicine (Baltimore) . 1985 Nov. 64(6):394-400. . Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore) . 1989 Mar. 68(2):85-94. . Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I. Necrobacillosis: a forgotten disease. Br Med J (Clin Res Ed) . 1984 May 19. 288(6429):1526-7

2014 eMedicine Emergency Medicine

128. Internal Jugular Vein Thrombosis (Overview)

and commonly isolated pathogen. [ ] Other organisms include Bacteroides and Peptostreptococcus species, Eikenella corrodens, and S aureus. Previous Next: Epidemiology Some studies suggest that the rate of thrombosis may be lower for Silastic (Dow Corning, Midland, MI) hemodialysis catheters inserted percutaneously than for those inserted surgically. Additionally, the rate of thrombosis may be lower in patients undergoing hemodialysis than in other critically ill patients. The incidence of Lemierre syndrome (...) thrombosis. Mortality has been reported to be 14% at 1 month, 33% at 3 months, and 42% at 12 months. [ ] Before the antibiotic era, Lemierre syndrome was associated with a mortality exceeding 50%. Today, however, death is uncommon when the syndrome is recognized early and treated with appropriate aggressive medical and surgical therapy. In one series of patients with septic thrombophlebitis occurring over a 9-year period, death occurred in 17% of patients. Many patients have ongoing critical illness

2014 eMedicine Surgery

129. Arcanobacterium Haemolyticum (Follow-up)

report. Ophthal Plast Reconstr Surg . 2015 Mar-Apr. 31 (2):e31-3. . Balakrishnan D. Arcanobacterium Hemolyticum Chorioamnionitis Leading to Preterm Labour – A Case Report. Basic Sci Med . 2017. 6(1):1-4. Smith HM, Arul I. Wound Infection and Sepsis Caused by Arcanobacterium haemolyticum. Clin Microbiol News . 2016. 38(6):49-50. Younus F, Chua A, Tortora G, Jimenez VE. Lemierre's disease caused by co-infection of Arcanobacterium haemolyticum and Fusobacterium necrophorum: a case report. J Infect (...) you like to print? Sections Arcanobacterium Haemolyticum Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties. Close encoded search term (Arcanobacterium Haemolyticum) and Arcanobacterium Haemolyticum What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According

2014 eMedicine.com

130. Pharyngitis (Treatment)

. . McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ . 2000 Oct 3. 163 (7):811-5. . Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med . 2012 Jun 11. 172 (11):847-52. . . Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am . 2005 Jun. 52(3):729-47, vi. . Lemierre's syndrome, reemergence of a forgotten disease: a case report. Cases J (...) On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties. Close encoded search term (Pharyngitis) and Pharyngitis What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Internists Recommended 2002 858001-overview Procedures Procedures 2002 849233-overview Procedures

2014 eMedicine Emergency Medicine

131. Internal Jugular Vein Thrombosis (Diagnosis)

and commonly isolated pathogen. [ ] Other organisms include Bacteroides and Peptostreptococcus species, Eikenella corrodens, and S aureus. Previous Next: Epidemiology Some studies suggest that the rate of thrombosis may be lower for Silastic (Dow Corning, Midland, MI) hemodialysis catheters inserted percutaneously than for those inserted surgically. Additionally, the rate of thrombosis may be lower in patients undergoing hemodialysis than in other critically ill patients. The incidence of Lemierre syndrome (...) thrombosis. Mortality has been reported to be 14% at 1 month, 33% at 3 months, and 42% at 12 months. [ ] Before the antibiotic era, Lemierre syndrome was associated with a mortality exceeding 50%. Today, however, death is uncommon when the syndrome is recognized early and treated with appropriate aggressive medical and surgical therapy. In one series of patients with septic thrombophlebitis occurring over a 9-year period, death occurred in 17% of patients. Many patients have ongoing critical illness

2014 eMedicine Surgery

132. Pediatrics, Pharyngitis (Diagnosis)

that in patients aged 15 to 30 years, 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 (...) Throat in Young Adults May Indicate Serious Illness. Medscape Medical News. Available at . Accessed: May 26, 2015. American Academy of Pediatrics. Report of the committee on infectious diseases. Pickering LK, Baker CJ, McMillan J, Long S (Editors). Red Book . . 27th Edition. Elk Grove Village, Il: American Academy of Pediatrics; 2006:430-439.: [Guideline] Ayanruoh S, Waseem M, Quee F, Humphrey A, Reynolds T. Impact of rapid streptococcal test on antibiotic use in a pediatric emergency department

2014 eMedicine Emergency Medicine

133. Arcanobacterium Haemolyticum (Diagnosis)

presenting with a deep ulcer. [ ] Diabetic patients are more vulnerable to infection by A haemolyticum , and wound and blood cultures are appropriate if the patient appears septic. Multiple wound cultures may be required before A haemolyticum is identified. A haemolyticum is sometimes a copathogen with other bacteria, including with Fusobacterium necrophorum in one case of Lemierre disease. [ ] Although A haemolyticum has been implicated in a wide spectrum of diseases, it has been most commonly (...) . . Balakrishnan D. Arcanobacterium Hemolyticum Chorioamnionitis Leading to Preterm Labour – A Case Report. Basic Sci Med . 2017. 6(1):1-4. Smith HM, Arul I. Wound Infection and Sepsis Caused by Arcanobacterium haemolyticum. Clin Microbiol News . 2016. 38(6):49-50. Younus F, Chua A, Tortora G, Jimenez VE. Lemierre's disease caused by co-infection of Arcanobacterium haemolyticum and Fusobacterium necrophorum: a case report. J Infect . 2002 Aug. 45(2):114-7. . Nyman M, Alugupalli KR, Strömberg S, Forsgren

2014 eMedicine.com

134. Drainage, Peritonsillar Abscess

looked at the bacteriology of PTA aspirates. A mixture of aerobic and anaerobic bacteria is commonly isolated. [ , ] The most common aerobic bacteria are Streptococcus group A (GAS), beta-hemolytic streptococci group C and G, and Staphylococcus aureus . The most common anaerobic bacteria isolated from PTA aspirates is Fusobacterium necrophorum (FN). FN is a gram-negative, obligate anaerobic, pleomorphic rod. It is also the pathogen most commonly associated with Lemierre syndrome. [ , ] In one study (...) Procedures) and Peritonsillar Abscess Drainage Procedures What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to General Surgeons Recommended 2002 858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine.com

135. Pharyngitis, Bacterial (Diagnosis)

information on pharyngitis in children, see the Medscape Reference article . Previous Next: Prognosis GABHS pharyngitis is usually a self-limited illness. Throat symptoms resolve within 3-4 days in untreated patients. Administration of penicillin shortly after disease onset may shorten symptoms by 1-2 days. [ ] Previous Next: Patient Education Symptomatic relief may be provided by warm saline gargles, throat lozenges, and ibuprofen. Acetaminophen or ibuprofen can be used for fever relief. Patients (...) . 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

136. Infections of the Lung, Pleura and Mediastinum: Surgical Perspective (Follow-up)

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

137. Infections of the Lung, Pleura and Mediastinum: Surgical Perspective (Overview)

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

138. Infections of the Lung, Pleura and Mediastinum: Surgical Perspective (Treatment)

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

139. Mastoiditis (Treatment)

. Complications of mastoiditis in children at the onset of a new millennium. Ann Otol Rhinol Laryngol . 2005 Feb. 114(2):147-52. . Fischer JB, Prout A, Blackwood RA, Warrier K. Lemierre Syndrome Presenting as Acute Mastoiditis in a 2-Year-Old Girl with Congenital Dwarfism. Infect Dis Rep . 2015 Apr 15. 7 (2):5922. . Enoksson F, Groth A, Hultcrantz M, Stalfors J, Stenfeldt K, Hermansson A. Subperiosteal abscesses in acute mastoiditis in 115 Swedish children. Int J Pediatr Otorhinolaryngol . 2015 Jul. 79 (7 (...) material copyrighted by 3rd parties. Close encoded search term (Pediatric Mastoiditis) and Pediatric Mastoiditis What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Pediatricians Recommended 2002 994656-overview Diseases & Conditions Diseases & Conditions 2002 858990-overview Procedures Procedures 2002 859316-overview Procedures Procedures 2002 860323-overview Procedures Procedures Need a Curbside Consult

2014 eMedicine Pediatrics

140. Mastoiditis (Follow-up)

. Complications of mastoiditis in children at the onset of a new millennium. Ann Otol Rhinol Laryngol . 2005 Feb. 114(2):147-52. . Fischer JB, Prout A, Blackwood RA, Warrier K. Lemierre Syndrome Presenting as Acute Mastoiditis in a 2-Year-Old Girl with Congenital Dwarfism. Infect Dis Rep . 2015 Apr 15. 7 (2):5922. . Enoksson F, Groth A, Hultcrantz M, Stalfors J, Stenfeldt K, Hermansson A. Subperiosteal abscesses in acute mastoiditis in 115 Swedish children. Int J Pediatr Otorhinolaryngol . 2015 Jul. 79 (7 (...) material copyrighted by 3rd parties. Close encoded search term (Pediatric Mastoiditis) and Pediatric Mastoiditis What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Pediatricians Recommended 2002 994656-overview Diseases & Conditions Diseases & Conditions 2002 858990-overview Procedures Procedures 2002 859316-overview Procedures Procedures 2002 860323-overview Procedures Procedures Need a Curbside Consult

2014 eMedicine Pediatrics

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