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Lemierre Syndrome

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141. Pharyngitis (Diagnosis)

, 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

142. Mastoiditis (Diagnosis)

. Masked mastoiditis. Laryngoscope . 1983 Aug. 93(8):1034-7. . Oestreicher-Kedem Y, Raveh E, Kornreich L, et al. 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

2014 eMedicine Pediatrics

143. Peritonsillar Abscess (Follow-up)

factors may reduce its occurrence. Previous Next: Complications Note the following possible complications: Airway compromise Aspiration of abscess contents (spontaneously or with incision and drainage) and development of aspiration pneumonia Parapharyngeal abscess Septic thrombophlebitis involving the internal jugular vein (Lemierre syndrome) or internal carotid artery leading to septicemia with metastatic foci of infection, especially in the lung (Lemierre syndrome, caused by Fusobacterium ) Carotid

2014 eMedicine Pediatrics

144. 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

145. 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

2014 eMedicine.com

146. 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

147. Mastoiditis (Overview)

. Masked mastoiditis. Laryngoscope . 1983 Aug. 93(8):1034-7. . Oestreicher-Kedem Y, Raveh E, Kornreich L, et al. 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

2014 eMedicine Pediatrics

148. 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

2014 eMedicine Pediatrics

149. Thrombophlebitis, Septic (Diagnosis)

are thrombophlebitis in the following (see Etiology): Peripheral veins Pelvic veins Portal vein (pylephlebitis) Superior vena cava (SVC) or inferior vena cava (IVC) Internal jugular vein (Lemierre syndrome) Dural sinuses The approach to treatment of septic phlebitis depends on which structures are involved, the underlying etiology of the phlebitis, the causative organisms, and the patient's underlying physiology. (See Treatment and Medication.) Peripheral septic thrombophlebitis is a common problem that can (...) nutrition. [ ] Patients are generally very ill appearing with high fever, and they may also have signs of venous occlusion, including arm and neck edema. The mortality rate of these infections is high, but cases of successful treatment have been reported. [ ] Lemierre syndrome is a suppurative thrombophlebitis of the internal jugular vein caused by oropharyngeal infections such as tonsillitis and dental infections. Spread of the infection into the parapharyngeal space that houses the carotid sheath

2014 eMedicine Emergency Medicine

150. Pharyngitis (Follow-up)

. . Lemierre's syndrome, reemergence of a forgotten disease: a case report. Cases J . 2009 Mar 10. 2:6397. . . Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics . 2009 Feb. 123(2):437-44. . Cohen JF, Cohen R, Bidet P, et al. Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective (...) abscess; or suppurative cervical lymphadenitis. It is unclear if antibiotic therapy can prevent these complications as abscess isolates are often polymicrobial. Many experts believe these are actually independent entities and not related to GAS pharyngitis. In addition to the above general complications, nonsuppurative complications (3% incidence) specific to GAS infection include acute rheumatic fever (3-5 wk postinfection), poststreptococcal glomerulonephritis, and toxic shock syndrome

2014 eMedicine Emergency Medicine

151. Pharyngitis (Diagnosis)

. . Lemierre's syndrome, reemergence of a forgotten disease: a case report. Cases J . 2009 Mar 10. 2:6397. . . Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics . 2009 Feb. 123(2):437-44. . Cohen JF, Cohen R, Bidet P, et al. Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective

2014 eMedicine Emergency Medicine

152. 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

2014 eMedicine Emergency Medicine

153. Pharyngitis, Bacterial (Diagnosis)

. 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

154. Infectious Mononucleosis (Diagnosis)

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

155. Thrombophlebitis (Diagnosis)

(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

156. 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

157. 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

2014 eMedicine Emergency Medicine

158. Internal Jugular Vein Thrombosis (Treatment)

, 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

159. Peritonsillar Abscess (Overview)

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

160. Internal Jugular Vein Thrombosis (Overview)

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

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