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Lemierre Syndrome

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161. 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

162. Just a simple case of tonsillitis? Lemierre’s Syndrome and thrombosis of the external jugular vein. Full Text available with Trip Pro

Just a simple case of tonsillitis? Lemierre’s Syndrome and thrombosis of the external jugular vein. Oropharyngeal infections are routinely encountered within general practice and accident and emergency departments. Most settle with simple analgesia and antibiotics; occasionally such patients may develop Lemierre's syndrome (LS) a rare and potentially fatal sequela that can be easily overlooked. We aim to highlight the main symptoms, pathology, investigations and management. © JSCR.

2011 Journal of surgical case reports

163. Severe Pneumonia and Jaundice in a Young Man: An Atypical Presentation of an Uncommon Disease. Full Text available with Trip Pro

Severe Pneumonia and Jaundice in a Young Man: An Atypical Presentation of an Uncommon Disease. We present a patient with an atypical presentation of Fusobacterium infection, the genus responsible for Lemierre's syndrome. This syndrome, which often affects healthy, young people and can be fatal if not recognized and treated early, is defined as a history of recent oropharyngeal infection with clinical or radiological evidence of internal jugular vein thrombosis and isolation of anaerobic (...) pathogens, mainly Fusobacterium necrophorum. The history, presentation, investigations and management of the patient are described and then contrasted with the existing literature surrounding Lemierre's syndrome, once termed the 'forgotten disease'.

2011 Journal of Medical Microbiology

164. 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 (...) ." Related Posts More in Conditions < Previous post Next post > Find jobs at Careers by KevinMD.com Search thousands of physician, PA, NP, and CRNA jobs now. × The conundrum of clinical medicine is what makes it difficult 9 comments Comments are moderated before they are published. Please read the . Leave a Comment Name Email Website Comment Close X Most Popular Past Week | | | | | | Past 6 Months | | | | | | Recent Posts | | | | | | Founded in 2004 by , KevinMD.com is the web’s leading platform where

2016 KevinMD blog

165. 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

166. 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 (...) Medical Rants. Add to FAVORITE […] Post a comment Name (required) Mail (will not be published) (required) Website Meta Random Quotes : "The good physician treats the disease; the great physician treats the patient who has the disease" : There are no facts, only interpretations. : "The man who never alters his opinion is like standing water, and breeds reptiles of the mind." : " The best test of a person's character is how he or she treats those with less power." : "Anyone can make the simple

2016 db's Medical Rants blog

167. Cognitive theory in medicine: A brief overview

shingles might actually be an unlikely distribution of poison oak. The practitioner may not have seen enough cases to develop an accurate pattern. You may have seen 10,000 sore throats and developed a very rapid diagnostic pattern recognition approach, but if you have never seen a case of Lemierre’s disease, you will miss that pattern. The pattern may not be classic. The elderly woman presenting with fatigue does not fit our classic pattern of ACS and is more likely to be missed. We are also likely (...) to miss diseases that present very early, before the classic pattern develops, or diseases for which the classic pattern significantly overlaps with other diseases. Our vigilance over the shortcomings of pattern recognition may become compromised. For example, you might recognize GERD by its pattern, but remain constantly vigilant for a myocardial infarction with a similar presentation. However, at 3am after 2 horrendous resuscitations, that vigilance may be compromised, resulting in misdiagnosis

2015 First10EM

168. 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 (...) %) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance

2015 db's Medical Rants blog

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

already written about the differences between pre-adolescents and adolescents & young adults. Some illness scripts differ by gender, or socioeconomic status, or country of origin. We should not ignore these factors. Lesson #4 – every medical problem is complex. Many physicians and patients consider sore throats as a simple medical condition. But our sore throat illness script should include some red flags. Duration of symptoms is a red flag. Sweats or rigors is a red flag. An asymmetric bulge (...) 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

2015 db's Medical Rants blog

170. 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

171. Thoughts from #SGIM15 & #ProudtobeGIM

among the departments of clinical microbiology from 0 to 6.1 cases of Lemierre’s syndrome per million per year. Internists generally understand that proper diagnosis underlies excellent care. I use diagnosis broadly to include identifying the correct disease(s), understanding who the patient is and what they expect from us, and understanding when we should focus on the disease and when we should shift our focus to the patient and the associated symptoms. Performance measures cannot capture this key (...) 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

2015 db's Medical Rants blog

172. Parapharyngeal Abscess

. Posterior space abscess can erode into the carotid artery or cause septic thrombophlebitis of the internal jugular vein (Lemierre syndrome). Symptoms and Signs Most patients have fever, sore throat, odynophagia, and swelling in the neck down to the hyoid bone. Anterior space abscesses cause trismus and induration along the angle of the mandible, with medial bulging of the tonsil and lateral pharyngeal wall. Pharyngeal Abscess Image provided by Clarence T. Sasaki, MD. Posterior space abscesses cause (...) Parapharyngeal Abscess Parapharyngeal Abscess - Ear, Nose, and Throat Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge

2013 Merck Manual (19th Edition)

173. Retropharyngeal Abscess

) bacteria and, increasingly in adults and children, HIV and TB. The most serious consequences include airway obstruction, septic shock, rupture of the abscess into the airway resulting in aspiration pneumonia or asphyxia, mediastinitis, carotid rupture, and suppurative thrombophlebitis of the internal jugular veins (Lemierre syndrome). Symptoms and Signs Symptoms and signs are usually preceded in children by an acute URI and in adults by foreign body ingestion or instrumentation. Children may have (...) Retropharyngeal Abscess Retropharyngeal Abscess - Ear, Nose, and Throat Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge

2013 Merck Manual (19th Edition)

174. Deep Venous Thrombosis (DVT)

complete stasis of venous and arterial blood flow in the lower extremity because venous return is occluded or massive edema cuts off arterial blood flow. Venous gangrene may result. Rarely, venous clots can become infected. Jugular vein suppurative thrombophlebitis (Lemierre syndrome), a bacterial (usually anaerobic) infection of the internal jugular vein and surrounding soft tissues, may follow tonsillopharyngitis and is often complicated by bacteremia and sepsis. In septic pelvic thrombophlebitis (...) conditions (eg, liver disease, trauma, pregnancy, positive rheumatoid factor, inflammation, recent surgery, cancer), further testing is necessary. If pretest probability of DVT is moderate or high, d -dimer testing can be done at the same time as duplex ultrasonography. A positive ultrasound result confirms the diagnosis regardless of the d -dimer level. If ultrasonography does not reveal evidence of DVT, a normal d -dimer level helps exclude DVT. Patients with an elevated d -dimer level should have

2013 Merck Manual (19th Edition)

175. Pakistan Epidemiological Survey in Acute Pharyngitis

Details Study Description Go to Brief Summary: GABHS are common etiological agents for acute pharyngitis. However, local data is limited and large scale surveillance studies have not been done. This study aims to evaluate the disease burden in the community due to GABHS. In this study, patients presenting with signs of acute pharyngitis will be evaluated. Patients with fulfilling the inclusion criteria will be tested for Rapid Antigen Detection test (RADT) Condition or disease Acute Pharyngitis Study (...) written authorization to participate in the study Exclusion Criteria: Recurrent or persistent cases of sore throat Complicated pharyngitis (peritonsillar abscesses, Lemierre disease, Vincent's angina) Severe comorbidity Immunosuppression or history of acute rheumatic fever Special circumstances, such as sore throat after travel in past 2 weeks, sore throat linked to sexual transmission or rare epidemics (e.g. diphtheria) Contacts and Locations Go to Information from the National Library of Medicine

2012 Clinical Trials

176. Lemierre's Syndrome Mimicking Leptospirosis Full Text available with Trip Pro

Lemierre's Syndrome Mimicking Leptospirosis Lemierre's syndrome is a suppurative thrombophlebitis involving the internal jugular vein, most commonly associated with Fusobacterium necrophorum, usually a complication of oropharyngeal infections. This syndrome is rare and is often overlooked. We present a case of sepsis mimicking initially severe leptospirosis (Weil's disease) due to acute febrile illness with multiorgan failure and hyperbilirubinemia. Finally, blood cultures revealed

2010 Hawaii Medical Journal

177. In response toLemierre's Syndrome: A Systematic Review Full Text available with Trip Pro

In response toLemierre's Syndrome: A Systematic Review In response to Lemierre's Syndrome: A Systematic Review - Karkos - 2010 - The Laryngoscope - Wiley Online Library Working off-campus? Learn about our By continuing to browse this site, you agree to its use of cookies as described in our . Search within Search term Search term Letter to the Editor Free Access In response to Lemierre's Syndrome: A Systematic Review Department of Otolaryngology, Liverpool University Hospitals, Liverpool (...) on the inclusion criteria set by the authors of each article. So, given our different inclusion/exclusion criteria, it is hardly surprising that we had identified a different number of pooled studies than Syed et al. did in their 2007 case series and review. In particular, we opted to exclude “variants or atypical Lemierre's syndrome cases, negative fusobacteria cultures, and papers without radiological evidence of thrombophlebitis.” Clinical evidence alone of internal jugular vein thrombosis is, in our

2010 The Laryngoscope

178. Lemierre's and Lemierre's-like syndromes in association with infectious mononucleosis. (Abstract)

clinical and laboratory findings as well as the outcome of infection in patients aged 21 years or less with a diagnosis of Lemierre's syndrome. An additional case of Lemierre's-like syndrome was also included. The illness severity and duration of in-patient management of those testing positive for heterophile antibody were then compared with the same parameters in patients who tested negative.Of the five patients diagnosed with Lemierre's syndrome, two had concomitant acute infection with Epstein-Barr (...) to admission, and tested positive for heterophile antibody. These patients subsequently underwent more extensive in-patient treatment, including intensive care management and ventilator support. The patients who tested negative for heterophile antibody experienced a milder course of illness, with a shorter duration of in-patient management.Two patients diagnosed with Lemierre's syndrome, and a third with Fusobacterium necrophorum sepsis, had coexisting acute Epstein-Barr virus infection. Patients who

2010 Journal of Laryngology & Otology

179. Lemierre syndrome: a pediatric case series and review of literature. (Abstract)

Lemierre syndrome: a pediatric case series and review of literature. Lemierre syndrome is a rare disease of the head and neck often affecting adolescents and young adults. Classically, infection begins in the oropharynx with thrombosis of the tonsillar veins followed by involvement of the parapharyngeal space and the internal jugular vein. Septicemia and pulmonary lesions develop as infection spreads via septic emboli. Although a rare entity in modern times, Lemierre syndrome remains a disease (...) was crucial in all cases.Lemierre syndrome is a rare but severe opportunistic infection with poor prognostic outcomes if left untreated. Early diagnosis and treatment is essential. Aggressive antibiotic therapy coupled with surgical intervention, when necessary, provides excellent outcomes.

2010 American Journal of Otolaryngology

180. Lemierre syndrome: unusual cause and presentation. (Abstract)

Lemierre syndrome: unusual cause and presentation. Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The most frequently isolated pathogen is Fusobacterium necrophorum. We report an unusual case of Lemierre syndrome in a 4-year-old child caused by Staphylococcus aureus, with multivisceral emboli to the brain, orbits, lungs, and heart valves. We also (...) discuss its atypical clinical presentation, the crucial role of imaging in the early diagnosis, and the different treatment modalities of this life-threatening syndrome.

2010 Pediatric Emergency Care

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