scholarly journals Metagenome of Covid19 patient from Bangladesh corroborates the anaerobic colonization enabled by SAR-Cov2 with a novel, hard to culture, bacteria - Lawsonella clevelandensis - that is implicated in disease by causing abscesses

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Septic Shock ◽  
Epstein Barr Virus ◽  
Jugular Vein ◽  
Bacterial Load ◽  
Anaerobic Bacteria ◽  
Lemierre’S Syndrome ◽  
Barr Virus ◽  
Blood Clots ◽  
Epstein Barr ◽  
Lemierre's Syndrome

I have hypothesized [1] that SARS-Cov2 [2,3] enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis. This finds resonance in the ‘forgotten disease’ Lemierre’s Syndrome [4–9,9,10], caused by anaerobic bacteria enabled by Epstein Barr Virus [11, 12]. Common symptoms include ARDS, septic shock, blood clots and arterial stroke [?,13–17]. A key difference is that Lemierre’s Syndrome originates in the jugular vein, while Covid19 starts from the lungs (possibly making it easier to treat).Here, metagenome from a Covid19 patient in Bangladesh Accid:PRJNA633241) is analyzed (Table 1). While, bacterial load is low (and this might be due to removal of reads), it corroborates the anaerobic domination with a novel anaerobic bacteria - Lawsonella clevelandensis - being implicated.

scholarly journals Prevotella/Streptococcus and other anaerobes colonize the metagenome (nasopharyngeal swab) submitted by Emory University School of Medicine, Georgia in Covid19 patient, corroborating the hypothesis that SARS-Cov2 is enabling anaerobes

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Bacterial Load ◽  
Anaerobic Bacteria ◽  
Nasopharyngeal Swab ◽  
Lemierre’S Syndrome ◽  
Barr Virus ◽  
School Of Medicine ◽  
Emory University ◽  
Blood Clots ◽  
Epstein Barr ◽  
Lemierre's Syndrome

The hypothesis [1] that SARS-Cov2 [2,3] enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis finds resonance in the ‘forgotten disease’ Lemierre’s Syndrome [4–9,9,10]. Lemierre’s Syndrome is also caused by anaerobic bacteria enabled by Epstein Barr Virus [11,12]. Symptoms common to both diseases include ARDS, septic shock, blood clots and arterial stroke [?,13–17]. Covid19 starts from the lungs (possibly making it easier to treat), in contrast to Lemierre’s Syndrome that originates in the jugular vein.Nasopharyngeal swab(Accid:SRR11829376)Here, metagenome from a Covid19 patient in Emory University School of Medicine, Georgia is analyzed (Table 1). Prevotella/Streptococcus and other anaerobes colonize the metagenome, corroborating the hy- pothesis that SARS-Cov2 is enabling anaerobes [1]. The bacterial load is quite high, the first five species comprise 70% of the load.Gut metageome (Accid:SRR11827437)Another sample shows Enterococcus colonization, and although the source of the sample is mentioned as nasopharyngeal swab, most of the bacteria are gut related (Table 2).

scholarly journals SARS-Cov2 enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis, causing long-drawn chronic symptoms, and acute severe symptoms (ARDS, septic shock, clots, arterial stroke) which finds resonance, with key differences, in the ‘forgotten disease’ Lemierre Syndrome, enabled by Epstein Barr Virus

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Septic Shock ◽  
Calcium Binding ◽  
Epstein Barr Virus ◽  
Anaerobic Bacteria ◽  
Lemierre Syndrome ◽  
Barr Virus ◽  
Lung Sample ◽  
Initial Symptoms ◽  
Epstein Barr ◽  
Bacterial Genes

Metagenomic studies of Covid19 patient sequencing data from different countries (China, Brazil, Peru, Cambodia, USA) shows a pattern that SARS-Cov2 enables anaerobic bacteria (eg Prevotella, Veil- lonella, Capnocytophaga, Fusobacterium, Oribacterium and Bacteroides) colonize the lungs, disrupting the homeostasis found in healthy patients. Long drawn symptoms in Covid19 have caused great con- sternation, and could be explained by persistence of biofilms. Some of these bacteria are implicated in increasing IL-6, cause ground glass opacity in lungs and are associated with cardiac injury - all symp- toms associated with Covid19. Many studies also show several bacterial infection markers - like D-dimer, LDH, C-reactive protein and ferritin - being significantly high, while the viral immune response is at- tenuated (reported by three studies till date). This is also confirmed here in the lung sample from a 74 year old deceased patient, showing high levels of IFITM3, ferritin and S100 calcium binding protein. Anaerobic bacteria causing initial symptoms like persistent fever, chills, pain and later symptoms like ARDS, blood clots, arterial stroke and septic shock finds resonance in a ”forgotten disease” - Lemierre syndrome (LS). While, LS is enabled by Epstein Barr Virus - possibly by ‘a transient depression of T cell immunity’, two recent studies show that IFN-λ might promote bacterial superinfection in Covid19. Also, 16S rRNA bacterial genes and endotoxins (LPS) were discovered in 18/19 severely ill pneumonia patients in one study, suggesting dissemination of endotoxins, and not actual bacteria, might suffice to cause severity. Autopsies also show foci of acute bronchopneumonia. There are key differences with LS - for example origin of LS is the jugular vein while Covid19 starts in the lungs (and this difference should result in Covid19 to be easier to treat). Co-infection of EBV and SARS-Cov2 leads to greater symptoms (fever, higher CRP) in a study of 67 patients. SARS-2003 showed a lot of similar symptoms, which did not get enough media attention. There was a specific warning issued in 2004 for ‘an increased vigilance against stroke and other thrombotic complications among critically-ill SARS patients in future outbreaks’. Enhanced pathogen testing kits, which include RT-PCT for bacterial genes and endotoxin tests, could confirm this disruption in Covid19, and thus anaerobic-specific antibiotics could significantly help in therapy.

Lemierre's and Lemierre's-like syndromes in association with infectious mononucleosis

2010 ◽  
Vol 124 (12) ◽  
pp. 1257-1262 ◽  
Author(s):  
E M Chacko ◽  
L R Krilov ◽  
W Patten ◽  
P J Lee
Keyword(s):  
Virus Infection ◽  
Infectious Mononucleosis ◽  
Epstein Barr Virus ◽  
Epstein Barr Virus Infection ◽  
Lemierre’S Syndrome ◽  
Heterophile Antibody ◽  
Barr Virus ◽  
Epstein Barr ◽  
Barr Virus Infection ◽  
Lemierre's Syndrome

AbstractObjective:This study aimed to review cases of Lemierre's and Lemierre's-like syndromes in paediatric patients, to examine a possible association with Epstein–Barr virus as a predisposing factor, and to assess the impact of this virus on the severity of illness.Methods:We performed a retrospective analysis of data from the in-patient database at Winthrop University Hospital, from January 2001 to October 2007. We reviewed 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.Results:Of the five patients diagnosed with Lemierre's syndrome, two had concomitant acute infection with Epstein–Barr virus. Additionally, a 19-year-old adolescent was admitted during this period with acute infectious mononucleosis, Fusobacterium necrophorum sepsis, sinusitis, frontal lobe abscess and ophthalmic vein thrombosis. The clinical presentation of all patients included fever, sore throat, and ear or neck pain. The duration of symptoms ranged from two days to three weeks prior to admission. The patients with acute Epstein–Barr virus infection had been diagnosed with infectious mononucleosis prior 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.Conclusion:Two patients diagnosed with Lemierre's syndrome, and a third with Fusobacterium necrophorum sepsis, had coexisting acute Epstein–Barr virus infection. Patients who tested positive for heterophile antibody experienced a more severe course of illness. These observations suggest a possible association between Epstein–Barr virus infection and the severity of concomitant Lemierre's syndrome.

A case of Lemierre's syndrome following Epstein–Barr virus infection

Anaerobe ◽  
2005 ◽  
Vol 11 (3) ◽  
pp. 185-187 ◽  
Author(s):  
G.A. Boz ◽  
S. Iskender ◽  
R. Caylan ◽  
K. Aydin ◽  
I. Koksal
Keyword(s):  
Virus Infection ◽  
Epstein Barr Virus ◽  
Epstein Barr Virus Infection ◽  
Lemierre’S Syndrome ◽  
Barr Virus ◽  
Epstein Barr ◽  
Barr Virus Infection ◽  
Lemierre's Syndrome

scholarly journals Fatal Septic Shock in a Patient with Hemophagocytic Lymphohistiocytosis Associated with an Infectious Mononucleosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Giorgio Berlot ◽  
Ariella Tomasini ◽  
Lorenzo Zandonà ◽  
Eugenio Leonardo ◽  
Rossana Bussani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Infectious Mononucleosis ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Multiple Organ ◽  
Aggressive Lymphoma ◽  
Systemic Involvement ◽  
Barr Virus ◽  
Epstein Barr ◽  
Clinical Pictures

The authors describe the case of a young woman who developed a clinical pictures resembling a septic shock-related multiple organ dysfunction syndrome a couple of months after having been diagnosed suffering from a hemophagocytic lymphohistiocytosis associated with an infectious mononucleosis. Despite the aggressive treatment, which included antibiotics, vasopressors, IV immunoglobulins, and the use of an extracorporeal device aimed to remove mediators released both during sepsis and the cytokine storm determined by the hemophagocytic lymphohistiocytosis, the patient died. At the autopsy, an extremely uncommon aggressive lymphoma of Epstein-Barr virus-positive T-lymphocytes with systemic involvement was discovered.

scholarly journals A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Aynur Turan ◽  
Harun Cam ◽  
Yeliz Dadali ◽  
Serdar Korkmaz ◽  
Ali Özdek ◽  
...  
Keyword(s):  
Otitis Media ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Anaerobic Bacteria ◽  
Transverse Sinus ◽  
Lemierre’S Syndrome ◽  
Lemierre Syndrome ◽  
Mortality And Morbidity ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome

Lemierre’s syndrome is a rare clinical condition that generally develops secondary to oropharyngeal infection caused byFusobacterium necrophorum, which is an anaerobic bacteria. A 62-year-old patient with diabetes mellitus presented with internal jugular vein and sigmoid sinus-transverse sinus thrombophlebitis, accompanying otitis media and mastoiditis that developed after an upper airway infection. Interestingly, there were air bubbles in both the internal jugular vein and transverse sinus. Vancomycin and meropenem were started and a right radical mastoidectomy was performed. The patient’s clinical picture completely resolved in 14 days. High mortality and morbidity may be prevented with a prompt diagnosis of Lemierre’s syndrome.

Coinfection with Parvovirus B19 and Epstein Barr Virus in An Adolescent with Sickle Cell Disease Manifesting As Septic Shock

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4854-4854
Author(s):  
Jyoti Panicker ◽  
Robyn Gartrell Harris ◽  
Stephen Dale Smith
Keyword(s):  
Septic Shock ◽  
Epstein Barr Virus ◽  
Parvovirus B19 ◽  
Supportive Therapy ◽  
Red Cell ◽  
Barr Virus ◽  
Ebv Reactivation ◽  
Life Threatening ◽  
Epstein Barr ◽  
Dna Pcr

Abstract Abstract 4854 Patients with Sickle Cell Disease (SCD) are at an increased risk of serious and life-threatening infections. Epstein Barr Virus (EBV) and Human Parvovirus B19 (HPV-B19) are common viral infections that are usually asymptomatic or self-limiting in healthy children. However, SCD patients can have significant morbidity and mortality caused by these infections. In patients with SCD, EBV can cause splenic rupture, thrombocytopenia, agranulocytosis, hemolytic anemia and hemophagocytic lymphocytosis while HPV-B19 can cause severe aplastic crisis, stroke, nephrotic syndrome, myocardial infarction and splenic sequestration. Coinfection with EBV and HPV-B19 has not been reported in SCD patients and there are no reports of EBV or HPV B19 causing septic shock. A 15 year old male with SCD presented with a one day history of fever, oliguria, and hypotension caused by simultaneous viremia with EBV and HPV-B19. He had been discharged 2 days previously after an admission for a vaso-occlusive crisis. He did not have pharyngitis, rash hepatosplenomegaly (spleen likely autoinfarcted) or lymphadenopathy. Peripheral smear did not show lymphocytosis, atypical lymphocytes or features of microangiopathic hemolytic anemia. Fluid resuscitation with normal saline and then with red cell transfusion was done and he was transferred to pediatric intensive care unit. He received supportive therapy for septic shock with fluids, antibiotics and red cell transfusions. Blood and urine bacterial cultures were negative and blood quantitative DNA PCR was positive for EBV (3300 copies/ml) and HPV-B19 (2.3×107 copies/ml). His EBV titers were positive for viral capsid antigen (VCA)-IgM and IgG and Epstein Barr nuclear antigen (EBNA)-IgG. He had EBV titers done 2 years previously which were positive for VCA-IgG and EBNA-IgG documenting previous primary EBV infection. The patient gradually improved with supportive therapy and was discharged on Day 8. The patient returned to Pediatric Hematology clinic on Day 19 and had resolution of signs and symptoms. Table 1 shows an overview of his blood counts and transfusion requirements.Table 1 Coinfection with EBV and HPV-B19 in healthy adults has rarely been reported. Severe aplastic anemia caused by EBV and HPV-B19 infections was reported in a previously healthy 22-year-old male. He was treated with immunosuppressive therapy followed by allogeneic bone marrow transplant (Kaptan K et al, Am J Hematol 2001). Acute HPV-B19 infection and concomitant EBV reactivation causing moderate hemophagocytic syndrome was reported in a previously healthy 37-year-old-male (Larroche C et al, Eur J Clin Microbiol Infect Dis 2002). HPV-B19 infection with EBV reactivation has not been reported in children. Sepsis from viremia is not common with either EBV or HPV-B19, however together this co-infection can be life-threatening as seen in our patient. HPV-B19 infection has been reported to produce false positive EBV VCA-IgM serology assay. Our patient had a true coinfection because he had viremia documented by EBV DNA PCR. This is the first report of viremia and septic shock associated with an acute HPV-B19 infection and EBV reactivation in a patient with SCD. WBC- White Blood Cell Count, ANC- Absolute Neutrophil Count, ALC- Absolute Lymphocyte Count, Plt- Platelet Count, Hgb- Hemoglobin, HCT- Hematocrit, Retic: Corrected Reticulocyte Count, U- Units, PRBC- Packed red blood cells, ER- Emergency room Disclosures: No relevant conflicts of interest to declare.

scholarly journals Lemierre’s Syndrome: Case Presentation of a Rare and Possibly Life-Threatening Condition

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1102
Author(s):  
Lucian Giubelan ◽  
Livia Dragonu ◽  
Vlad Pădureanu ◽  
Alexandru Neacșu ◽  
Mirela Mănescu ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Anaerobic Bacteria ◽  
Rare Condition ◽  
Fusobacterium Necrophorum ◽  
Lemierre’S Syndrome ◽  
Case Presentation ◽  
Oropharyngeal Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Lemierre's Syndrome

Lemierre’s syndrome is, presently, a very rare condition, but a life-threatening one. The syndrome was first described in 1936 by Andre Lemierre and comprises an oropharyngeal infection (most commonly associated with anaerobic bacteria Fusobacterium necrophorum), internal jugular vein thrombophlebitis and, possibly, secondary septic metastasis (common sites are lungs or brain). We describe such a rare case diagnosed at our Infectious Diseases Department in September 2019.

scholarly journals Epstein-Barr Virus-Related Hemophagocytic Lymphohistiocytosis: Hematologic Emergency in the Critical Care Setting

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Neda Hashemi-Sadraei ◽  
Pimprapa Vejpongsa ◽  
Muhamed Baljevic ◽  
Lei Chen ◽  
Modupe Idowu
Keyword(s):  
Septic Shock ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Care Setting ◽  
Clinical Syndrome ◽  
Barr Virus ◽  
Life Threatening ◽  
Triggering Conditions ◽  
Epstein Barr ◽  
Delayed Recognition

Hemophagocytic lymphohistiocytosis (HLH) is a rare and potential life-threatening clinical syndrome that results from uncontrolled activation of the immune system. Secondary HLH, more commonly observed in adult patients, is seen in the context of underlying triggering conditions. Epstein-Barr virus (EBV) has been recognized as the leading infectious cause and is associated with a poor outcome. As clinical and laboratory features of HLH could overlap with septic shock syndrome in most patients, the diagnosis of HLH, especially in adults, is the most challenging aspect of the disease that results in delayed recognition and treatment of rapidly progressive multiorgan system failure. We report a case of Hemophagocytic lymphohistiocytosis in a patient who presented with signs of septic shock syndrome and we review the literature on the topic.

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