oropharyngeal infection
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2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Johnny Michel ◽  
Luc-Marie Joly ◽  
Virginie Eve Lvovschi

Abstract Background Fusobacterium nucleatum is an anaerobic bacterium mainly responsible for acute or chronic infection of the ear, nose, and throat, potentially bacteremic with a risk of extraoral metastatic infection. Bacteremia occurs mainly in the elderly or in immunodeficient individuals, with high mortality. F. nucleatum is not the first cause of tonsillar infection in emergency departments, which are more often the consequence of a viral or streptococcal infection, but it is a risk factor for severe bacterial infection, especially in a viral pandemic context. Case presentation A 25-year-old European woman with no history presented to the emergency department with fever (38.9 °C), pharyngeal symptoms, intermittent headaches, and alteration of general condition. On examination, she presented odynophagia associated with moderate tonsillar hypertrophy, her neck was painful but flexible. A rapid diagnostic test for beta-hemolytic group streptococcus was negative. First biological analyses revealed an inflammatory syndrome with C-reactive protein of 76 mg/L. Procalcitonin was measured secondarily, and was 2.16 µg/L. Faced with discordant clinical and biological findings, a lumbar puncture was performed, which came back negative. At hour eight, hypotension was observed but corrected after filling with physiological serum. The patient was hospitalized for monitoring, based on a hypothesis of severe viral presentation. At hour 24, pyrexia confirmed this hypothesis. A spontaneous but transient improvement and no new hemodynamic event led to early discharge. At day three, she was rehospitalized for increased and continuous headaches, without hemodynamic severity. A broad-spectrum probabilistic antibiotic therapy of ceftriaxone and metronidazole was started due to first blood cultures positive for anaerobic Gram-negative bacilli, while waiting for identification of the pathogen. Three days later, F. nucleatum was identified. According to the microbiological results, antibiotic therapy was adapted with amoxicillin and clavulanic acid, and no further complications were observed during clinical or complementary examinations. The final diagnosis was a F. nucleatum oropharyngeal infection complicated by bacteremia, without metastatic spread. Conclusion The etiologies of tonsillar infection are not limited to benign viruses or bacteria. These should not be overlooked in emergency medicine, especially when the clinical presentation is discrepant. A combination of early bacterial investigations as blood culture and close clinical monitoring is the only safe way to detect bacteremia, especially in immunocompetent patients.


2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Fatima Hemani ◽  
Anjum Naveed ◽  
Shakil Akhtar ◽  
Saba Shahid

Lemierre’s Syndrome (LS) is a rare syndrome most frequently due to an anaerobic organism, Fusobacterium Necrophorum. It is commonly a complication of an acute oropharyngeal infection, but there are exceptions to its presentations. In our case the cause of LS was otitis media caused by Streptococcus species. This is a rather unusual presentation of LS. LS is caused due to septic complications of oropharyngeal infections, which lead to thrombophlebitis of internal jugular vein leading to thrombosis formation. In this case report, we present a case of Lemierre’s syndrome in a seven-year-old male child. The patient presented with high grade fever spikes and earache, which were unresponsive to oral antibiotics. LS was diagnosed in this patient on the basis of clinical, microbiological and radiological findings. After the diagnosis, treatment involved using broad spectrum antibiotics and anticoagulants, followed by surgery. Though role of anticoagulants is controversial in LS, but there is no specific guideline contraindicating the use of anti-coagulants. In our case, timely diagnosis and management enabled us to discharge the patient without any symptoms. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5773 How to cite this:Hemani F, Naveed A, Akhtar S, Shahid S. Lemierre’s syndrome in a child. Pak J Med Sci. 2022;38(2):433-435.  doi: https://doi.org/10.12669/pjms.38.ICON-2022.5773 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1102
Author(s):  
Lucian Giubelan ◽  
Livia Dragonu ◽  
Vlad Pădureanu ◽  
Alexandru Neacșu ◽  
Mirela Mănescu ◽  
...  

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.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Catherine Rawes ◽  
Vanessa Badas ◽  
Kathryn Alyward ◽  
Annika Whittle ◽  
Peter Brown ◽  
...  

Abstract Background Lemierre’s Syndrome (LS) is a rare condition with a prevalence of around 0.6-2.3 cases per million of population. Typically, LS starts with a Fusobacterium Necophorum oropharyngeal infection which spreads rapidly causing infective thrombophlebitis, classically of the internal jugular. This is a life-threatening condition which left untreated has a mortality of 90%. In less than 10% of LS cases thrombophlebitis occurs outside of the internal jugular vein. These atypical presentations can result in delay in diagnosis thus treatment and hence have an increased risk of mortality. Case Report Here we present a case report of a patient with Abdominal Variant Lemierre’s syndrome. A 47-year-old female with no past medical history was admitted to the emergency department with severe epigastric abdominal pain. The patient was stable, her National Early Warning Score (NEWS) was 2, blood tests on admission showed thrombocytopenia (Hb 121g/dl, Platelets 50x109/l, WCC 17.1x1012/l), raised CRP 299mg/l and deranged Liver Function Tests (Total protein 56g/l, Bilirubin 45mg/dl, ALT 94U/L, AlkPhos- 121U/L). A Venous Blood Gas was abnormal with Lactate 2.1mmol/l. A sepsis pathway was initiated. The blood cultures grew Fusobacterium Necophorum. MRI Imaging confirmed the diagnosis of Abdominal Variant Lemierre’s Syndrome. Haematology and Microbiology were consulted. The patient was treated with antibiotics and anticoagulation and was discharged 29 days later, she has made a full recovery. Conclusion This case highlights the importance of sepsis vigilance in Acute General Surgery admissions and emphasises that multidisciplinary teamwork is essential to achieve effective and prompt treatment for patients.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Samantha Below ◽  
Elizabeth Williams

Abstract Background Lemierre’s syndrome is a rare oropharyngeal infection that can lead to metastatic septic emboli and thrombocytopenia. However, current literature does not report an effect on other cell lines, which we report for the first time in this case. Case A previously healthy young African American male presented with profound thrombocytopenia and leukopenia. He was tachypenic on presentation which progressed to respiratory failure requiring intubation. Blood cultures grew Fusobacterium necrophorum and imaging revealed internal jugular venous thrombosis. He was later diagnosed with Lemierre’s syndrome. The patient was treated with zosyn and fully recovered with no residual deficits in hemoglobin, white cell count, platelet level, or renal function. Conclusion Lemierre’s syndrome can cause severe disease in otherwise healthy patients via septicemia and widespread metastatic foci which can cause severe illness. While pulmonary complications are most common, there is little report of effects on other organ systems such as bone marrow and the kidneys. Clinicians should readily evaluate for Lemierre’s syndrome as the complications are severe and can lead to multiorgan failure.


2021 ◽  
pp. 1-3
Author(s):  
Mohamed Ali GLITI ◽  
◽  
Lina EL Messaoudi ◽  
Sophia Nitassi ◽  
Bencheikh Razika ◽  
...  

Introduction: Lemierre’s syndrome complicates oropharyngeal infection and associates septic thrombophlebitis of the internal jugular vein with sepsis and distant septic emboli (especially pulmonary). We report a pediatric case with thrombophlebitis of the jugular vein in the context of cervicofacial cellulitis. Summary of the Clinical Case: A 2-year-old girl consulted in the emergency room for angina complicated by right cervicofacial cellulitis with thrombosis of the right jugular vein. The diagnosis of atypical Lemierre syndrome was made and the patient received first medical treatment (antibiotic therapy, anticoagulation) allowing a cure without sequelae. And secondary surgical treatment (adenoidectomy and tonsillectomy). Discussion: The presence of a cervical venous thrombosis complicating an oropharyngeal infection should lead to a search for Lemierre’s syndrome (blood cultures and chest CT) rare but serious and require immediate treatment


2021 ◽  
Vol 14 (6) ◽  
pp. e242468
Author(s):  
Dilpat Kumar ◽  
Wasif Elahi Shamsi ◽  
Thales Gomes ◽  
FNU Warsha

Lemierre syndrome (LS) is an acute oropharyngeal infection with secondary septic thrombophlebitis and distant septic embolisation. A 29-year-old woman with sore throat, dyspnoea and left shoulder pain, who was on levofloxacin for 3 days, presented with worsening symptoms. She was tachycardic, tachypneic and hypoxic on presentation. CT of neck and chest revealed multiple loculated abscesses on her left lower neck and shoulder, right peritonsillar abscess, thrombosis of the right external jugular vein and multiple bilateral septic emboli to the lungs. She was started on clindamycin and ampicillin sulbactam for LS. She developed septic shock and required intubation due to respiratory failure. Drainage of the left shoulder abscess grew Fusobacterium nucleatum. After 2 weeks of a complicated intensive care unit stay, her haemodynamic status improved and she was transferred to the floor. LS has variable presentations, but regardless of the presentation, it is a potentially fatal disease-requiring prompt diagnosis and management.


2021 ◽  
Author(s):  
Norma V Solis ◽  
Rohan S Wakade ◽  
Tomye L Ollinger ◽  
Melanie Wellington ◽  
Aaron P Mitchell ◽  
...  

Oropharyngeal candidiasis (OPC) is a common infection that complicates a wide range of medical conditions which can cause either mild or severe disease depending on the patient. The pathobiology of OPC shares many features with candidal biofilms of abiotic surfaces. The transcriptional regulation of C. albicans formation of biofilms on abiotic surfaces has been extensively characterized and involves six key transcription factors (Efg1, Ndt80, Rob1, Bcr1, Brg1, and Tec1). To determine whether this same in vitro biofilm transcriptional regulatory network played a role in OPC, we have carried out the first systematic genetic interaction analysis in a mouse model of C. albicans infection. Whereas all six transcription factors are required for in vitro biofilm formation, only three homozygous deletion mutants ( tec1 ??, bcr1 ??, and rob1 ??) and one heterozygous mutant ( tec1 ?/ TEC1 ) have reduced infectivity in a mouse model of OPC, indicating the network is more robust in vivo than in vitro. Although single mutants (heterozygous or homozygous) of BRG1 and EFG1 have no effect on fungal burden, the double heterozygous and homozygous mutants have dramatically reduced infectivity, indicating a critical genetic interaction between these two transcription factors. Using epistasis analysis, we have formulated a genetic circuit [ EFG1 + BRG1 ]→ TEC1 → BCR1 that is required for OPC infectivity and oral epithelial cell endocytosis. Surprisingly, we also found transcription factor mutants with in vitro defects in filamentation such as efg1 ?? and brg1 ?? filament during oral infection and that decreased filamentation did not correlate with decreased infectivity. Taken together, these data indicate that key in vitro biofilm transcription factors are involved in OPC but that the network characteristics and functional connections are remodeled significantly during interactions with tissues.


2021 ◽  
pp. practneurol-2021-002928
Author(s):  
Eng Chuan Foo ◽  
Matthew Tanti ◽  
Helen Cliffe ◽  
Marc Randall

Lemierre’s syndrome is a rare and potentially life-threatening condition that follows an oropharyngeal infection, typically from Fusobacterium necrophorum, and usually affects healthy adolescents or young adults. The characteristic features are septic thrombophlebitis of the internal jugular vein and septic embolism leading to multiorgan involvement, commonly the brain, lungs and bones. We report a man with presenting symptoms suggesting hemicrania continua, whose initial imaging showed no features of dural venous sinus or jugular thrombosis. Two weeks later, he had fever, sore throat, cervical lymphadenopathy and Actinomyces meyeri grew from peripheral blood cultures. Further imaging identified thrombosis of the internal jugular vein and cerebral venous sinuses, with multifocal cavitating lung lesions. Following antibiotics and anticoagulation, he recovered without residual deficits. Lemierre’s syndrome when recognised and treated early has a good prognosis but delayed treatment may result in significant morbidity or mortality.


2021 ◽  
Vol 14 (5) ◽  
pp. e242145
Author(s):  
Darragh Rice ◽  
Naomi Fearon ◽  
John V Reynolds ◽  
Narayanasamy Ravi

This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.


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