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Liu Y, Li Z, Fu H, Ruan W, Wang H, Ding Y, Zhang M. The first case report: diagnosis and management of necrotizing fusobacterium lung abscess via BALF next-generation sequencing. BMC Infect Dis 2024; 24:218. [PMID: 38373919 PMCID: PMC10875748 DOI: 10.1186/s12879-024-09087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Fusobacterium necrophorum (F. necrophorum)-induced necrotizing pneumonia is a rare but severe pulmonary infection. Insufficient microbiological detection methods can lead to diagnostic difficulties. METHODS We report a case of F. necrophorum lung abscess diagnosed by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF). RESULTS BALF-NGS detected F. necrophorum, guiding subsequent targeted antibiotic therapy. With active drainage and metronidazole treatment, the patient's condition was effectively treated. CONCLUSION BALF-NGS is a valuable tool for the rapid diagnosis of infections caused by difficult-to-culture bacteria. It played a decisive role in the early identification of F. necrophorum, enabling timely and targeted antibiotic intervention. Early diagnosis and appropriate treatment are crucial for the management of F. necrophorum pneumonia.
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Affiliation(s)
- Yang Liu
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China.
| | - Ziye Li
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Handan Fu
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Weiliang Ruan
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Hua Wang
- Special Inspection Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Yuhong Ding
- Respiratory Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
| | - Miao Zhang
- Radiology Department, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, 312030, Shaoxing, China
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Sharma A, Mahajan Z, Mehta S, Puri A. Lemierre syndrome: a diagnostic dilemma of critical care in the post-COVID era. BMJ Case Rep 2024; 17:e257143. [PMID: 38216157 PMCID: PMC10806918 DOI: 10.1136/bcr-2023-257143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Lemierre syndrome (LS) is referred to as the 'forgotten Disease' owing to its rarity in the postantibiotic era with an estimated yearly incidence of 1/million population. The classic triad of LS includes internal jugular vein thrombosis, oropharyngeal infection and metastatic septic emboli. We present a case of typical LS with Fusobacterium and Prevotella infection, presenting with peritonsillar abscess and jugular vein thrombosis complicated by sepsis, acute hypoxic respiratory failure due to multiple pulmonary emboli and severe thrombocytopaenia in the absence of disseminated intravascular coagulation.
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Affiliation(s)
- Akhya Sharma
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Zubin Mahajan
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Sameera Mehta
- Pathology, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Aditi Puri
- Internal Medicine, Loyola University Chicago, Chicago, Illinois, USA
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3
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Imaging assessment of deep neck spaces infections: an anatomical approach. LA RADIOLOGIA MEDICA 2023; 128:81-92. [PMID: 36574110 DOI: 10.1007/s11547-022-01572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
Despite the widespread use of antibiotics, deep neck infections are still a relevant clinical problem and can cause severe and potentially life-threatening complications. Imaging plays a pivotal role into the clinical management of deep neck infections, allowing identification of the source of infections, definition of the precise extension of the disease and early diagnosis of local or distant complications. The complex anatomy of deep neck spaces may hide the actual extent of disease: the knowledge of neck anatomy enables radiologists to rapidly evaluate expected routes of spread of infections and to effectively communicate crucial information to surgeons. Computed Tomography is the most used imaging modality for assessing primary site of infection, extent of disease and local complications. Magnetic resonance imaging may be used as a second level imaging modality for individuating intracranial or spinal complications. The present work aims to review the imaging of deep neck spaces infections, focusing on relevant anatomy and clinical scenarios, underlining practical teaching points for each of them. Familiarity with deep neck spaces anatomy and knowledge of most common routes of spread of infections allow the radiologist to make a prompt diagnosis and to look for early signs of potential complications.
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4
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High risk and low prevalence diseases: Lemierre's syndrome. Am J Emerg Med 2022; 61:98-104. [DOI: 10.1016/j.ajem.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
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Factors Affecting Patients with Concurrent Deep Neck Infection and Lemierre's Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12040928. [PMID: 35453976 PMCID: PMC9029513 DOI: 10.3390/diagnostics12040928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
Deep neck infection (DNI) is a severe disease affecting the deep neck spaces, and is associated with an increased risk of airway obstruction. Lemierre’s syndrome (LS) refers to septic thrombophlebitis of the internal jugular vein after pharyngeal infection, and is linked with high morbidity and mortality. Both diseases begin with an oropharyngeal infection, and concurrence is possible. However, no studies have examined the risk factors associated with co-existence of LS and DNI. Accordingly, this study examined a patient population to investigate the risk factors associated with concurrent DNI and LS. We examined data from a total of 592 patients with DNI who were hospitalized between May 2016 and January 2022. Among these patients, 14 had concurrent DNI and LS. The relevant clinical variables were assessed. In a univariate analysis, C-reactive protein (odds ratio (OR) = 1.004, 95% CI: 1.000−1.009, p = 0.045), involvement of multiple spaces (OR = 23.12, 95% CI: 3.003−178.7, p = 0.002), involvement of the carotid space (OR = 179.6, 95% CI: 22.90−1409, p < 0.001), involvement of the posterior cervical space (OR = 42.60, 95% CI: 12.45−145.6, p < 0.001) and Fusobacterium necrophorum (F. necrophorum, OR = 288.0, 95% CI: 50.58−1639, p < 0.001) were significant risk factors for concurrent DNI and LS. In a multivariate analysis, involvement of the carotid space (OR = 94.37, 95% CI: 9.578−929.9, p < 0.001), that of the posterior cervical space (OR = 24.99, 95% CI: 2.888−216.3, p = 0.003), and F. necrophorum (OR = 156.6, 95% CI: 7.072−3469, p = 0.001) were significant independent risk factors for concurrent LS in patients with DNI. The length of hospitalization in patients with concurrent LS and DNI (27.57 ± 14.94 days) was significantly longer than that in patients with DNI alone (10.01 ± 8.26 days; p < 0.001), and the only pathogen found in significantly different levels between the two groups was F. necrophorum (p < 0.001). Involvement of the carotid space, that of the posterior cervical space and F. necrophorum were independent risk factors for the concurrence of DNI and LS. Patients with concurrent LS and DNI had longer hospitalization periods than patients with DNI alone. Furthermore, F. necrophorum was the only pathogen found in significantly different levels in DNI patients with versus those without LS.
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Recchia A, Cascella M, Altamura S, Borrelli F, De Nittis N, Dibenedetto E, Labonia M, Pavone G, Del Gaudio A. Early Diagnosis and Antibiotic Treatment Combined with Multicomponent Hemodynamic Support for Addressing a Severe Case of Lemierre's Syndrome. Antibiotics (Basel) 2021; 10:antibiotics10121526. [PMID: 34943737 PMCID: PMC8698451 DOI: 10.3390/antibiotics10121526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
A 20-year-old man was admitted to the intensive care unit for septic shock due to Lemierre’s syndrome. It is a rare syndrome that manifests as an upper respiratory infection, although systemic involvement, severe coagulopathy, and multi-organ failure can dangerously complicate the clinical picture. In this syndrome, sepsis-related neuroendocrine dysregulation and microcirculation impairment can have a rapid deleterious progression. Consequently, proper diagnosis, early source control, and appropriate antibiotics administration are mandatory to improve the prognosis. The intensive treatment is aimed at limiting organ damage through hemodynamic optimization. Remarkably, in septic shock due to Lemierre’s syndrome, hemodynamic optimization can be achieved through the synergic effect of norepinephrine, argipressin, and hydrocortisone.
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Affiliation(s)
- Andreaserena Recchia
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Marco Cascella
- Anesthesia and Pain Medicine Istituto Nazionale Tumori-IRCCS, Fondazione G. Pascale, 80100 Napoli, Italy
- Correspondence: (A.R.); (M.C.); Tel.: +39-0882-4107-03 (A.R.)
| | - Sabrina Altamura
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Felice Borrelli
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Nazario De Nittis
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Elisabetta Dibenedetto
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Maria Labonia
- Microbiology and Virology, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giovanna Pavone
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
| | - Alfredo Del Gaudio
- Anesthesia and Intensive Care 2, IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (S.A.); (F.B.); (N.D.N.); (E.D.); (G.P.); (A.D.G.)
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Ge J, Zhou P, Yang Y, Xu T, Yang X. Anticoagulation may contribute to antimicrobial treatment of Lemierre syndrome: a case report. Thromb J 2021; 19:80. [PMID: 34736465 PMCID: PMC8567340 DOI: 10.1186/s12959-021-00336-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial. CASE PRESENTATION A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution. CONCLUSIONS Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.
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Affiliation(s)
- Jie Ge
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Peipei Zhou
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Yifei Yang
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Tianshu Xu
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China
| | - Xu Yang
- Department of stomatology, Changzhou First People's Hospital, Juqian Street, Changzhou, 185, Jiangsu, China.
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A case of Lemierre's syndrome with double vision as the first symptom. J Infect Chemother 2021; 28:286-289. [PMID: 34598877 DOI: 10.1016/j.jiac.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/20/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022]
Abstract
Lemierre's syndrome is a serious disease that typically causes oropharyngeal infection with internal jugular vein thrombosis, followed by distant infection focus, such as septic pulmonary embolism. The main causative organisms are anaerobic bacteria in the oral cavity, namely Fusobacterium necrophorum. We encountered an extremely rare case of Lemierre's syndrome, where double vision was found to be the first symptom. The patient's blood culture results showed the presence of F. nucleatum, which spread from the sphenoid sinus to the skull base because of chronic sinusitis; the patient presented with longus colli abscess, clivus osteomyelitis, venous thrombosis, and hematogenous infection. Antibiotic treatment with sulbactam/ampicillin was continued for 14 weeks, and no recurrence has been observed so far. Lemierre's syndrome can be complicated with atypical symptoms such as double vision if the cranial nerves are involved. It might be important to consider this disease in the differential diagnosis in the presence of cranial nerve symptoms of unknown origin with fever or inflammatory findings.
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9
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Ishihara T, Yanagi H, Oki M, Ozawa H. Fusobacterium necrophorum pelvic peritonitis and bacteremia mimicking intestinal necrosis. IDCases 2021; 24:e01134. [PMID: 34012772 PMCID: PMC8113991 DOI: 10.1016/j.idcr.2021.e01134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fusobacterium necrophorum infection is known to cause Lemierre's syndrome, not pelvic peritonitis. Herein, we report a case of Fusobacterium necrophorum pelvic peritonitis and bacteremia, without Lemierre's syndrome, mimicking intestinal necrosis. A 28-year-old woman with peritoneal irritation and shock was suspected of having intestinal necrosis due to the presence of hepatoportal venous gas and pneumatosis intestinalis. Intestinal necrosis was ruled out by emergency laparotomy. However, massive opaque ascites and inflammatory changes in the uterus and fallopian tubes were observed. Fusobacterium necrophorum and Gardnerella vaginalis were found in ascetic fluid cultures. Moreover, Fusobacterium necrophorum was also found in blood culture. Systemic management of septic shock and antibiotic treatment improved the patient's general condition and abnormal gas on imaging. The patient had untreated bacterial vaginosis prior to admission. Pelvic peritonitis caused by Fusobacterium necrophorum is extremely rare. However, it must be recognized to avoid its rapid development into severe onset mimicking intestinal necrosis.
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Affiliation(s)
- Toru Ishihara
- Division of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hidetaka Yanagi
- Division of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masayuki Oki
- Division of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hideki Ozawa
- Division of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Mariniello G, Corvino S, Teodonno G, Pagano S, Maiuri F. Postoperative Lemierre’s syndrome: a previously unreported complication of transoral surgery. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20118. [PMID: 35855218 PMCID: PMC9245783 DOI: 10.3171/case20118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Lemierre’s syndrome is a rare but potentially life-threatening clinical condition characterized by bacteremia and thrombophlebitis of the internal jugular vein, usually secondary to oropharyngeal infection and often caused by Fusobacterium necrophorum; rarely, it occurs after surgical procedures. The most common clinical presentation includes acute pharyngitis, high fever, and neck pain. The diagnosis is based on blood culture and cranial and cervical spine computed tomography (CT)/magnetic resonance imaging (MRI) with contrast. Antibiotic therapy for 3–6 weeks is the mainstay of treatment, while the use of anticoagulant drugs is controversial.
OBSERVATIONS
The authors describe a case of Lemierre’s syndrome that occurred after transoral surgery. The patient underwent a combined surgical approach from above (transoral) and below (anterolateral transcervical) to the upper cervical spine for the resection of a large anterior osteophyte causing dysphagia, globus sensation, and dysphonia. Three weeks after the surgical procedure, she developed fever and severe neck pain.
LESSONS
The aim of this paper is to consider Lemierre’s syndrome as a possible complication after the transoral approach, underlining the importance of its early diagnosis and with a suggestion to perform cranial and cervical spine CT or MRI venous angiography in patients who undergo surgery with a transoral approach and exhibit local or systemic signs of infection such as neck pain, persistent fever, and positive blood culture results.
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Furuncuoglu Y, Oven BB, Mert B, Yilmaz EC, Demir MK. Abdominal Variant of Lemierre's Syndrome in a Patient with Pancreatic Adenocarcinoma. Medeni Med J 2021; 36:58-62. [PMID: 33828891 PMCID: PMC8020179 DOI: 10.5222/mmj.2021.17992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
Lemierre’s syndrome is an illness characterized by internal jugular vein thrombophlebitis related to infectious agents, primarily Fusobacterium necrophorum. These bacteria, residing in both the oropharynx and the gastrointestinal tract, may lead to pylephlebitis, a serious condition that could result in the development of hepatic abscesses. This manifestation of the disease is regarded as the abdominal variant of Lemierre’s syndrome. Patients with gastrointestinal malignancies, especially those who undergo surgeries, are susceptible to the abdominal variant of Lemierre’s syndrome. Timely diagnosis is required to avoid the life-threatening complications of the abdominal variant of Lemierre’s syndrome. Diffusion-weighted magnetic resonance imaging (MRI) might be very useful in differentiating this disease from liver metastasis in patients with malignancies. Radiologists and clinicians need to be aware of this challenging condition to prevent misdiagnosis, since prompt treatment is often lifesaving.
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Affiliation(s)
- Yavuz Furuncuoglu
- Bahçeşehir University School of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Bala Basak Oven
- Bahçeşehir University School of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | - Basak Mert
- Bahçeşehir University School of Medicine, Istanbul, Turkey
| | | | - Mustafa Kemal Demir
- Bahçeşehir University School of Medicine, Department of Radiology, Istanbul, Turkey
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Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:513-517. [PMID: 32303484 DOI: 10.1016/j.jmii.2020.03.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023]
Abstract
Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. Modern physicians have "forgotten" this disease. The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. The causative focus mostly originated from pharyngitis or tonsillitis, accounting for over 85% of the cases of Lemierre's syndrome. Pneumonia or pleural empyema is the most common metastatic infection in Lemierre's syndrome. Antimicrobial therapy should be prescribed for 3-6 weeks. The treatment regimens include metronidazole and β-lactam antibiotics. In recent years, the antibiotic stewardship program has resulted in decreased antibiotic prescription for upper respiratory tract infections. The incidence of Lemierre's syndrome has increased over the past decade. F. necrophorum is an underestimated cause of acute pharyngitis or tonsillitis. A high index of suspicion is required for the differential diagnosis of acute tonsillopharyngitis with persistent neck pain and septic syndrome.
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Affiliation(s)
- Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shio-Shin Jean
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Medical Center, Taipei Medicine University, Taipei, Taiwan
| | - Fu-Lun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Szu-Min Hsieh
- Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Departments of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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