A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre’s syndrome and peritonsillar abscesses

Bank, Steffen; Christensen, K. J. S.; Kristensen, Lise; Prag, Jørgen

doi:10.1007/s10096-012-1715-6

Cited by 30 publications

(21 citation statements)

References 28 publications

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“…2 With the advent of antibiotics, mortality has been reported as low as 5%. About 10% of patients experience permanent sequelae, 3 including longterm neurologic effects of cerebral abscesses and meningitis, valve replacements for endocarditis and chronic osteomyelitis. …”

Section: Discussionmentioning

confidence: 99%

“…2,6 Incidence rates rise to 14.4 cases per million in those aged 15-24 years. 3,7 This rise is thought to be due to involution of tonsillar tissue, predisposing this age group to infections in tonsillar crypts. 4 Complications of Lemierre syndrome are a result of septic emboli from the thrombus, systemic effects of sepsis and clot extension.…”

Section: Diagnosismentioning

confidence: 99%

“…Infection with F. necrophorum is more likely in patients aged 15-24 years, those with recurrent sore throats and those with a raised C-reactive protein level. 3,5,6 However, it is appreciated that these features are not unique to this bacteria.…”

Section: Early Detectionmentioning

confidence: 99%

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Lemierre syndrome: early recognition and management

Dalen

Mekhail

2015

CMAJ

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A previously well 16-year-old boy presented to the emergency department with fever, rigor, and pain in his chest, neck and dorsal right hand. The illness had begun 10 days earlier with a sore throat, which was reviewed at an after-hours walk-in clinic and presumed to be viral. He remained unwell and began to experience neck pain, and so presented to the emergency department two days later. Following a normal lumbar puncture, he was discharged home with a provisional diagnosis of Epstein-Barr virus. A throat swab was taken during this visit that grew group G Streptococcus. Treatment was not given as per hospital policy for this type of infection.Two days later he returned to the emergency department with persistent fever, rigor, neck pain and pleuritic chest pain. The sore throat had resolved, but his right hand had become swollen and painful.The patient appeared clammy and pale despite normal vital signs. His neck was tender to the left of the trachea, along the line of the sternocleidomastoid; there were no signs of meningism. His throat appeared inflamed, but there was no tonsillar exudate. His cervical lymph nodes were tender and enlarged. There were no rashes or peripheral stigmata of infective endocarditis. Cardiorespiratory and abdominal examination were normal. The dorsum of the right hand was tender and swollen, and had reduced range of motion secondary to pain.Initial investigations showed an inflammatory response, with C-reactive protein 106 (normal 0-5) mg/L and leukocyte count 13.8 (normal 4.0-11.0) × 10 9 /L. Liver tranaminase levels were mildly elevated, the international normalized ratio was 1.3 and the albumin level was 23 (normal 34-48) g/L. Renal function and electrolytes were normal. A chest radiograph showed numerous right-sided pulmonary nodules. The right wrist joint was aspirated, but no fluid was obtained. Computed tomography of the neck and chest showed abnormal filling of contrast in the left internal jugular vein extending from C3 to the thoracic inlet ( Figure 1); there were no drainable abscesses in the neck. There were multiple cavitating lesions within both lungs and a small associated empyema (Figure 2).The patient was given empirical treatment with intravenous piperacillin-tazobactam and clindamycin based on a radiologic diagnosis of Lemierre syndrome, pending the results of cultures and sensitivities. He was transferred to the high dependency (intermediate care) unit because of severe sepsis and low urine output. Blood cultures later grew Fusobacterium necrophorum.Despite treatment, the patient continued to have temperature spikes and his right hand became progressively more painful and swollen. Ultrasonography confirmed a superficial collection in the soft tissue of the dorsum of the right hand, which required two surgical washouts and drain insertion. Ultrasonography of the neck, performed to investigate increasing neck swelling, showed that the thrombus had extended to completely occlude the left internal jugular vein. Anticoagulation with warfarin, with bridging enoxaparin, ...

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Section: Discussionmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Lemierre syndrome: early recognition and management

Dalen

Mekhail

2015

CMAJ

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“…1 La mayoría es de causa viral y autolimitada. 2 Cuando la etiología es bacteriana y no se trata de forma adecuada, pueden ocurrir complicaciones, supurativas y no supurativas. La más frecuente es el absceso periamigdalino.…”

Section: Introductionunclassified

“…10,12 El diagnóstico molecular con la reacción en cadena de la polimerasa (PCR) es más caro que el cultivo, pero puede confirmar rápidamente la infección y ser útil en casos de cultivos negativos. 2,7 El tratamiento de la trombosis de la VYI e272 / Arch Argent Pediatr 2014;112(6):e269-e272 / Presentación de casos clínicos se basa en la administración de antibióticos y anticoagulantes. Es infrecuente la indicación de cirugía.…”

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Trombosis de la vena yugular interna secundaria a faringoamigdalitis aguda

2014

Arch Argent Pediat

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Presentación de casos clínicos RESUMENLa faringoamigdalitis aguda es una de las enfermedades más comunes en niños y adolescentes. La etiología más frecuente es la viral, seguida por la bacteriana. Entre las causas bacterianas, el principal agente es el estreptococo beta hemolítico del grupo A. Una complicación infrecuente de los procesos infecciosos faríngeos es la tromboflebitis séptica de la vena yugular interna. El diagnóstico se sospecha ante la tumefacción laterocervical unilateral de carácter inflamatorio. Se confirma mediante tomografía computada con contraste. El tratamiento consiste en la administración prolongada de antibióticos; el uso de anticoagulantes es controvertido. El diagnóstico precoz y el tratamiento apropiado son esenciales para evitar la oclusión vascular persistente y la progresión del trombo, que puede ocasionar émbolos pulmonares. Presentamos a una adolescente con tromboflebitis de la vena yugular interna secundaria a faringoamigdalitis aguda estreptocócica, con el objetivo de describir las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta rara complicación vascular. Palabras clave: trombosis de la vena yugular interna, faringitis aguda. ABSTRACTAcute pharyngotonsillitis is one of the most common diseases in children and adolescents. The most frequent etiology is virus, followed by bacteria. The main bacterial agent is beta hemolytic Streptococcus group A. A rare complication of pharyngeal infectious processes is septic thrombophlebitis of the internal jugular vein. The diagnosis is suspected in the presence of an inflammatory unilateral neck swelling. The diagnosis is confirmed by contrast computed tomography. Treatment consists of prolonged administration of antibiotics, being the use of anticoagulants controversial. Early diagnosis and appropriate treatment are essential to prevent persistent vascular occlusion and progression of the thrombus, which can cause pulmonary emboli. In the present study, we present a teenager with thrombophlebitis of the internal jugular vein secondary to acute streptococcal pharyngotonsillitis. Clinical manifestations, diagnostic methods and treatment of this rare vascular complication are described herein. Key words: thrombosis of the internal jugular vein, acute pharyngitis. Trombosis de la vena yugular interna secundaria a faringoamigdalitis agudaThrombosis of the internal jugular vein secondary to acute pharyngotonsillitis

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Bacteroides , Porphyromonas , Prevotella , Fusobacterium , and Other Anaerobic Gram‐Negative Rods

Conrads,

Nagy,

Könönen

2023

ClinMicroNow

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With increasing use of sequencing techniques, obligate anaerobic Gram‐negative rods are increasingly detected in clinical infections, such as brain or liver abscesses with Prevotella and Fusobacterium species predominating. Production of pigment is visible characteristic valuable in presumptive identification; the pigmented Gram‐negative anaerobic rods are composed of saccharolytic and asaccharolytic species of the genera Prevotella and Porphyromonas and pigment‐producing Alistipes species. Bacteroides species can be involved in part in polymicrobial necrotizing soft tissue infections, and the B. fragilis group is, after Gram‐positive anaerobic cocci, one of the most common anaerobes found in infected moderate to severe diabetic foot wounds. Antimicrobial resistance among Gram‐negative anaerobes continues to rise. The chapter gives characteristics of anaerobic Gram‐negative genera that have grown from clinical specimens.

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A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre’s syndrome and peritonsillar abscesses

Cited by 30 publications

References 28 publications

Lemierre syndrome: early recognition and management

Lemierre syndrome: early recognition and management

Trombosis de la vena yugular interna secundaria a faringoamigdalitis aguda

Bacteroides , Porphyromonas , Prevotella , Fusobacterium , and Other Anaerobic Gram‐Negative Rods

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