Incidence and Clinical Epidemiology of Necrobacillosis, including Lemierre's Syndrome, in Denmark 1990-1995

Hagelskjaer, L H; Prag, J.; Malczynski, J.; Kristensen, J.H.

doi:10.1007/s100960050130

Cited by 35 publications

(63 citation statements)

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“…With increased use of penicillin for bacterial throat infections since the 1960s, the number of reports of Lemierre's syndrome has dropped [13]. Lemierre's syndrome remains a rare condition, with one retrospective study from Denmark estimating an incidence of around 1 case per million [14]. In our case, the patient had a charted "unknown allergy to penicillin," so he received Azithroymycin for a perceived strep throat infection instead of Penicillin.…”

Section: Discussionmentioning

confidence: 89%

Lemierre’s Syndrome: The Result of an Incorrect Penicillin Allergy

Christopher¹,

Alyson²,

Katherine³

2017

Int Med Care

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We present a case of a previously healthy 21 year old male who presents with Lemierre's syndrome after getting inadequate treatment of a throat infection because of a penicillin allergy label. Lemierre's syndrome is a rare complication following an acute oropharyngeal infection due to the common use of penicillin in modern medicine. Unfortunately, many patients are labeled with a penicillin allergy at a young age and are therefore more susceptible to complications of not receiving the most effective treatment for, what should be, a routine illness.Correspondence to: Christopher DeZorzi, Internal Medicine PGY-1, 1759 Louis Place, Iowa City, IA 52245, USA; E-mail: christopher-dezorzi@uiowa.edu Case presentationA 21 y.o. male with no significant past medical history presents to the Emergency Room with shortness of breath and fever. Five days prior to presentation, he noted sore throat, fevers, and heartburn. Since that time, he has also noted increasing shortness of breath. He presented to an acute care clinic three days prior to presentation and had a positive rapid strep screen. He was given a script for azithromycin, due to a history of penicillin allergy, and magic mouthwash. He took Ibuprofen alternating with acetaminophen for fever, but continued having worsening dyspnea and a cough productive of clear sputum. He had significant pain over the right chest, 10/10 in severity, sharp in quality, exacerbated by deep breathing.In the ER his vital signs were significant for fever to 40.1 C, tachycardia, tachypnea, and hypoxia requiring 3L oxygen. Physical exam revealed significant diaphoresis and decreased breath sounds at the right base. He had dullness to percussion over the right lower lung field, but no egophany was noted. A chest X-Ray showed possible right pleural effusion with no consolidation (Figure 1). CTA was obtained and showed no pulmonary emboli but found right air space concerning for pneumonia and an abscess superior to his right lower lobe bronchus. Blood cultures were obtained, he was given fluids and started on Ceftriaxone and Azithromycin (Figure 2).On admission, Clindamycin was started for the concern of a pulmonary abscess until gram stains on the blood cultures grew Gram Negative and Gram Positive Rods. The patient was then converted to Ceftazidime, to cover possible pseudomonas, and Vancomycin, for possible MRSA. Over the next day, he continued to have significant right sided chest pain and persistent leukocytosis, fevers, and oxygen requirement. A repeat CXR was obtained on his third day of admission which showed a large right sided pleural effusion ( Figure 3). Blood cultures at this time came back positive for Fusobacterium necrophorum which raised immediate concern for Lemierre's syndrome. He was restarted on IV Clindamycin and a CT larynx and chest was obtained, showing a possible non-loculated empyema, worsening infectious pneumonia, a clot in the left internal jugular vein, but no retropharyngeal abscess (Figures 4 and 5). The Cardiothoracic surgery team was consulted and the...

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Section: Discussionmentioning

confidence: 89%

Lemierre’s Syndrome: The Result of an Incorrect Penicillin Allergy

Christopher¹,

Alyson²,

Katherine³

2017

Int Med Care

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“…Antibiotics should be continued for a total of 3–6 weeks. Even in the presence of appropriate antibiotics fever might take 8–9 days to defervesce which doesn’t necessarily indicate resistance[18]. Prolonged course of antibiotics is required as antibiotics penetration is poor in abscess and fibrin clot which is the most likely explanation for recurrent fevers in this disease.…”

Section: Discussionmentioning

confidence: 99%

Some neck swellings are serious; a case of Lemierre’s Syndrome

Ghani

Hamid

Raza

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Lemierre’s syndrome also termed post-anginal septicemia, is a disease characterized by internal jugular septic thrombophlebitis leading to Fusobacterium septicemia with multiple metastatic foci following an oropharyngeal infection. Diagnosis and management is challenging and can result in fatal consequences due to potential multisystem involvement and multiple complications. We describe here a case of Lemierre’s syndrome with multifocal pneumonia, acute renal failure and protracted course of illness over forty days with successful recovery. A brief overview of literature is also presented.

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“…Lemierre's syndrome, being a rare entity (incidence 1 in a million) [4] has been drawing our attention because of its increasing incidence and dreaded complications; reemergence of this disease is most likely due to the antibiotic resistance and discouragement of the use of antibiotics for sore throat.…”

Section: Discussionmentioning

confidence: 99%