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Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Sometimes the portal of entry is obvious and in itself suggests the diagnosis. This is true for cases of cutaneous suppuration, infected wound or burns, septic sore throat and adenitis, pulmonary, gynecologic and urinary infections, and surgery involving a septic focus. However, it is often necessary to search for an infected thrombus, particularly in patients with venous catheters. Thrombophlebitis is characterized by microabscess formation in the cannulated vein and repeated bacterial embolization into the circulation, which can be life-threatening.14 Septic thrombophlebitis may be superficial or deep. In descending order of frequency, it arises in the saphenous system, antecubital veins, jugular veins, and iliac veins. The most common pathogens, again in descending order, are Klebsiella, Enterobacter, Staph, aureus, providencia, Proteus, E. coli, Serrana, and Ps. aeruginosa. In immunocompromised patients, frequently no primary focus is apparent. An example of a primary focus very difficult to detect, is an infected intramural myocardial thrombus after a myocardial infarction.21 The signs and symptoms linked to secondary foci may sometimes dominate the clinical picture and mimic primary disorders of the organs where septic metastases have developed. This can lead to errors in diagnosis as the associated bacteremia is not appreciated.
Complications of Rhinosinusitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
In the 18th century Percival Pott described the case of a patient with a pericranial abscess related to trauma. The area, he noted, was ‘swollen and puffy’. The term Pott’s puffy tumour is now used to describe a subperiosteal cellulitis or abscess of the frontal bone associated with frontal oeteomyelitis and presenting with headache, swelling and, on occasion, a discharging frontal fistula (Figure 101.8). The infection can spread posteriorly giving rise to intracranial sepsis either by erosion of the posterior table or more likely by septic thrombophlebitis via the diploeic veins.47 The reported rate of coexistent intracranial complications is high between 29% and 60%, though not all are present on initial imaging47,48 which suggests prompt cross-sectional imaging and treatment are paramount. Both Gallagher and Jones48,49 noted a preponderance of Streptococcus anginosus infection in series of such patients, where positive cultures were obtained.
Infections of the Respiratory Tract
Published in Keith Struthers, Clinical Microbiology, 2017
Streptococcus pyogenes infection can progress to peritonsillar abscess or quinsy. Such infections can involve anaerobes such as Fusobacterium necrophilum. A complication of the condition is septic thrombophlebitis of the jugular vein.
Management and outcomes of pediatric septic thrombophlebitis: a case series
Published in Pediatric Hematology and Oncology, 2020
Jenny Koo, Alice Pong, Christopher Dory, Lauge Farnaes, Courtney D. Thornburg
Septic thrombophlebitis is traditionally defined by venous thrombosis with associated bacteremia,1 however thrombosed vessels associated with adjacent infection (e.g. osteomyelitis, mastoiditis) are often presumed to be infected leading to extended antibiotic and anticoagulation therapy. Lemierre’s syndrome (LS) specifically refers to thrombophlebitis of the internal jugular (IJ) vein typically following a pharyngitis with associated metastatic embolic event, commonly to the lungs.2–8