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Sepsis in the Head and Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Gradenigo’s triad/syndrome – VI nerve palsy, pain in the distribution of the trigeminal nerve and otitis media – occurs when an abscess forms in the petrous apex. Bezold’s abscess is a collection of pus in the neck due to tracking of infection behind the sternomastoid. Lemierre’s syndrome is a septic thrombosis of the internal jugular vein, usually secondary to mastoiditis due to the bacterium Fusobacterium necrophorum.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Venous thromboembolism is a common cause of initially aseptic cavitary nodules or masses, which form as a result of pulmonary infarcts, within two months of the initial embolic event. A minority of these aseptic cavities can become superinfected, most commonly with Clostridium species. More commonly, infected cavities form from an infectious embolic source. The most common cause of septic emboli is prosthetic intravascular devices such as central venous catheters. Other special populations include children with S. aureus osteomyelitis, young adults with oropharyngeal infections leading to Lemierre syndrome, IV drug abusers with S. aureus bacteremia, and immunocompromised patients who are at risk for Salmonella bacteremia [93]. Cavitations caused by septic emboli may be thick or thin-walled on chest radiographs and CT. On CT, these are peripherally distributed and frequently have associated feeding vessels (Figure 5.23). They may be at different stages of development and healing [81].
Retropharyngeal abscess
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Complications include airway compromise, especially with children <1 year of age. A definitive airway, when necessary, must be established cautiously and carefully to avoid rupture of the abscess. Mediastinitis is more common in younger children and in those with methicillin-resistant S. aureus with a mortality rate from 16.5% to 50%. Lemierre syndrome with thrombosis of the ipsilateral internal jugular vein is a rare complication but is increasing in incidence.
Best management of patients with an acute sore throat – a critical analysis of current evidence and a consensus of experts from different countries and traditions
Published in Infectious Diseases, 2023
Ronny K. Gunnarsson, Mark Ebell, Robert Centor, Paul Little, Theo Verheij, Morten Lindbæk, Pär-Daniel Sundvall
Patients with potentially complicated acute sore throat require assessment by a physician to explore the presence of potential complications or diagnoses requiring special action. Certain symptoms suggest the possibility of suppurative complications indicating a potentially complicated acute sore throat (Table 3). Warning signs are worsening symptoms after 3 days (also after antibiotics), inability to open the mouth fully, unilateral neck swelling, rigours (shaking chills which have a high odds ratio for bacteraemia) and dyspnoea. Patients with these symptoms require careful investigation, often including imaging and it may be relevant to test for the presence of F. necrophorum or S. dysgalactiae subsp. equisimilis, especially in adolescents and young adults. The most common serious suppurative complication is peritonsillar abscess. It occurs most frequently in adolescents and young adults (approximately 15–30 years old). The very rare Lemierre Syndrome should be kept in mind in very few cases with rapid deterioration.
A Lemierre-like syndrome caused by Staphylococcus aureus: an emerging disease
Published in Infectious Diseases, 2020
Frederik Van Hoecke, Bart Lamont, Ann Van Leemput, Steven Vervaeke
A few years after the first descriptions of postanginal septicaemia by Schottmüller, Goldman and Mosher early in the twentieth century, André Lemierre, a French physician, was the first to review 20 mutually similar cases and to characterise a syndrome that was later named after him [1–2]. The classical presentation of Lemierre’s syndrome is that of an acute oropharyngeal infection followed by bacteraemia caused by anaerobic organisms, signs of septic thrombophlebitis of the internal jugular vein and distant metastatic abscesses, typically in the lungs. In most patients Fusobacterium necrophorum can be isolated from the blood. Since this early description in the pre-antibiotic era, more liberal definitions can be found in the literature [3–4]. Infections not related to an oropharyngeal infection and/or caused by other organisms have been linked to Lemierre’s syndrome or even named Lemierre’s syndrome, because they all share obvious similarities to the original Lemierre’s syndrome [1]. Remarkably and to the best of our knowledge, not a single report can be found describing S. aureus as causative pathogen of these Lemierre-like entities before the year 2002 [5]. We report a case of acute bacteraemia due to a methicillin susceptible S. aureus (MSSA) strain and septic thrombophlebitis of the right internal jugular vein, complicated by septic emboli in the lungs and a metastatic cervical epidural abscess in an elderly patient without any upper respiratory tract infection in the recent medical history.
Lemierre’s syndrome: a case study with a short review of literature
Published in Acta Clinica Belgica, 2019
Ken De Smet, Paul-Emile Claus, Gudrun Alliet, An Simpelaere, Geert Desmet
Lemierre’s syndrome (LS) is a rare condition that typically starts with a bacterial oropharyngeal infection complicated by a thrombophlebitis of the internal jugular vein and septic emboli to the lungs or other organs. The most common causative microorganism is Fusobacterium necrophorum, an anaerobic, non-spore-forming gram negative rod that mostly infects young people with the highest incidence between 15–25 years of age, with a blank medical history. Little is known regarding the reason for this age distribution. Possible reasons are anatomy, hormonal changes, social behaviour (human to human oral contact), co-infections and the presence of tonsils (reaching their largest size in puberty) [1]. In the past two decades, several international studies have reported a slight increase in the incidence of LS. A possible reason is the reduction in the empirical use of antibiotics worldwide in patients with sore throat and upper respiratory infections [2]. Some studies, however, question this increase in cases and claim that there are not enough long-term surveillance data to make a conclusive statement [3]. Beside Fusobacterium species, other microorganisms, such as methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, group A and other beta-haemolytic Streptococci are known to cause LS in rare cases [4].