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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postanginal sepsis or Lemierre's syndrome is characterised by septic thrombophlebitis of the jugular vein, metastatic abscesses in the lungs, soft tissues, joints or elsewhere, occurring several days to two weeks after tonsillitis or pharyngitis. The primary pathogen is a Gram-negative anaerobic rod, mostly Fusobacterium necrophorum. Previously healthy, young adults are affected mainly and the syndrome was seen more frequently in the pre-antibiotic era than it is nowadays. In the three young patients described here, a girl aged 15 and two boys aged 18 and 16, F. necrophorum was isolated from blood or pus. Histories and examinations were suggestive of Lemierre's syndrome. Ultrasound and CT scanning of the neck and other localisations proved to be important diagnostic tools in assessing the diagnosis. Response to therapy was slow and depended in at least one case on adequate drainage of abscesses. If the syndrome is suspected, initial antibiotic treatment should provide adequate coverage of anaerobic bacteria. In previously healthy patients with chills and fever occurring several days after a sore throat, Lemierre's syndrome should be considered.
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PMID:[Postanginal sepsis caused by Fusobacterium necrophorum: Lemierre syndrome]. 836 43

We report a case of Lemierre syndrome. Although it is seen infrequently, it must be considered in patients with sore throat or dental pain, lateral neck pain, sepsis, and pulmonary symptoms. Diagnosis is based on clinical presentation, occurrence of anaerobic septicemia, radiologic evidence of internal jugular venous thrombosis, and pulmonary septic emboli.
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PMID:Lemierre syndrome. 886 3

Severe pulmonary hemorrhage was observed in two patients who died of serious group A streptococcal infections. These two patients initially presented with fever and sore throat. This was followed by sudden onset of septicemia caused by the bacteria and by the subsequent development of severe pulmonary hemorrhage. Hemoptysis, cyanosis, and dyspnea were observed prior to death in both cases. This pulmonary lesion resulted in asphyxia and sudden death in one patient. Pathological examinations of the lung revealed severe intraalveolar hemorrhage, with no evidence of inflammation or necrosis of the pulmonary tissue. There was no evidence of aspiration of blood due to hemorrhage in the upper respiratory or alimentary tract. This visceral lesion appears to be an hitherto undescribed, novel clinicopathologic feature of patients with serious group A streptococcal infections.
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PMID:Severe pulmonary hemorrhage in patients with serious group A streptococcal infections: report of two cases. 1045 Nov 75

There are three clinical presentations of anthrax in humans: cutaneous (>95% of cases), orogastric and inhalational. The infectious form, the spore, enters the body and is thought to germinate within macrophages either at the site of inoculation (cutaneous or orogastric) or in the regional lymph node (inhalational). The bacillus then synthesizes its antiphagocytic capsule and the lethal and oedema toxins which interfere with the non-specific host defences leading to the characteristic locally destructive lesion and spread by lymphatics to the systemic circulation and other organs. The cutaneous form begins as a papule which progresses over several days to a vesicle and then ulcerates. There is often oedema, sometimes massive, probably due to the oedema toxin that surrounds the lesions which then develop a characteristic black eschar. The patient may be febrile with mild to severe systemic symptoms of malaise, headache and toxicity. Oropharyngeal anthrax presents with severe sore throat or an ulcer in the oropharyngeal cavity associated with neck swelling, fever, toxicity and dysphagia. Gastrointestinal anthrax begins with anorexia, nausea, vomiting and abdominal pain which may be similar to an acute abdomen. There may be diarrhoea and ascites, both of which may be haemorrhagic. Inhalational anthrax begins with non-specific symptoms of malaise, fever, myalgia and non-productive cough. After a period of 2-3 days, this is followed by a sudden onset of severe respiratory distress associated with diaphoresis, cyanosis and increased chest pain. There may be a widened mediastinum and pleural effusions on chest X-ray. Death follows in 24-36 h from respiratory failure, sepsis and shock. The diagnosis of anthrax is easy if it is considered. The organism is readily observed by Gram or Wright stain in local lesions or blood smear and can be easily cultured from the blood and other body fluids. However, because of its rarity, it is not often included in the differential diagnosis and in inhalational disease the diagnosis is rarely made until the patient is moribund. More rapid diagnostic tests are under development. Penicillin, combined with supportive care, remains the mainstay of treatment, although the organism is susceptible in vitro to many antibiotics. In recent years, there have been significant advances in our knowledge of the organism and its toxins and it is anticipated that similar progress will be made in the future in developing more rapid diagnostic tests and new modalities of treatment.
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PMID:Clinical aspects, diagnosis and treatment of anthrax 1047 74

A retropharyngeal abscess is a potentially fatal deep neck infection. Classical symptoms include fever, neck swelling, sore throat, dysphagia, and cervical rigidity. Sometimes small children present with nonspecific symptoms. We report a rare case whereby the Ga-67 citrate scan was the first investigation to reveal an inflammatory process in the retropharyngeal or submastoid region of a 3-year-old child with sepsis. This directed the line of investigation to a more precise anatomic imaging modality, CT scanning, to localize the abscess. With prompt administration of intravenous antibiotics, the child recovered quickly and did not require surgery. The Ga-67 scan is thus a useful screening test to detect inflammatory foci because of its high sensitivity. It is also valuable in the follow-up of the patient's response to therapy.
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PMID:Retropharyngeal abscess on a Ga-67 scan: a case report. 1059 73

Previously healthy people without interfering conditions are rarely affected by anaerobic infections. We report a young patient with extended septic emboli in the lungs, after an episode of sore throat, due to anaerobic bacteremia with Fusobacterium necrophorum. The first description of oropharyngeal infection complicated by sepsis was given by Lemierre in 1936. Knowledge of Lemierre's syndrome should lead to early recognition and prompt action against this sporadic and possible fatal illness.
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PMID:Lemierre's syndrome. Sepsis complicating an anaerobic oropharyngeal infection. 1157 93

Lemierre's syndrome, also known as postanginal sepsis, is a rare condition that presents as an increasing sore throat due to acute pharyngitis or tonsillitis and progresses to sepsis, due to suppurative thrombophlebitis of the internal jugular vein. We present an atypical case of Lemierre's syndrome complicated by carotid thrombosis. The etiological factors and the diagnostic and therapeutic measures are discussed.
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PMID:Lemierre's syndrome complicated by carotid thrombosis. 1191 80

We describe a retrospective case series of postanginal sepsis and Lemierre's syndrome (LS) identified from laboratory records of Fusobacterium necrophorum isolates and from clinical case note review. Some patients presented with sore throat, tonsillitis, quinsy or a septicaemic illness, whereas others presented with symptoms related to metastatic septic lesions with later recognition of the significance of the preceding sore throat. Patients with otitis media and mastoiditis are included in the study. The incidence of postanginal sepsis and LS appears to have increased over the study period (1994-99). The population of patients who had received antibiotics pre-admission has decreased in recent years. Attention is drawn to features which may assist in differentiating this condition from simple viral sore throats not requiring antibiotic therapy. A prospective study of the incidence of this rare but life-threatening condition mainly affecting young people is required in view of the more restricted use of antibiotic treatment for sore throat now recommended.
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PMID:Investigation of postanginal sepsis and Lemierre's syndrome in the South West Peninsula. 1210 95

Lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. Fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. Hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. Mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.
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PMID:The evolution of Lemierre syndrome: report of 2 cases and review of the literature. 1244 2

We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G-CSF). A 72-year-old woman with a history of thyrotoxicosis presented with sore throat and fever two weeks after starting carbimazole. Investigations confirmed a leucopenia and neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.
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PMID:Treatment of carbimazole-induced agranulocytosis and sepsis with granulocyte colony stimulating factor. 1266 1


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