Late presentation of ‘Lemierre’s syndrome’: how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated<i>Fusobacterium necrophorum</i>infection during the global COVID-19 pandemic

Howley, Fergal; O’Doherty, Laura; McEniff, Niall; O’Riordan, Ruth M.

doi:10.1136/bcr-2020-239269

Cited by 20 publications

(19 citation statements)

References 10 publications

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“…Fear of nosocomial SARS-CoV-2 infection may limit medical facilities attendance. Delayed diagnoses and increased disease severity have already been reported in an adult with LS (29) and in children with various conditions (30). This underlines a specificity of pediatric neurology, in which clinical examination of children with acute symptoms remains of utmost importance, and reminds us about the limits of telemedicine in acute settings.…”

Section: Discussionmentioning

confidence: 79%

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

et al. 2021

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Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.

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Section: Discussionmentioning

confidence: 79%

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

et al. 2021

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“…Reported risk factors for Fusobacterium bacteremia include immunosuppression, alcohol abuse, malignancy, older age, dialysis, and hospital acquired [ 17 ]. Moreover, Fusobacterium nucleatum has been shown to be associated with liver involvement [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lack of characteristic neck symptoms or a negative initial neck ultrasound exam does not rule out LS [ 20 ]. Case studies have demonstrated metastatic infections in the lung and brain including meningitis that also a complicated hospital course that require aggressive management and therapies [ 21 , 22 , 18 ]. Another case study demonstrated patient with LS showing septic arthritis of right shoulder, as well as parapharyngeal abscess extending from base of skull to thoracic inlet, complicated by right IJV and subclavian vein thrombosis, and multiple lung emboli [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this particular case report, the patient had severe respiratory and renal involvement without thrombosis of the jugular vein similar to our case [ 14 ]. Lastly, it is imperative to not delay seeking medical attention due to concerns about the SARS-CoV-2 outbreak, as our patient with delayed care presented with atypical Lemierre's syndrome involving the brain, liver, and lungs following a dental infection, ultimately resulting in serious and complex sequelae [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Case report of atypical Lemierre's Syndrome associated with Fusobacterium nucleatum infection without internal or external jugular venous thrombophlebitis

Nguyen

Whitley-Williams

Uppaluri

et al. 2022

Respiratory Medicine Case Reports

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“…Identified themes can assist healthcare organizations with future planning to address such concerns, while specific routine care delivery processes and procedures will be dependent upon organization type and other inherent organizational characteristics. Management of chronic conditions [ 13 , 23 , 25 , 35 ], obstetrical care [ 9 , 31 ] and other routine care [ 14 , 18 , 21 , 26 ] have been identified as successful routine care delivery services continued during COVID-19. Still, a recognized backlog of delayed routine care will require additional industry initiatives and adaptations as vaccinations continue to be administered and the pandemic eventually subsides.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

2021

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The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

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Late presentation of ‘Lemierre’s syndrome’: how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminatedFusobacterium necrophoruminfection during the global COVID-19 pandemic

Cited by 20 publications

References 10 publications

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

Case report of atypical Lemierre's Syndrome associated with Fusobacterium nucleatum infection without internal or external jugular venous thrombophlebitis

Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

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