Lemierre's syndrome and genetic polymorphisms: a case report

Constantin, Jean-Michel; Mira, Jean‐Paul; Guerin, R; Cayot-Constantin, Sophie; Lesens, Olivier; Gourdon, F.; Romaszko, J.-P.; Linval, Philippe; Laurichesse, H.; Bazin, Jean-Étienne

doi:10.1186/1471-2334-6-115

Cited by 30 publications

(20 citation statements)

References 15 publications

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“…A molecular thrombophilic predisposition was observed in children with invasive infection [12][13][14][15], and a single nucleotide polymorphism in the toll-like receptor 5 gene was found in an affected child [12].…”

Section: Pathogenesismentioning

confidence: 98%

Fusobacterial head and neck infections in children

Brook

2015

International Journal of Pediatric Otorhinolaryngology

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Section: Pathogenesismentioning

confidence: 98%

Fusobacterial head and neck infections in children

Brook

2015

International Journal of Pediatric Otorhinolaryngology

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“…Coagulation studies identified an antiphospholipid syndrome. Constantin et al (95) reported a patient who had a combination of one prothrombogenic and one antifibrinolytic variation. The latter was the 4G-4G homozygous genotype of the PAI-1 gene, which encodes a primary antifibrinolytic molecule.…”

Section: Host Factorsmentioning

confidence: 99%

Human Infection withFusobacterium necrophorum(Necrobacillosis), with a Focus on Lemierre's Syndrome

2007

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SUMMARYSummary:Human infection withFusobacterium necrophorumusually involvesF. necrophorumsubsp.funduliformerather thanF. necrophorumsubsp.necrophorum, which is a common pathogen in animals. Lemierre's syndrome, or postanginal sepsis, is the most common life-threatening manifestation. Tonsillitis is followed by septic thrombophlebitis of the internal jugular vein and then a septicemia with septic emboli in lungs and other sites. Recent evidence suggests thatF. necrophorumcan be limited to the throat and cause persistent or recurrent tonsillitis.F. necrophorumis unique among non-spore-forming anaerobes, first for its virulence and association with Lemierre's syndrome as a monomicrobial infection and second because it seems probable that it is an exogenously acquired infection. The source of infection is unclear; suggestions include acquisition from animals or human-to-human transmission. Approximately 10% of published cases are associated with infectious mononucleosis, which may facilitate invasion. Recent work suggests that underlying thrombophilia may predispose to internal jugular vein thrombophlebitis. Lemierre's syndrome was relatively common in the preantibiotic era but seemed to virtually disappear with widespread use of antibiotics for upper respiratory tract infection. In the last 15 years there has been a rise in incidence, possibly related to restriction in antibiotic use for sore throat.

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“…According to a review, a female patient with LS and genetic polymorphisms presented functional variations of Toll-like-5 receptor (TLR-5) gene and two coagulation variations (Tissue Factor (TF) -603 and Plasminogen-Activator-Inhibitor-1 (PAI-1) 4G-4G homozygous), which are frequently associated with thrombotic events. Another LS case revealed Prothrombin A20210G gene mutation, MTHFR gene polymorphism (C677T) mutation, and increased apolipoprotein levels with normal homocysteine levels [1][2][3][4] . Screening for an underlying malignancy or thrombophilia should be considered in some cases since an underlying hypercoagulable state may predispose to thrombosis in LS and may alter the type and duration of treatment [4] .…”

Section: Discussionmentioning

confidence: 99%

“…Another LS case revealed Prothrombin A20210G gene mutation, MTHFR gene polymorphism (C677T) mutation, and increased apolipoprotein levels with normal homocysteine levels [1][2][3][4] . Screening for an underlying malignancy or thrombophilia should be considered in some cases since an underlying hypercoagulable state may predispose to thrombosis in LS and may alter the type and duration of treatment [4] . The mainstay of LS treatment relies on a combination of broad-spectrum intravenous antibiotics directed against anaerobes, staphylococci, and streptococci (the treatment of choice is b-lactams/beta-lactamase inhibitor antibiotics with or without metronidazol or clindamycin).…”

Section: Discussionmentioning

confidence: 99%

Complicated Lemierre Syndrome Caused by Streptococcus gordonii and Possible Rickettsial Co-Infection in a Patient with Thrombophilia Predisposition

Ioannou

Dimitriou

et al. 2017

European Journal of Case Reports in Internal Medicine

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Aims:Lemierre syndrome is a life-threating condition characterized by recent oropharyngeal infection, internal jugular vein thrombosis, and anaerobic septicemia. It is usually caused by Fusobacterium necrophorum. Methods: A young Romanian male presented with fever and rigors, mild tachypnea, hypoxia, sore throat, decayed teeth, and tenderness of the left carotid triangle. Laboratory examination indicated severe sepsis with disseminated intravascular coagulation, acute renal failure, and acute respiratory distress syndrome while the Doppler ultrasonography of the carotids revealed left internal jugular venous thrombosis. The patient was administered piperacillin/tazobactam and vancomycin intravenously, doxycycline orally, and anti-coagulation by enoxaparin based on the diagnosis of Lemierre syndrome. Meanwhile, he was complicated by bilateral diffuse pulmonary cavities and encapsulated pleural effusions and so transcutaneous drainage was performed. The patient was discharged after a month and continued his treatment with oral phenoxypenicillin and doxycycline until full radiographic improvement. He was switched to oral anti-coagulation by vitamin-K antagonists and was referred to a hematologist, a vascular-surgeon, and a dentist. Results: Streptococcus gordonii was isolated from the patient's blood and pleural fluid cultures and serology for Rickettsial spp. IgM was positive. Thrombophilia genetic tests revealed three minor mutations for fibrinogen-455, plasminogen activator inhibitor-1, and methylenetetrahydrofolate reductase. According to the literature, S. gordonii is not usually a causative agent and Rickettsial spp. have as yet not been correlated with Lemierre syndrome. The failure of left jugular vein recanalization shows a possible causative role of the underlying thrombophilic predisposition. Discussion: Because of the syndrome's rarity and the atypical microorganisms isolated in this case, increased awareness is advised for its diagnosis and the underlying mechanisms involved in its genesis. The role of anti-coagulation is debatable. LEARNING POINTS• Very rare condition. Medical practitioners should be vigilant in its diagnosis since septic jugular vein thrombophlebitis could be misdiagnosed as neck lymphadenitis.• Duration of antibiotic therapy and additional anticoagulation treatment are still under discussion.• Underlying thrombophilia predisposition should be excluded.

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Lemierre's syndrome and genetic polymorphisms: a case report

Abstract: Background: Lemierre's syndrome presents a classic clinical picture, the pathophysiology of which remains obscure. Attempts have been made to trace genetic predispositions that modify the host detection of pathogen or the resultant systemic reaction.

Cited by 30 publications

References 15 publications

Fusobacterial head and neck infections in children

Fusobacterial head and neck infections in children

Human Infection withFusobacterium necrophorum(Necrobacillosis), with a Focus on Lemierre's Syndrome

Complicated Lemierre Syndrome Caused by Streptococcus gordonii and Possible Rickettsial Co-Infection in a Patient with Thrombophilia Predisposition

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