Lemierre's Syndrome: Methicillin-Resistant Staphylococcus aureus (MRSA) Finds a New Home

Bentley, Thomas P.; Brennan, Daniel F.

doi:10.1016/j.jemermed.2007.07.066

Cited by 23 publications

(10 citation statements)

References 14 publications

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“…The causative organisms include the anaerobic gram-negative Fusobacterium species, but also Eikenella, Porphyromonas, Streptococci and Bacteroides [180,181]. Recently, methicillin-resistant Staphylococcus aureus has been identified as a new causative agent [182]. Extension of the infection to the adjacent lateral pharyngeal tissue results in haematogenous spread.…”

Section: Septic Emboli Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Septic Emboli Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…[3][4][5][6] Eight of these 11 cases were reported as being MRSA-induced. Half of the patients affected were children and the other half were no older than 32 years.…”

Section: Discussionmentioning

confidence: 99%

Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review

Kizhner

Samara²,

Panesar

et al. 2013

J. Laryngol. Otol.

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Community-acquired methicillin-resistant Staphylococcus aureus bacteraemia can lead to pulmonary sequelae. When it is associated with pharyngitis, nasopharyngitis or parapharyngeal lymphadenitis, the affected patient may be predisposed to Lemierre's syndrome. As bacterial carriage is predominantly nasal, pharyngitis may not be present. Methicillin-resistant Staphylococcus aureus should be included as an offending bacterium where there is suspicion of Lemierre's syndrome. It is unclear whether anticoagulation alters the course of the bacterium, and surgery is probably contraindicated.

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“…Other identified organisms include Bacteroides, Streptococcus, Peptostreptococcus, and Eikenella species. Staphylococcus aureus has been reported very rarely [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Clinical Pearls in Pediatric Infections

et al. 2011

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This series of Clinical Pearls presents four cases presenting with infection. Each of these cases had clinical clues to the correct diagnosis, which could be picked up on meticulous history, clinical examination, or basic laboratory investigations. The authors highlight the important lessons to be learnt from each case. The first is a 7 year old boy with recurrent respiratory tract infections since early life. Clinical examination revealed the presence of dextrocardia and situs inversus and bronchiectasis leading to a diagnosis of Primary Ciliary Dyskinesia. The second case is a 1.5-month-old infant who presented with meningitis and increasing head size since birth. CSF examination and CT scanning led to the correct diagnosis of congenital Toxoplasmosis. The next case is an infant with high grade fever and neck swelling. He had the rare Lemierre's syndrome comprising of oro-pharyngeal infection, suppurative thrompbophlebitis of the internal jugular vein and systemic dissemination of septic emboli. The fourth case is a 2-year-old infant with recurrent respiratory tract infections and discharging neck swellings from early life. Repeated testing for tuberculosis was negative. The diagnosis was Chronic granulomatous disease. The authors describe the clinical approach and investigations in these cases; along with an outline of the management.

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Lemierre's Syndrome: Methicillin-Resistant Staphylococcus aureus (MRSA) Finds a New Home

Cited by 23 publications

References 14 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review

Clinical Pearls in Pediatric Infections

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