Radiological Case of the Month

Narsinghani, Umesh; Mb, Schmidt; Rf, Jacobs; Krishnan, Anand

doi:10.1001/archpedi.155.8.965

Cited by 9 publications

(5 citation statements)

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“…Abnormal liver function was detected in 49% of patients by Hagelskjaer et al (177), and patients may be frankly jaundiced (162,327,389,400). Liver abscesses, commonly multiple (37,92,125,218,227,279,286,365,400), were identified in 4% of patients in the current series of Lemierre's syndrome and splenic abscesses (9,106,219,222,236,327,392) in 3% patients. Liver abscesses have been reported in other necrobacillosis cases not fulfilling the criteria for Lemierre's syndrome (8,176,188,199,296,379).…”

Section: Natural History and Forms Of F Necrophorum Septicemiamentioning

confidence: 56%

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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Section: Natural History and Forms Of F Necrophorum Septicemiamentioning

confidence: 56%

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

2007

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“…(blood culture and abscess aspirate)- Drainage of abscess- Removal of diseased teeth- Oral amoxicillin/clavulanate (3 weeks)SIngleOropharynx (PF)33 [11]64M F. necrophorum (abscess aspirate)- Aspiration of abscess (R)- Cefuroxime and metronidazole (2 weeks)- Oral metronidazole and oral ciprofloxacin (UTP)MultipleLower GI tract (haemorrohoids)34 [63]22M F. necrophorum (abscess aspirate)- Aspiration of abscess (R)- Gentamicin, clarithormycin, metronidazole, ceftriaxone and low molecular weight heparin (6 weeks)MultipleOropharynx (PLS)35 [64]19F F. necrophorum (blood culture and abscess aspirate)- Drainage of the largest hepatic abscess- IV benzylpenicillin, metronidazole, and ciprofloxacin (5 weeks)MultipleOropharynx (PLS)36 [65]71M F. necrophorum (abscess aspirate)- IV benzylpenicillin (6 weeks)- Oral amoxicillin (6 weeks)MultipleLower GI (diverticular disease)37 [66]44M F. necrophorum (abscess aspirate)H. Parainfluenzae (abscess aspirate)- Drainage of hepatic abscess (R)- IV tetracycline (3 days)- Co-trimoxazole (8 days)- IV cefazolin + IV gentamicin (UTP)- IV ceftriaxone (3 weeks)SingleUnidentified38 [67]18M F. necrophorum (blood culture)- Cefotaxime, vancomycin, and azithromycin. Then cefepime and metronidazole (unspecified chronology or time period)SingleOropharynx (PLS)39 [68]17F F. necrophorum (blood culture)- Nafcillin and ceftriaxone (3 days)- Nafcillin, ceftriaxone, and metronidazole (6 weeks)MultipleOropharynx (PLS)40 [69]27M F. necrophorum (blood cultures and abscess aspirate)- Drainage of hepatic abscess (R)- IV ampicillin, gentamicin, and metornidazole (10 days)- Oral ampicillin and metronidazole (5 weeks)SingleOropharynx (PLS)41 [70]55M F. necrophorum (abscess aspirate)- Aspiration of abscess- IV ampicillin/sulbactam (1 month)- Oral amoxicillin/clavulanate (21 days)MultipleUpper GI tract (HPB)42 [71]31M F. necrophorum (abscess aspirate)…”

Section: Resultsmentioning

confidence: 99%

Fusobacterial liver abscess: a case report and review of the literature

Jayasimhan

Huggan

2017

BMC Infect Dis

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BackgroundFusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature.Case presentationA 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment.A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords “Fusobacterium” and “Liver abscess”. Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search.Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre’s Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks.ConclusionFusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.

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“…They were septic with fever and had painful unilateral swelling of the neck, probably due to septic thrombophlebitis of the internal jugular vein. Thrombophlebitis can be diagnosed by ultrasound or, better, by computerised tomography (CT) scanning of the neck, but this was rarely performed in our patients and, therefore, was not of any help as a diagnostic tool in our study [7,[33][34][35][36][37][38][39][40][41][42][43][44]. There are casuistic reports of Lemierre's syndrome developing from a peritonsillar abscess [45,46].…”

Section: The Oropharyngeal Cases Of Lemierre's Syndromementioning

confidence: 99%

Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey

Kristensen

Prag

2008

Eur J Clin Microbiol Infect Dis

233

197

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In a 3-year prospective study, all cases of disseminated Fusobacterium necrophorum infections found in Denmark from 1998 to 2001 were analysed, with the aim of describing the epidemiology and clinical features of the variants of Lemierre's syndrome and disseminated non-head-and-neck-associated F. necrophorum infections. Fifty-eight cases of Lemierre's syndrome were reported in previously healthy persons, with an incidence of 14.4 cases per million per year in youngsters aged 15-24 years old. There was no increase during the study period. Lemierre's syndrome originating from an oropharyngeal infection was seen in 37 youngsters. An otogenic variant of Lemierre's syndrome was seen in 5 children with dissemination to nearby regions, and other variants of Lemierre's syndrome, e.g. from the sinuses and teeth, were seen in 16 adults. Patients often had metastatic infections already on admission and needed prolonged hospitalisation. The overall mortality of Lemierre's syndrome was 9%. Forty-two elderly patients had disseminated F. necrophorum infections originating from foci in lower parts of the body. They frequently had predisposing diseases, e.g. abdominal or urogenital cancers, which contributed to the high mortality of 26%. This study shows that the incidence of Lemierre's syndrome is higher than that previously found and has a characteristic age distribution. Early suspicion of the diagnosis, several weeks of antibiotic therapy, often combined with surgical drainage, is mandatory to lower the mortality. In disseminated non-head-and-neck-associated F. necrophorum infections, underlying cancers must be considered.

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Radiological Case of the Month

Cited by 9 publications

References 0 publications

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

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

Fusobacterial liver abscess: a case report and review of the literature

Lemierre’s syndrome and other disseminated Fusobacterium necrophorum infections in Denmark: a prospective epidemiological and clinical survey

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