|
|
| (3 intermediate revisions by the same user not shown) |
| Line 1: |
Line 1: |
| '''Quick Start:''' ''You can begin to add to or edit text on this wiki doc page by clicking on the edit button above and to the left on this same page. Type in the text you want to add. Once you are done, click the save changes button at the bottom.
| | #Redirect[[Lemierre's syndrome]] |
| | |
| ''''''
| |
| | |
| ==== Editor-In-Chief: ====
| |
| | |
| Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please email [[mgibson@perfuse.org]] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
| |
| ----
| |
| | |
| = Overview =
| |
| Lemierre’s Syndrome refers to human necrobacillosis (infections with F. necrophorum) with primary foci in the head (oropharynx, face, ears, mastoid, teeth), often with septic thrombophlebitis of the internal jugular vein.
| |
| ===== References =====
| |
| ----
| |
| | |
| = Epidemiology and Demographics =
| |
| :*Rare
| |
| :*Previously healthy persons without underlying diseases:
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| | |
| = Risk Factors =
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| = Screening =
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| = Pathophysiology & Etiology=
| |
| | |
| ===== References =====
| |
| ----
| |
| = Molecular Biology =
| |
| ''Fusobacterium necrophorum''
| |
| :*nonmotile, filamentous, nonfusiform pleomorphic non-spore-forming obligate anaerobic gram negative rod
| |
| :*Normal microbiota of the oropharynx, GI tract, genitourinary tract
| |
| :*Unknown why F. necrophorum penetrates mucosa in some patients
| |
| :*reduced host defense (EBV); synergistic, pathogenic complex with other bacteria.
| |
| ===== References =====
| |
| ----
| |
| | |
| = Genetics =
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| = Natural History =
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| = Diagnosis =
| |
| == Differential Diagnosis ==
| |
| :*Descending necrotizing mediastinitis
| |
| :*Meningitis (mostly in children with otitis media
| |
| :*Beware false positive chlamydia PCR
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == History and Symptoms ==
| |
| | |
| :*Intense rigors and high fever within 1 week after primary local infection
| |
| :*Leukocytosis
| |
| :*Subclincical hyperbilirubinemia (50%)
| |
| :*Mild DIC (23%)
| |
| | |
| | |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == Physical Examination ==
| |
| | |
| === Appearance of the Patient ===
| |
| | |
| === Eyes ===
| |
| | |
| === Ear Nose and Throat ===
| |
| :*Ipsilateral neck tenderness parallel with sternocleidomastoid muscle
| |
| === Heart ===
| |
| | |
| === Lungs ===
| |
| :*Metastatic abscesses mainly to lungs (85%), but also joints (26%)
| |
| === Abdomen ===
| |
| :*Abdominal pain 2nd to microabscesses vs. thrombophlebitis of abdomino- pelvic veins
| |
| | |
| === Extremities ===
| |
| | |
| === Neurologic ===
| |
| | |
| === Other ===
| |
| | |
| ===== References =====
| |
| ----
| |
| == Laboratory Findings ==
| |
| | |
| === Electrolyte and Biomarker Studies ===
| |
| | |
| | |
| =====References=====
| |
| ----
| |
| | |
| === Electrocardiogram ===
| |
| | |
| | |
| =====References=====
| |
| ----
| |
| | |
| === Chest X Ray ===
| |
| | |
| | |
| =====References=====
| |
| ----
| |
| | |
| === MRI and CT ===
| |
| | |
| | |
| =====References=====
| |
| ----
| |
| | |
| === Echocardiography or Ultrasound ===
| |
| :*Unilateral suppurative thrombophlebitis of IJ: Ultrasound, CT, MRA
| |
| =====References=====
| |
| ----
| |
| | |
| === Other Imaging Findings ===
| |
| | |
| =====References=====
| |
| ----
| |
| === Other Diagnostic Studies ===
| |
| | |
| ===== References =====
| |
| ----
| |
| | |
| = Risk Stratification and Prognosis=
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| = Treatment =
| |
| | |
| | |
| == Pharmacotherapy ==
| |
| | |
| === Acute Pharmacotherapies ===
| |
| :*Penicillin + Flagyl vs. Clindamycin ?
| |
| :*Debridement of necrotic tissues
| |
| :*Anticoagulation normally not advised unless clot propagates towards cavernous sinus
| |
| ===== References =====
| |
| ----
| |
| | |
| === Chronic Pharmacotherapies ===
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| | |
| == Surgery and Device Based Therapy ==
| |
| | |
| === Indications for Surgery ===
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| === Pre-Operative Assessment ===
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| | |
| === Post-Operative Management ===
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| === Transplantation ===
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == Primary Prevention ==
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == Secondary Prevention ==
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == Cost-Effectiveness of Therapy ==
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| == Future or Investigational Therapies ==
| |
| | |
| | |
| ===== References =====
| |
| ----
| |
| | |
| ==Suggested Revisions to the Current Guidelines==
| |
| | |
| | |
| == References ==
| |
| <biblio>
| |
| </biblio>
| |
| ----
| |
| == Acknowledgements ==
| |
| The content on this page was first contributed by: Stephen Wiviott, M.D.
| |
| | |
| List of contributors:
| |
| ----
| |
| | |
| == Suggested Reading and Key General References ==
| |
| | |
| == Suggested Links and Web Resources ==
| |
| | |
| == For Patients ==
| |
| | |
|
| |
| | |
| ----
| |
| [[Category:]
| |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |