Lemierre syndrome: Difference between revisions
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== Clinical Manifestations == |
== Clinical Manifestations == |
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* Acute pharyngitis that becomes severe |
* [[Acute pharyngitis]] that becomes severe |
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* Neck pain |
* Neck pain |
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* Fever |
* Fever |
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* May have septic emboli, including to lung |
* May have [[septic emboli]], including to lung |
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== Diagnosis == |
== Diagnosis == |
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* [[Is treated by::Piperacillin-tazobactam]] or [[Is treated by::ampicillin-sulbactam]] |
* [[Is treated by::Piperacillin-tazobactam]] or [[Is treated by::ampicillin-sulbactam]] |
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*May step down to oral [[amoxicillin-clavulanic acid]] when clearly improving |
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*Duration 3 to 6 weeks total, for example 2 weeks IV and 2 weeks p.o.) |
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*Alternatives include [[penicillin G]] (if susceptible), [[clindamycin]], [[Carbapenem|carbapenems]], and [[metronidazole]] (occasionally resistant) |
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*Resistant to [[Macrolide|macrolides]] |
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* Unclear if need for anticoagulation |
* Unclear if need for anticoagulation |
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Latest revision as of 17:12, 22 February 2022
Background
- Suppurative thrombophlebitis involving the jugular vein following acute pharyngitis, classically secondary to Fusobacterium necrophorum
Microbiology
- Fusobacterium necrophorum, the most common cause
- Other oral flora, including Fusobacterium, Staphylococcus aureus, and Streptococcus pyogenes
Clinical Manifestations
- Acute pharyngitis that becomes severe
- Neck pain
- Fever
- May have septic emboli, including to lung
Diagnosis
- CT with contrast demonstrating internal jugular thrombosis
- Blood cultures positive to causative organism
Management
- Piperacillin-tazobactam or ampicillin-sulbactam
- May step down to oral amoxicillin-clavulanic acid when clearly improving
- Duration 3 to 6 weeks total, for example 2 weeks IV and 2 weeks p.o.)
- Alternatives include penicillin G (if susceptible), clindamycin, carbapenems, and metronidazole (occasionally resistant)
- Resistant to macrolides
- Unclear if need for anticoagulation
