Oropharyngeal Infection Research Articles

141. Lemierre’s Syndrome – A pulmonary complication following Dental Extraction

A rare complication of oropharyngeal infection, Lemierre’s Syndrome – occurs with haematogenic spread of bacteria via the internal jugular vein. Traditionally, this originates from such pathology as a peri-tonsillar abscess, however this case explores a more unusual presentation of a patient presenting to hospital following a dental extraction.

Optimisation of treatments for oral Neisseria gonorrhoeae infection: Pharmacokinetics Study (STI-PK project) – study protocol for non-randomised clinical trial

IntroductionNeisseria gonorrhoeae infections are common and incidence increasing. Oropharyngeal infections are associated with greater treatment failure compared with other sites and drive transmission to anogenital sites through saliva. Gonococcal resistance...

Risk Factors Associated with Post-Operative Complications in Multidisciplinary Treatment of Descending Necrotizing Mediastinitis.

Descending necrotizing mediastinitis (DNM) is a severe, life-threatening complication of oropharyngeal infections with cervical necrotizing fasciitis. In this study, we aimed to identify any possible factors that correlate with favorable outcomes. We retrospectively analyzed our series of 18 patients who underwent surgical treatment for DNM from a cervical abscess. Gender, age, symptoms, etiopathogenesis, comorbidities, time to surgery from diagnosis, degree of diffusion, identified microorganisms, surgical procedure, days in the intensive care unit, need for tracheostomy, complications, and surgical outcomes were reviewed. The main type of surgery was thoracotomy + cervicotomy in eight cases (50.0%), followed by cervicotomy +VATS in four (22.2%). Seven patients (38.9%) had two or more surgeries; a bilateral operation was necessary for four patients. Evaluating the risk factors associated with post-operative complications, age ≥ 60 years (p:0.031), cervicotomy alone as surgical approach (p = 0.040), and the bilateral approach (p = 0.048) resulted in significance in terms of the univariate analysis; age ≥ 60 years (p = 0.04) and cervical approach (p = 0.05) maintained their significance in terms of the multivariate analysis. The low mortality of our series emphasizes the importance of an extensive and immediate surgical drainage of both the neck and the mediastinum. Mediastinal drainage from cervicotomy seems to be a risk factor for post-operative complications. Minimally invasive surgery on the chest cavity, such as with Uniportal-VATS, could be a good approach above all in elderly patients and all those cases where bilateral access is required.

Structural and functional analysis of EntV reveals a 12 amino acid fragment protective against fungal infections

Fungal pathogens are a continuing challenge due to few effective antifungals and a rise in resistance. In previous work, we described the inhibition of Candida albicans virulence following exposure to the 68 amino acid bacteriocin, EntV, secreted by Enterococcus faecalis. Here, to optimize EntV as a potential therapeutic and better understand its antifungal features, an X-ray structure is obtained. The structure consists of six alpha helices enclosing a seventh 16 amino acid helix (α7). The individual helices are tested for antifungal activity using in vitro and nematode infection assays. Interestingly, α7 retains antifungal, but not antibacterial activity and is also effective against Candida auris and Cryptococcus neoformans. Further reduction of α7 to 12 amino acids retains full antifungal activity, and excellent efficacy is observed in rodent models of C. albicans oropharyngeal, systemic, and venous catheter infections. Together, these results showcase EntV-derived peptides as promising candidates for antifungal therapeutic development.

Antioxidant and Inhibitory Capacity of Tomato Leaf Ethanolic Extract against Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans

Background: Tomato is a source of bioactive compounds, antimicrobials, and antioxidants. Tomato leaf preparations have been empirically used for anti-inflammatory, analgesic, antibiotic, and antiseptic purposes. However, research on the potential activity of tomato leaf extracts against oral microorganisms and in managing oropharyngeal infections is scarce. Objective: To investigate tomato leaf ethanolic extract’s antioxidant and growth inhibitory capacity against common oral pathogenic microorganisms, namely, Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans. Methods: Ethanolic extracts were made from ‘Chonto’ tomato (Lycopersicon esculentum) leaves. The antimicrobial activity was measured with the microdilution technique using vancomycin and fluconazole as positive controls. The antioxidant capacity was measured with the ORAC assay using Trolox as a positive control. Results: We found a high percentage of growth inhibition (≥100%) against S. mutans and P. gingivalis at a concentration of 500 mg/L. However, the extract was ineffective in inhibiting the growth of C. albicans. Finally, we observed that the extract exerted a high antioxidant capacity (126%) compared to the positive control. Conclusions: This study provides new insights into the potential antimicrobial effect of tomato leaf extracts on common oral pathogenic bacteria, which may ultimately result in the development of new herbal products that might help prevent and treat oral infections, such as dental caries and periodontal disease. Our findings also support previous studies on the high antioxidant capacity of tomato leaf extracts.

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

An Unusual Presentation of a Patient with Covid-19 Infection—Lemierre’s Syndrome

Lemierre’s syndrome refers to septic thrombophlebitis of the internal jugular vein that is rarely seen after an oropharyngeal infection. We present the case of a 64-year-old female patient with Covid-19 infection and Lemierre’s syndrome. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein and non-contrast-enhanced computed tomography of the thorax was consistent with Covid19 infection. The patient was immediately hospitalized. Systemic antibiotics, anticoagulation therapy, and favipiravir treatment for Covid-19 infection were started. Unfortunately, the patient died about two weeks after hospitalization. To the best of our knowledge, this is the first case of Lemierre’s syndrome and Covid-19 overlap. Clinical suspicion of Lemierre’s syndrome is important for rapid diagnosis. During this Covid-19 pandemic, we should keep in mind that any patient may have Covid-19 infection. In addition to the patient’s primary disease, with clinical or laboratory suspicion of Covid-19 infection, diagnostic tests for it should also be conducted.

Portal Vein Thrombosis Associated With Fusobacterium nucleatum Bacteremia: A Rare Abdominal Variant of Lemierre’s Syndrome

Lemierre's syndrome is a rare but potentially severe complication of bacterial infections that usually affects previously healthy adolescents and young adults. It commonly presents as septic thrombophlebitis of the internal jugular vein and bacteremia following a recent oropharyngeal infection. The most commonly isolated organisms are Fusobacterium necrophorum, followed by Fusobacterium nucleatum and other anaerobes. Atypical Lemierre's syndrome is characterized by thrombophlebitis at sites distant from the head and neck veins and is far less encountered than typical Lemierre's syndrome. Here, we present a case of an elderly African American female with pylephlebitis, a rare abdominal variant of Lemierre's syndrome with extensive portal vein, splenic vein, and mesenteric vein thrombosis following perforated diverticulitis and resultant F. nucleatum bacteremia. She demonstrated complete recovery following appropriate long-term intravenous antibiotics and anticoagulation. This case calls attention to the re-emergence of the rare manifestation of this forgotten disease and highlights improved outcomes with prompt recognition and early treatment.

Antifungal activity of eugenol and clove leaf essential oil (Syzygium aromaticum L.) against clinical isolates of candida species

Candida species are causative microorganisms of oropharyngeal, vulvovaginal, and skin infections. Clove (Syzygium aromaticum L.) and eugenol oil have considerable antifungal activity against human pathogenic fungi, including Candida species. The anticandidal action of the studied oils is significantly dependent on the concentration of eugenol and further main and minor constituents of the oils with well-known antifungal effects must have additional and synergistic activities. This study was conducted to compare the antifungal activity of clove leaf essential oil (Syzygium aromaticum L.) and eugenol to determine the role of the content other than eugenol in clove leaf essential oil as an antifungal against Candida species isolates from HIV-AIDS patients. Methods: This study is an in vitro test using the disk diffusion method to determine the zone of inhibition of clove leaf essential oil (Syzygium aromaticum L.) concentrations of 5%, 10%, and 15% as well as eugenol which was equivalent to the concentration of eugenol in clove leaf essential oil at concentrations of 5%, 10% and 15% in 40 isolates of Candida species.

Lemierre's syndrome from odontogenic infection causing thrombophlebitis within the external and internal jugular veins—A case report

AbstractLemierre's syndrome is a rare but potentially life‐threatening condition primarily caused by anaerobic bacteria within in the oropharyngeal region. It largely affects otherwise healthy individuals, following an oropharyngeal infection, leading to sepsis and thrombophlebitis of the internal jugular vein. Management can involve a prolonged course of antibiotics, exclusion of the source of infection, surgical drainage and anticoagulant therapy. This case report describes a rare presentation of this condition causing thrombosis within the external jugular vein and significant sepsis in an otherwise healthy 41‐year‐old male. He presented with severe neck pain and trismus, and the source of the infection was deemed to be an infected mandibular molar. The patient has undergone a full recovery following intravenous antibiotics, anticoagulation and later extraction of the offending tooth. Our aim is to educate clinicians on the importance of this uncommon but clinically significant condition, that is increasing in prevalence and can lead to significant morbidity.

Neonatal oropharyngeal infection by HPV in our area

IntroductionAlthough infection by human papillomavirus (HPV) is mainly considered a sexually transmitted disease, newborns exposed to the virus in the perinatal period can also be infected through mechanisms that are not yet fully understood. The aim of our study was to increase our understanding of neonatal oropharyngeal infection by HPV, trying to establish its frequency, mechanisms of infection and persistence through age 2 years. Material and methodsWe conducted a prospective, observational and descriptive study in a cohort of neonates born vaginally whose mothers carried HPV in the lower genital tract at the time of delivery. Tests for detection of HPV in amniotic fluid, venous cord blood and oropharyngeal secretions were performed in every neonate, and we conducted microbiological follow-up of infants colonized by HPV up to age 2 years. ResultsThe prevalence of oropharyngeal colonization at birth was 58.24%. In the 24-month follow-up, the proportions of clearance and persistence of HPV in the oropharynx were 94.34% and 5.66%, respectively. ConclusionsThe results of this case series suggest that neonatal oropharyngeal colonization by HPV, while frequent in the postpartum period, is usually a self-limited process, and the main mechanism of infection transvaginal intrapartum vertical transmission. Although colonization in most neonates is transient and asymptomatic, the clinical significance of persistent carriage remains unknown.

Lemierre’s Syndrom Resulting from Cholesteatomatous Otitis Media and Mastoiditis: A Case Report

Lemierre’s syndrome is a rare and in some cases fatal thrombophlebitis of the internal jugular vein (IJV). It usually follows acute oropharyngeal or otologic infections in healthy, young children. Fusobacterium necrophorum is the most common bacteria that causes Lemierre’s syndrome, whereas various microorganisms are reported. We report a case of Lemierre’s syndrome secondary to chronic otitis media, which remains a rare occurrence of a very seldam disease.

Lemierre’s Syndrome with Facial Vein Thrombosis and Pulmonary Septic Emboli: A Case Report

Introduction: Lemierre’s syndrome (LS) is a rare and serious condition that often affects school-aged children, adolescents, and healthy young adults. It is defined as an oropharyngeal infection with secondary septicemia, internal jugular vein thrombosis, and septic emboli. Rare cases of atypical LS in which thrombosis occurs in other locations have been reported. Case Presentation: We presented a case of an adolescent with fever, sore throat, and neck tenderness. Physical examination revealed acute pharyngitis and bilateral small cervical lymph nodes. Rapid antigen group A Streptococcus and viral serologic tests were negative. Complete hemogram and blood biochemical analysis showed leukocytosis and elevated serum C-reactive protein (CRP). Cervical computerized tomography (CT) scan revealed a heterogeneous right tonsil and small cervical lymph nodes. The chest radiograph was normal. After admission, the adolescent started complaining of dyspnea and thoracic pain and had a painful small cervical right mass. In the thoracic CT angiography (CTA), several pulmonary septic emboli were apparent throughout the pulmonary parenchyma. Cervical Doppler ultrasound showed right facial vein thrombophlebitis, later confirmed in a CTA. Thromboses in other locations, including the internal jugular vein, were excluded, as well as cervical abscesses. The patient was successfully treated with intravenous antibiotic therapy and anticoagulation. Discussion: To this date, no reports of LS presenting with isolated thrombosis of the facial vein have been described in pediatric patients. We highlighted the importance of early recognition of LS and its atypical variants. Pediatric international guidelines regarding its management and treatment would also greatly affect the outcome of these patients.

Post-traumatic Lemierres Syndrome: A rare presentation secondary to mandibular fracture

Lemierre’s Syndrome is a rare phenomenon with a low prevalence and is characteristically seen in patients with an oropharyngeal infection that is complicated by thrombophlebitis of the internal jugular vein and secondary septic emboli. We present the case of a 16 year old previously well male who was diagnosed with a rare case of Lemierre’s syndrome secondary to a mandibular fracture. Blood tests and radiological imaging confirmed the diagnosis, with CT scan of the patients head and neck revealing a right mandibular fracture with abscess formation, bilateral parapharyngeal abscesses, bilateral internal jugular vein thromboses, left sigmoid sinus thrombosis, cavernous sinus thrombosis, post septal orbital cellulitis with enhancing infraorbital collections and a subdural empyema overlying the left tentorium cerebelli. The treatment is usually non-operative with antibiotics and in some instances surgical drainage. In this case a combination of surgical drainage for source control and antibiotics were used. Unfortunately, despite an initial improvement in the patient’s clinical status the patient died. This is the first case of Lemierre’s syndrome secondary to blunt facial trauma reported in the scientific literature. This case highlights the importance of clinicians having a high degree of suspicion of Lemierre’s syndrome when a patient presents with typical clinical features following facial trauma.

LEMIERRE'S SYNDROME: THE FORGOTTEN DISEASE

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Septic thrombophlebitis of the internal jugular vein (IJV) is a rare complication of anaerobic oropharyngeal infection. We present a case of Lemierre’s syndrome which was managed without systemic anticoagulation therapy. CASE PRESENTATION: A 63 year old female presented to the hospital with left jaw pain for one week. The admission labs were pertinent for leukocytosis, lactic acidosis, acute kidney injury and thrombocytopenia. Oral physical exam was significant for submandibular tenderness, ulcerative pharyngitis and tonsillitis. She was initiated on broad spectrum antibiotics. A venous ultrasound of the left upper extremity revealed an acute deep vein thrombosis in her left IJV and an acute superficial venous thrombosis in the right cephalic vein. The blood culture later grew an anaerobic gram negative bacteremia, identified to be part of the Fusobacterium species. The patient was managed on IV Unasyn for two weeks; she improved and her abnormal labs resolved. She was discharged with Amoxicillin for two weeks. DISCUSSION: The typical clinical picture of Lemierre’s syndrome is an acute oropharyngeal infection, anaerobic gram negative bacterial infection and an acute thrombosis of the internal jugular vein. Antibiotics are currently the primary treatment of this condition. Despite thrombosis of IJV, treatment with anticoagulation therapy remains unclear. CONCLUSIONS: We wish to highlight the importance of recognising Lemierre’s syndrome due to its increasing resurgence and high mortality rate (25%) if not treated adequately with antibiotics. This case also emphasises septic thrombophlebitis in the hospital setting and the need for further controlled studies to establish the role of anticoagulation therapy. DISCLOSURE: Nothing to declare. KEYWORD: lemierre's syndrome

Factors associated with the decreasing rate of oropharyngeal cancer in young adults in the United States.

10534 Background: To evaluate trends of HPV-associated oropharyngeal cancers and HPV infections in the United States. Methods: Data was extracted from the United States Cancer Statistics Public Use Database (USCS) between 2001 and 2017 and the National Health and Nutrition Examination Survey (NHANES) between 2011 to 2016. Data on oropharyngeal squamous cell carcinoma (OSCC) was obtained from the USCS database. HPV vaccination and screening (oral washings) data were obtained from NHANES. Based on CDC guidelines, HPV strains were further subdivided into high-risk strains (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). Results: Based on USCS, oropharyngeal cancer incidence rates have increased in males by 1.64% every year (p < 0.001) while remaining stable in females over the last 17 years. Oropharyngeal cancers have increased for all age groups over the age of 55, with the largest increase seen in those between the ages of 65-69 years old (p < 0.001). However, individuals between the ages of 30-34 had the largest decrease in oropharyngeal cancers over the same time period (p = 0.016). Based on race, Whites had the highest incidence rates at 5.12/100,000 followed by 2.99 in Blacks, 2.32 in Hispanics, and 1.11 in Asians. By geographical region, the incidence was found to be the highest in the Midwest with 4.68/100,000 and the lowest in the West at 3.78. Our intersectional analysis showed that White males in the South aged 65-69 had the highest incidence of oropharyngeal cancers at 40.57/100,000 and this same group aged 60-64 had the highest annual increase at 4.65% (p < 0.001). Using the NHANES database, we showed that those with greater than 4 lifetime sexual partners have a 3-fold higher risk of high risk HPV infection compared to those with 4 or under (7.1% vs 1.9%, p < 0.0001). 8.8% of current smokers are infected with high risk oral HPV compared to only 3.9% of non smokers (p < 0.001). The incidence of any HPV infection for those <39 years old was 5.9% in 2011 and 4.7% in 2016 (p = 0.4723). In contrast, the incidence in those > 39 years old was 6.6% in 2011 and 6.4% in 2016 (p = 0.99). On multivariate analysis, males have a 4-fold higher risk of high risk HPV infections compared to females (4.45, 95% CI: 2.94 - 6.74, p < 0.0001). Those with five or more sexual partners have 7-fold higher rate of high risk oral HPV infections compared to those without any sexual partners (7.15, 95% CI: 1.94 - 26.3, p = 0.0039). Furthermore, current smokers (1.81, 95% CI: 1.17 - 2.77, p = 0.0081) and three to four drinks per day (1.63, 95% CI: 1.05 - 2.55, p = 0.0312) have an increased risk of high risk oral HPV infections. Conclusions: Over the last 18 years, oropharyngeal cancers are increasing in individuals over the age of 55, particularly White males residing in the South. Individuals with greater than 4 lifetime sexual partners, current smokers, and those who consume three to four drinks per day have increased HPV infectivity rates.

Septic Thrombophlebitis of the Internal Jugular Vein in an Immunocompromised Patient with Lemierre Syndrome: A Case Report

Lemierre syndrome is a rare complication of oropharyngeal infection, especially acute pharyngotonsillitis, associated with septicemia and thrombophlebitis of the internal jugular vein (IJV). We present the case of a 52-year-old patient who underwent liver transplantation and returned with symptoms of pain, redness and left cervical bulging 1 month after surgery. After investigation, the diagnosis of septic thrombophlebitis of the IJV was made. The patient responded well to treatment with antibiotic therapy and full anticoagulation. To the best of our knowledge, the present report is the first report of Lemierre syndrome in a post-liver transplant patient.

La infección orofaríngea neonatal por VPH en nuestro medio

IntroductionAlthough infection by human papillomavirus (HPV) is mainly considered a sexually transmitted disease, newborns exposed to the virus in the perinatal period can also be infected through mechanisms that are not yet fully understood. The aim of our study was to increase our understanding of neonatal oropharyngeal infection by HPV, trying to establish its frequency, mechanisms of infection and persistence through age 2years. Material and methodsWe conducted a prospective, observational and descriptive study in a cohort of neonates born vaginally whose mothers carried HPV in the lower genital tract at the time of delivery. Tests for detection of HPV in amniotic fluid, venous cord blood and oropharyngeal secretions were performed in every neonate, and we conducted microbiological follow-up of infants colonized by HPV up to age 2years. ResultsThe prevalence of oropharyngeal colonization at birth was 58.24%. In the 24-month follow-up, the proportions of clearance and persistence of HPV in the oropharynx were 94.34% and 5.66%, respectively. ConclusionsThe results of this case series suggest that neonatal oropharyngeal colonization by HPV, while frequent in the postpartum period, is usually a self-limited process, and the main mechanism of infection is transvaginal intrapartum vertical transmission. Although colonization in most neonates is transient and asymptomatic, the clinical significance of persistent carriage remains unknown.

Review of Treatments for Oropharyngeal Fungal Infections in HIV/AIDS Patients

HIV and AIDS patients are susceptible to opportunistic infections. Oral candidiasis or thrush is the primary manifestation of fungal infection in these patients. The primary objective of this literature review was to summarize established and novel treatment options for oropharyngeal fungal infections in HIV/AIDS patients. Azoles and polyenes are the two primary antifungal drug classes employed for the treatment of oral candidiasis. A literature review was conducted on Medline and Google Scholar in October of 2021 using the keywords “Oral”, “Fungal”, “HIV”, and “Treatment”. Included studies were clinical trials, meta-analyses, and randomized controlled trials. Nineteen studies regarding azoles, polyenes, and novel treatments for oropharyngeal fungal infections in HIV/AIDS patients were examined in this review. The primary concern demonstrated from these studies is increased reports of resistance to antifungals, especially development of fluconazole resistance. Additionally, studies demonstrated that fluconazole had different relapse durations comparative to other medications, and that posaconazole could possibly act as an alternate form of treatment. Nystatin was indicated as a first-line therapy for thrush in multiple studies but could be upstaged by miconazole nitrate in resource-poor settings. Amphotericin B was an effective treatment option and was shown to be resilient in terms of fungal resistance, however potent adverse side effects were reported. Alternative treatments, such as immunoglobulin antibodies and lemon grass, revealed promising antifungal effects for immunocompromised individuals. Taken together, this review provides a thorough summary of treatment options of oropharyngeal fungal infections in HIV/AIDS patients.

Great saphenous vein suppurative thrombophlebitis due to Fusobacterium necrophorum infection

Abstract Fusobacterium necrophorum (F. necrophorum) is an anaerobic Gram-negative bacterium which does not form spores. F. necrophorum is usually associated with Lemierre's syndrome. The syndrome is characterized by thrombosis of the internal jugular vein with septicemia followed by oropharyngeal infection. In the present case report, a 27-year-old male with a significant medical history of intravenous drug use was presented in the emergency department. The patient presented a 3-day history of left lower extremity pain, redness, and swelling. His serological tests were positive for hepatitis C infection. The Duplex ultrasound (US) of the left lower extremity revealed extensive suppurative thrombophlebitis. The blood culture grew F. necrophorum, thus the patient was treated with IV ampicillin for 2 weeks, followed by additional 2 weeks of oral amoxicillin. At follow-up, 3 weeks later, the patient reported significant improvement in his symptoms. Three months later, lower extremity duplex in the US revealed resolving suppurative thrombophlebitis.