Septic Thrombosis Research Articles

Syndrome de Lemierre

Lemierre's syndrome is a rare disease, mostly affecting young adults in good health, which can lead to significant morbidity and mortality. We report one case with favourable outcome and clinical features stereotypics: angina, septic thrombosis of the internal jugular vein, pulmonary septic metastasis, Fusobacterium necrophorum on blood cultures. Antibiotic therapy targeting anaerobes has been rapidly initiated and maintained 4–6 weeks. The anticoagulation has been maintained 4 weeks.

Septic Knee-Induced Deep Venous Thrombosis in a Young Adult

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins. Pulmonary computed tomography-angiography was positive for acute pulmonary emboli. Initial management consisted of anticoagulation, intravenous antibiotics, and 2 arthroscopic irrigation and debridement procedures. After a normal transesophageal echocardiogram, a diagnosis of septic knee-induced deep venous thrombosis (DVT) of the left lower leg with subsequent septic pulmonary emboli was established. The patient was discharged to a long-term care facility for a 6-week monitored course of intravenous antibiotics. His DVT and pulmonary emboli were managed successfully with oral warfarin. Two months after his initial presentation, the patient returned with acute worsening knee pain. A knee arthrocentesis was unremarkable; however, radiographic imaging revealed fulminant osteomyelitis of the distal femur. He has since undergone open arthrotomy with excisional irrigation and debridement and is on a chronic oral antibiotic regimen. Sparse pediatric literature has shown an association between musculoskeletal sepsis and thrombosis. Only 1 case of septic knee-induced DVT exists in the adult literature, and it was not associated with pulmonary emboli. Our case provides evidence that DVT must be considered by the treating physician as a possible and devastating complication of septic arthritis.

Acute Pylephlebitis Following Gastrointestinal Infection: An Unrecognized Cause of Septic Shock

Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his unstable clinical status, was referred to the emergency room. A diagnosis of acute pylephlebitis complicated with septic shock was made. Treatment with a wide-spectrum antibiotic and anticoagulation was initiated. Fifteen days later, recanalization of the portal vein was achieved and clinical status was improved. Pylephlebitis following gastrointestinal infection is a potential cause of septic shock.

Complications infectieuses liées aux chambres implantables : caractéristiques et prise en charge

Totally implanted access port-related infections are responsible for their own morbidity and mortality. Main risk factors of totally implanted access port-related infections are total parenteral nutrition, young age, difficulties during insertion, poor general status and neutropenia. Recent guidelines defined intravascular catheter-related infections. This relies on a strict clinical and microbiological work-up including simultaneous culture of blood drawn from the catheter and a peripheral vein. The search for local or general complications is mandatory: clinical and possibly echographic assessments are therefore needed. Depending on the context and the type of microorganism, this evaluation may include transoesophageal echocardiography and search for suppurative thrombosis in case of catheter-related bloodstream infection caused by Staphylococcus aureus. Indeed, intravascular complications in this setting are frequent. Catheter removal is mandatory in case of local complication (tunnel infection or port pocket abscess), septic thrombosis, infective endocarditis, osteomyelitis, septic shock or infection related to specific pathogens (S. aureus, Candida spp., Pseudomonas aeruginosa). Otherwise, retention of the catheter might be proposed given results from recent studies including antibiotic lock therapy associated with systemic antibiotic. Future studies must focus on defining more precisely the factors associated with salvage therapy failure including host, pathogens virulence factors and biofilm formation.

Septic thrombosis of the cavernous sinus and dental infection

We report a case of septic thrombosis of the cavernous sinus and dental infection, and highlight the clinical features to enable prompt diagnosis and management.

Air Inclusion in Suppurative Deep Venous Thrombosis

Septic or suppurative deep venous thrombosis is an uncommon but occasionally lethal disease due to systemic complications. In most cases, it is caused by intravenous drug use or by percutaneous insertion of central venous catheter lines in critically ill patients. 1-3 Some patients have septic phlebitis after delivery or abortion or as a late complication of local infections such as pyonephrosis. 4 Most patients are admitted with clinical signs of severe sepsis and occasionally with complications as a result of septic embolization. 2 We report the case of an intravenous drug user with septic deep venous thrombosis of the left common femoral and external iliac veins diagnosed by sonography.

Superior Ophthalmic Vein Thrombosis in a Patient with Chronic Myeloid Leukemia Receiving Antifibrinolytic and Thrombopoietin Receptor Agonist Therapy

Isolated superior ophthalmic vein (SOV) thrombosis is a rare condition usually related to inflammation of the orbit or paranasal sinuses. Patients present with acute orbital signs, including proptosis, ophthalmoplegia, globe dystopia, and periorbital edema, and may have diminished vision secondary to optic neuropathy. SOV thrombosis is typically seen in the setting of septic cavernous sinus thrombosis, and antimicrobial therapy is the treatment of choice. We herein report what may be the first case of isolated SOV thrombosis related to hypercoagulability in a patient with cancer who was receiving antifibrinolytic and thrombopoietin receptor agonist medications.

Docetaxel, cisplatin, and capecitabine (DCX) as perioperative chemotherapy in gastroesophageal adenocarcinoma: A phase II study of the Arbeitsgemeinschaft Internistische Onkologie (AIO).

4116 Background: Perioperative chemotherapy with ECF or ECX is the standard approach in Europe for resectable gastroesophageal cancer. Docetaxel significantly improves efficacy if added to cisplatin and 5-FU as palliative treatment. To translate this efficacy into the curative approach this study investigates docetaxel (D), cisplatin (C) and capecitabine (X) in the perioperative setting. Methods: Pts with curatively resectable adenocarcinoma of the distal esophagus, gastroesophageal junction (GEJ) or stomach were treated with 3 preop and 3 postop cycles of chemotherapy: D 75 mg/m2 d1, C 60 mg/m2 d1 and × 1875 mg/m2/d d1-14, q3w. G-CSF was not routinely administered. Results: Accrual is completed with 50 pts included. Here we report on the protocol specified interim safety analysis of the preop chemo and surgery after 15 patients: male/female:15/0; med. age 65 yrs (45-73); esophagus/GEJ/stomach: 2/12/1 pts; ECOG PS 0/1/2: 7/8/0 pts; reduction of preop chemo was necessary in 7/15 pts; chemo toxicity, see Table. Resection ypR0: 14/15 pts. Surgical complications: 3/15 pts: anastomotic leakage with septic shock (1 pt), pneumonia and thrombosis (1 pt); urinary tract infection (1 pt); mortality: 0/50. Conclusions: DCX seems well tolerated and can safely be administered as preoperative chemotherapy as part of a perioperative regimen. Updated results will be presented. Toxicity of preop chemotherapy (worst grade per pt) (n;%) CTC 1 CTC 2 CTC 3 CTC 4 Nausea 9 (60%) 3 (20%) 1 (7%) - Vomiting 3 (20%) 2 (13%) - - Loss of appetite 4 (27%) 4 (27%) 1 (7%) - Diarrhea 3 (20%) 5 (33%) 1 (7%) 1 (7%) Asthenia 7 (47%) 7 (47%) 1 (7%) - Stomatitis 6 (40%) 5 (33%) - - Alopecia 4 (27%) 11 (73%) - - Neutrop. fever - - 3 (20%) - Hand-foot syndrome 8 (53%) 3 (20%) - - Nail changes 5 (33%) - - - Taste changes 10 (67%) 3 (20%) - - Paresthesia 9 (60%) 1 (7%) - - Central neurotoxicity 1 (7%) 1 (7%) - - Visual disturbances 1 (7%) 2 (13%) - - Hearing impairment 2 (13%) - - - Dizziness 7 (47%) 2 (13%) - - Leukopenia 3 (20%) 4 (27%) 7 (47%) 1 (7%) Neutropenia 2 (13%) - 2 (13%) 11 (73%) thrombocytes 5 (33%) 3 (20%) - - Anemia 4 (27%) 2 (13%) - 1 (7%) Other 6 (40%) 4 (27%) 2 (13%)* - * GI-bleed., sigma-perf. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Roche, sanofi-aventis Roche, sanofi-aventis Roche, sanofi-aventis

추체골염을 동반하지 않는 급성 유양돌기염에 의한 외전신경마비 1예

A 29-month-old boy presented with acute onset of esodeviation and limitation of ocular movement in his right eye. He had a history of right otitis media for 6 weeks, was diagnosed as abducens nerve palsy. Ventilation tube insertion was done after the eye symptom developed. At first day after surgery, esotropia of 30 prism diopters (PD) and abduction limitation (-4) was still obseved in the right eye due to abducens nerve palsy of the right side. A computed tomography of the temporal bone and magnetic resonance imaging of the brain showed severe mastoiditis without involvement of the abducens nerve pathway including petrous bone. At 6 days after onset of esotropia, simple mastoidectomy was done. An esotropia was improved gradually and at 4 months after surgery, orthotropia and normal ocular movement were acquired. We report a rare case of abducens nerve palsy presumed to be complicated by septic thrombosis of inferior petrosal sinus from mastoiditis without petrous apicitis. (J Clinical Otolaryngol 2010;21:74-78)

Forget Me Not

A 37-year-old man presented with a facial abscess that progressed to external ophthalmoplegia and proptosis. Neuroimaging was consistent with cavernous sinus thrombosis. The diagnosis, management options, and management controversies of septic cavernous sinus thrombosis are discussed, including neuroimaging, antibiotic choice, and the role of corticosteroids and anticoagulation.

Variant of Lemierre's Syndrome Secondary to Trauma

Classic Lemierre's syndrome is a septic internal jugular venous (IJV) thrombophlebitis secondary to oropharyngeal anaerobic infection in adolescent and young adult. Though upper respiratory tract infection is the most common antecedent, it has also been described following skin, soft tissues, genitourinary and gastrointestinal infections. Fusobacteria necrophorum is the commonest pathogen isolated from blood and tissue cultures but other bacteria like Eikenella correndens, Bacteroides melaninogenicus and Non Group A Streptococcal species have also been reported. The overall incidence of Lemierre's and Lemierre's like syndromes has declined since the first case report in 1936. There is however, a resurgence of cases in recent years due to more judicious use of antibiotics for treatment of upper respiratory tract infection among medical practitioners. The main stay of treatment of complete Lemierre's syndrome is prolonged antibiotic coverage and surgical drainage of nonresolving abscesses. Currently, there is no consensus opinion on the use of anticoagulation in patient with complete Lemierre's syndrome complicated by septic internal jugular thrombosis and embolism. High index of suspicion is required for early diagnosis of Lemierre's and Lemierre's like syndromes. Early and effective antibiotics therapy may prevent the development full spectrum of the syndrome and its associated complication.

Septic Pulmonary Embolism Case Report: Optimal Outcome after Insertion of an Inferior Vena Cava Filter in a Patient withStaphylococcus aureusBacteraemia

A 14-year-old patient presented with bilateral pneumonia and pleural effusions, septic arthritis of the hip, deep venous thrombosis, and pulmonary thromboembolism. Methicillin-sensitive Staphylococcus aureus (S. aureus) containing the Panton Valentine Leukocidin (PVL) genes was isolated. Contraindication to anticoagulation prompted inferior vena cava filter placement. He completed 4 weeks of treatment with flucloxacillin, with good clinical outcome. S. aureus containing PVL genes should be sought in cases of necrotizing pneumonia as it seems to increase the risk of severe multifocal infection and thrombotic complications. There are few reports of placement of filters during S. aureus sepsis and bacteraemia. This case highlights that when anticoagulation is not feasible, an inferior vena cava filter can be inserted safely, even in patients with active sepsis and high risk for seeding of the filter. Long-term follow-up confirmed a successful outcome with sterilization of the septic thrombosis with no further pulmonary embolism or additional sepsis episodes.

Pyléphlébite septique associée à une septicémie à Enterobacter cloacae

Septic pylephlebitis or purulent thrombosis of the portal venous system generally results from a progressive extension of suppurated thrombophlebitis, secondary to an intrabdominal infection. Germs most often found are Escherichia coli and Streptococcus, isolation of Enterobacter cloacae is unusual. We report a particular observation of septic pylephlebitis associated with E. cloacae bacteremia, without biliary, digestive or pancreatic lesion on the CT-scan. The antibiotic sensitivity pattern of the isolated germ and the negative epidemiologic investigation pled in favour of community acquired infection. The infection resolved with antibiotics and anticoagulation, followed by total repermeation of the portal system.

Candida septic thrombosis of the left atrium in twins: Report of two cases

Preterms are often exposed to nosocomial infections in NICU. Candida infections are particularly common and can result in progressive organization of intracardiac thrombosis, usually in the right atrium. GB (24.4 wg, 460 g, bigeminal pregnancy): he was affected by RDS, PDA, jaundice, anaemia and had been submitted to TPN with CVC, also because of anus imperforate. On the 50th day, haemoculture resulted positive for Candida parapsilosis and, by echocardiography, hyperecogen peduncolate formation in the appendix of left auricola. Despite antifungal therapy, exitus occurred. CM (32.4 wg, 1390 g, bigeminal pregnancy): on 2nd day, she was operated for “apple-peel” type intestinal atresia, and submitted to TPN. On the 21st day, the clinical features became worse with CRP rise and hypha in urines. By echocardiography, hyperecogenicity of left auricola appendix was noted. Amphotericin B liposomal had been done for 21 days with gradual regression of the echocardiographic findings. Despite CVC correct position by echocardiography, these two cases suggest that TPN, besides other risk factors such as twinning, can also lead to thrombosis in the left atrium, because of the anatomic and hemodynamic characteristics of left auricola. Sepsis, recurrent infections or acidosis reduces the function of anticoagulation system, and newborns with CVC are at high risk for intracardiac thrombosis. Echomonitoring is useful during prolonged TPN for early identification, particularly in preterms with gastrointestinal malformation at risk of fungal infections.

Gradenigo's syndrome with lateral venous sinus thrombosis: successful conservative treatment

Gradenigo's syndrome (GS) is a rare disease characterised by the triad otitis media, pain in the region innervated by the first and the second division of trigeminal nerve and abducens nerve palsy. Septic sinus thrombosis is one of the most frequent and relevant complication of GS; it is often due to persistent damage and late diagnosis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allow the correct diagnosis in most cases. Surgical therapy may be necessary for a better and more rapid resolution of the disease. We report the case of a 4-year-old child that was admitted for facial nerve palsy and abducens nerve palsy subsequent to a 2-week persistent pain in the right ear. MRI showed infective acute process of the right mastoid and partial ipsilateral sinus thrombophlebitis. The child was treated with high-dose intravenous antibiotics and with oral anticoagulants. A complete resolution of symptoms and radiological alterations were observed within 7 weeks. In conclusion, lateral sinus thrombosis and Gradenigo's syndrome are rare but potential fatal complications of otitis media and mastoiditis. High-dose intravenous antibiotics and a low dose of anticoagulant can achieve a complete recovery without surgery.

ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications)

When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion and maintenance. These too depend on appropriate choice of device, skilled implantation and correct positioning of the catheter, adequate stabilization of the device (preferably avoiding stitches), and the use of infusion pumps, as well as adequate policies for flushing and locking lines which are not in use.

Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications

Classically, Lemierre syndrome is a rare clinical entity in which acute oropharyngeal infection causes septic internal jugular vein thrombosis and leads to septic lesions to distant organs, such as the lung. Lemierre syndrome also presents with odontogenic infections, mastoiditis, parotitis, and sinusitis. We report the first case of Lemierre syndrome following acute isolated sphenoid sinusitis that was complicated with cavernous sinus thrombophlebitis and bilateral infectious aneurysms of the intracavernous internal carotid artery. Treatment with endoscopic sphenoidotomy, culture-directed antibiotics, heparinization, and endovascular GDC coiling were performed and the patient recovered without major neurologic morbidity. Immediate and intensive treatment with careful evaluation to localize the primary infectious focus of the head and neck, including the paranasal sinus, improves the prognosis of patients with rhinogenic Lemierre syndrome.

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i>

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Thrombectomy reduces the systemic complications in device-related right atrial septic thrombosis

Septic thrombosis of the right atrium is an unusual complication associated with the use of indwelling devices. The optimal management of this condition is unclear. Our experience with a patient with hemodialysis catheter-related septic thrombosis of the right atrium illustrates the difficulties associated with this condition. To determine the effects of surgical thrombectomy compared with nonsurgical treatment with antibiotics (with or without anticoagulation) on mortality rates and complications in patients with device-related septic thrombosis of the right atrium. A retrospective analysis of all reported cases of device-related right heart septic thrombosis in which therapy and outcome were reported was conducted using a PubMed search in the English-language literature (1985 to 2006). Forty cases of device-related right atrial septic thromboses were reported in the literature during the chosen time period. The treatments administered were none (12.5%), antibiotics (12.5%), antibiotics and anticoagulation (20%), and thrombectomy (55%). The mean clot size was significantly larger in patients who underwent thrombectomy. All untreated patients died. Excluding the untreated patients from the analysis, systemic complications were significantly lower in the thrombectomy group than in the groups receiving nonsurgical therapies. Using multivariate modelling with survival as the primary outcome, age, sex, clot size, clot location, microbial organism or type of treatment were not predictive of the outcome. Device-related right atrial septic thrombosis is associated with significant mortality and is uniformly fatal if untreated. Surgical thrombectomy is associated with less frequent systemic complications. A well-designed prospective, randomized trial is needed to determine the optimal treatment of this condition.