1/22. mycoplasma penetrans bacteremia and primary antiphospholipid syndrome.mycoplasma penetrans, a rare bacterium so far only found in hiv-infected persons, was isolated in the blood and throat of a non-hiv-infected patient with primary antiphospholipid syndrome (whose etiology and pathogenesis are unknown).- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
2/22. Lemierre's syndrome: a complication of acute oropharyngitis.Lemierre's syndrome is a recognized but infrequently seen complication of acute oropharyngitis. In this case report the patient presented with acute sore throat that led to a bacteraemia with internal jugular vein thrombosis and subsequent cranial nerve palsies.- - - - - - - - - - ranking = 242.12496785846keywords = pharyngitis, sore throat, throat (Clic here for more details about this article) |
3/22. ralstonia pickettii bacteraemia in a cord blood transplant recipient.A seven-year old boy with acute lymphoblastic leukemia underwent an HLA mismatched cord blood transplant. He developed grade 2 mucositis requiring morphine infusion and grade 3-4 hyperacute graft-versus-host disease affecting the skin, gastrointestinal tract, and liver requiring pulse methylprednisolone. On days 21, 23, and 24 post-transplant, blood culture obtained through the central line and periphery were positive for ralstonia pickettii. The same strain (with the same biochemical profile and antibiotic susceptibility pattern) was also recovered from surveillance throat swab cultures from day 11 to day 24 and surveillance rectal swab cultures from day 16 to day 24. The patient responded to intravenous cefoperazone/sulbactam and ciprofloxacin and blood culture became negative 3 days after commencement of the antibiotics. Although R. pickettii is of low virulence and is a frequent contaminant of blood cultures, it should not be overlooked when it is repeatedly recovered from sterile body fluids, especially in immunocompromised hosts.- - - - - - - - - - ranking = 1keywords = throat (Clic here for more details about this article) |
4/22. The evolution of lemierre syndrome: report of 2 cases and review of the literature.lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.- - - - - - - - - - ranking = 153.07202331342keywords = pharyngitis, sore throat, throat (Clic here for more details about this article) |
5/22. Disseminated gonococcemia.A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for neisseria gonorrhoeae and negative for chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.- - - - - - - - - - ranking = 19.492606495857keywords = sore throat, throat (Clic here for more details about this article) |
6/22. Intrathoracic infections with bacteraemia due to eikenella corrodens as a complication of peritonsillar abscesses: report of a case and review of the literature.A 52-year-old man, without previous disease, presented with dysphagia, dyspnoea, high fever and sore throat after peritonsillar abscesses drainage. Physical and complementary examinations were consistent with pericarditis, mediastinitis, pneumonia and pleuritis. Blood cultures grew eikenella corrodens resistant to clindamycin and amikacin. We emphasize the pathogenic potential of eikenella corrodens. To the best of our knowledge, this is the first reported case of this organism as a pathogen in intrathoracic infections after peritonsillar abscesses drainage.- - - - - - - - - - ranking = 19.492606495857keywords = sore throat, throat (Clic here for more details about this article) |
7/22. Emergence of invasive group A streptococcal disease among young children.Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.- - - - - - - - - - ranking = 44.526472272521keywords = pharyngitis (Clic here for more details about this article) |
8/22. critical care nurses be aware: Lemierre's syndrome is on the rise.Lemierre's syndrome (LS) typically occurs in previously healthy young adolescents and young adults who become acutely ill following an attack of pharyngotonsillitis. Also known as post anginal sepsis, those afflicted develop pyrexia, rigours and multiple metastatic abscesses that lead to septic thrombophlebitis of the internal jugular vein. In the pre-antibiotic era this particularly virulent syndrome had a mortality rate in excess of 90%, but since the introduction of antibiotics and the widespread treatment of throat infections, it has became almost unknown. However, due to a number of factors, including a reduction in the use of antibiotics for the treatment of sore throats, misdiagnosis and/or improvements in microbiology diagnostic techniques, several reports have indicated a resurgence of the condition. This has major ramifications for critical care nurses as LS is still associated with significant morbidity and mortality. This paper discusses the aetiology, pathophysiology, bacteriology, diagnosis and management aspects of this syndrome. A case study of a young woman is presented to illustrate the complexity of the condition, and highlight how early diagnosis and prompt initiation of appropriate intravenous antibiotic therapy ensured a favourable clinical outcome.- - - - - - - - - - ranking = 20.492606495857keywords = sore throat, throat (Clic here for more details about this article) |
9/22. Group A streptococcus septicemia and an infected, ruptured abdominal aortic aneurysm associated with pharyngitis.A 65-year-old man had a 3-day history of sore throat, fever, rigors, back pain, abdominal discomfort, nausea, vomiting, and diarrhea. The patient's daughter had group A streptococcus pharyngitis. The patient was found to have a ruptured abdominal aortic aneurysm. He underwent resection of the aneurysm and right axillary femoro-femoral bypass graft. The patient died 40 hours after admission. Gram stain of the aneurysm showed numerous gram-positive cocci. Group A streptococcus grew from cultures of blood, throat, and aneurysm. The group A streptococcus was M type 3, T type 3 and produced streptococcal pyrogenic exotoxin A. This case is a very rare fatal complication of group A streptococcus pharyngitis.- - - - - - - - - - ranking = 287.65144013098keywords = pharyngitis, sore throat, throat (Clic here for more details about this article) |
10/22. Lemierre's syndrome: how a sore throat can end in disaster.Lemierre's syndrome is characterised by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombophlebitis and isolation of an anaerobic pathogen. We present a case report and review the literature.- - - - - - - - - - ranking = 77.970425983429keywords = sore throat, throat (Clic here for more details about this article) |
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