ABSTRACT
In this case report, we present a young man with Lemierre's syndrome, which is a potentially fatal condition most commonly caused by the bacterium Fusobacterium necrophorum. When Lemierre's syndrome is suspected, it is important to consider X-ray, ultrasound, and CT scan, as they can bring tremendous diagnostic value.
Subject(s)
Lemierre Syndrome , Male , Humans , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapy , Lemierre Syndrome/microbiology , Fusobacterium necrophorum , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Adherence to antimicrobial guidelines is key to ensuring a correct treatment of severe infections and to lessening misuse of broad-spectrum antimicrobials. We conducted a retrospective cross-sectional study at the Emergency Department of Aalborg University Hospital, North Denmark Region. Our aim was to examine adherence to local antimicrobial guidelines in the empirical treatment of community-acquired infections and to identity any predictors of guideline non-adherence. METHODS: We identified 1,555 patients who had blood cultures performed and were admitted to the medical emergency department in 2016. We reviewed the medical charts of 755 patients and included those who received at least one antibiotic prescription within the first 24 hours of admission. We excluded patients with known immunodeficiency, severe renal failure or hospitalisation within the previous month. RESULTS: Of the 383 included patients, 203 (53%) received guideline-concordant antibiotic treatment. The treatment was guideline-concordant in 41% of patients with suspected sepsis of unknown origin, in 44% with pneumonia and in 37% with urinary tract infections. Patients with underlying chronic obstructive pulmonary disease (25%) received guideline-concordant treatment significantly more often (83%, p < 0.01) than other groups. CONCLUSIONS: Adherence to local antimicrobial guidelines was not high. Further studies are needed to identify barriers to guideline adherence. FUNDING: None. TRIAL REGISTRATION: The study was registered with the Danish Data Protection Agency (R. no. 2008-58-0028).
Subject(s)
Anti-Infective Agents/standards , Community-Acquired Infections/drug therapy , Emergency Service, Hospital/standards , Guideline Adherence/statistics & numerical data , Hospitalization/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Denmark , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Fusobacterium necrophorum is a well-known cause of Lemierre's syndrome. Recent studies suggest a causative association between F. necrophorum and acute appendicitis. We present a case of a 15-year-old previously healthy girl who presented with acute non-perforated appendicitis, intra-abdominal abscesses and thrombosis that led to omental necrosis. This resulted in a life-threatening septic shock with the need for prolonged intensive care. We suggest that F. necrophorum identified in pus from the abdomen caused this fulminant variation of appendicitis with findings similar to those seen with Lemierre's syndrome.
