ABSTRACT
Since the widespread availability and use of antibiotics the prevalence of Lemierre syndrome (L.S.) has decreased. It is a well-described entity, consisting of postanginal septicaemia with thrombophlebitis of the internal jugular vein with metastatic infection, most commonly in the lungs. The most common causative agent is a gram-negative, non-spore-forming obligate anaerobic bacterium, Fusobacterium necrophorum (F.n.). We describe the unusual clinical features of a 12-year-old boy with Lemierre syndrome with isolated hypoglossal nerve palsy - the latter symptom is an extremely rare manifestation of this disease.
Subject(s)
Fusobacterium Infections/diagnosis , Hypoglossal Nerve Diseases/etiology , Lemierre Syndrome/diagnosis , Anti-Bacterial Agents/therapeutic use , Child , Critical Illness/therapy , Follow-Up Studies , Fusobacterium Infections/drug therapy , Fusobacterium necrophorum/drug effects , Fusobacterium necrophorum/isolation & purification , Humans , Hypoglossal Nerve Diseases/diagnostic imaging , Hypoglossal Nerve Diseases/therapy , Intensive Care Units , Lemierre Syndrome/drug therapy , Male , Rare Diseases , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate contemporary trends in etiology, diagnosis, management, and outcome of descending necrotizing mediastinitis (DNM) and to draw the clinician's attention on this probably underappreciated disease. SUMMARY OF BACKGROUND DATA: An uncommon but one of the most serious forms of mediastinitis is DNM which is caused by downward spread of deep neck infections and arises as a major complication of "banal" odontogenic, pharyngeal, or cervicofacial foci. As most studies are based on small patient populations, current data on risk factors, etiology, and outcome vary significantly. Also, the optimal form of treatment remains controversial. METHODS: This retrospective study, which is the largest single-center study since 1960, is based on the management of 45 patients with DNM treated over a period of 12 years. Additionally, a meta-analysis of 26 studies on DNM published between 1999 and 2008 was performed and compared with own data and 2 previous meta-analyses covering the interval from 1960 to 1998. RESULTS AND CONCLUSIONS: Today DNM most commonly arises from pharyngeal foci and mixed polymicrobial aerobic and anaerobic infections. Reduced tissue oxygenation and impaired immune function promotes its development. Most cases of DNM are limited to the upper mediastinum and can be adequately drained by a transcervical approach. Formal thoracotomy should be reserved for cases extending below the plane of the tracheal bifurcation. Although DNM remains an aggressive infection with high morbidity, a favorable outcome can now be obtained in 85% of patients, even with this selective approach. Early diagnosis and surgical intervention are crucial.
Subject(s)
Mediastinitis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Mediastinitis/diagnosis , Mediastinitis/etiology , Mediastinitis/therapy , Middle Aged , Necrosis , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
CONCLUSIONS: Early diagnosis and aggressive antimicrobial and surgical treatment are essential to successfully treat extensive cervico-mediastinal abscesses of odontogenic origin. Patient management should be performed by experienced clinicians well trained in managing possible complications. We recommend close clinical and radiological postoperative follow-up investigations with early surgical re-intervention if necessary. OBJECTIVES: While neck infections affecting the perimandibular space have a high prevalence and their clinical aspects have repeatedly been discussed, further spread of the inflammation and life-threatening situations have rarely been described. The objective was to determine clinical, diagnostic, and therapeutic aspects of severe neck infections of odontogenic origin. Emphasis was placed on grave descending deep neck space infections, sometimes resulting in mediastinitis as a life-threatening complication. PATIENTS AND METHODS: We reviewed 10 patients with severe odontogenic abscesses treated during an 8-year interval in a single center. RESULTS: The submandibular space was the most frequently encountered location of deep neck space infections. Mediastinitis was found in five patients. The most frequent causative bacteria were Streptococcus and Bacteroides species. All patients underwent intravenous antibiotic treatment and surgical therapy. Mediastinotomy was inevitable in five cases and thoracotomy in one case. All patients survived.
