[Sore throat and a swollen neck: Lemierre's syndrome until proven otherwise]. / Keelpijn en een gezwollen hals: syndroom van Lemierre totdat het tegendeel is bewezen.

Physicians seldom prescribe antibiotics to patients presenting with a combination of sore throat and feelings of malaise. However, this restrictive regimen may have a downside. Two patients, men aged 23 and 19 years, respectively, with pharyngitis developed a life-threatening syndrome following a Fusobacterium throat infection. They suffered from Lemierre's syndrome, referred to in recent literature as the 'forgotten disease'. The second patient recovered uneventfully after prompt intravenous antibiotic treatment. The first, however, succumbed following overwhelming multiple organ failure. A classical case of Lemierre's syndrome is characterised by bacterial embolisation from a clogged internal jugular vein following a sore throat. Spread of organisms may lead to sepsis and organ failure. The main pathogen is Fusobacterium necrophorum. Early recognition is essential, since prompt antibiotic treatment is usually effective. This syndrome should be suspected until proven otherwise in any patient with signs of pharyngitis, a painful swollen neck and pulmonary symptoms.

Bacteriology of abdominal wounds in elective open colon surgery: a prospective study of 100 surgical wounds.

This article describes a prospective bacteriological study designed to assess the value of bacterial sampling during elective open colon surgery. Swabs of the subcutaneous tissue were taken after closure of the abdominal fascia, but before closure of the skin, in 100 patients during elective colon surgery. Of the 100 swabs, 52 were sterile with no resulting wound infection, while ten of the remaining 48 contaminated swabs were associated with a wound infection caused by colonic pathogens and nosocomial microorganisms. Bacterial sampling seems to be a useful method for the prediction of wound infection following elective colon surgery.

Hemolytic uremic syndrome after capnocytophaga canimorsus (DF-2) septicemia.

A 66-year-old man developed a hemolytic uremic syndrome (HUS) with acute renal failure, thrombocytopenia, fragmented red cells in the blood film and elevated serum LDH following a capnocytophaga canimorsus (DF-2) infection after a dog bite. He was treated with antibiotics, plasmapheresis and hemodialysis. Although hematologic values improved, the patient remained hemodialysis-dependent for six months. In the literature several cases of renal failure following capnocytophaga canimorsus septicemia have been described, caused by hypotension or disseminated intravascular coagulation (DIC). In our patient there were no signs of hypotension or extensive DIC. A few case reports described HUS and thrombotic thrombocytopenic purpura (TTP) following DF-2 sepsis.