Authors: K Holm P J Svensson M Rasmussen
Publish Date: 2015/08/14
Volume: 34, Issue: 11, Pages: 2199-2207
Abstract
The purpose of this investigation was to describe the clinical spectrum of invasive Fusobacterium necrophorum infections and Lemièrre’s syndrome to examine the role of underlying thrombophilia and concomitant mononucleosis in Lemièrre’s syndrome and to describe thromboembolic complications Patients with invasive F necrophorum infections were identified either prospectively or retrospectively through the regional database of clinical microbiology from 2000 to 2015 Patient records were reviewed and blood samples from patients with Lemièrre’s syndrome were collected for Epstein–Barr virus EBV serology and screening for thrombophilia Of the 65 patients included 33 had Lemièrre’s syndrome Of the remaining 32 patients other infections of the respiratory tract and abdominal or urogenital infections were most common Patients with Lemièrre’s syndrome or other tonsillar infections were younger than patients from the other groups For Lemièrre’s syndrome the 26 patients with severe sepsis on admittance had longer duration of symptoms Three of five patients who developed distant manifestations had more than 14 days of symptoms Jugular vein thrombosis was verified in 14 patients two of whom developed serious complications Three of 26 patients tested had factor V Leiden mutation corresponding to the background prevalence One of 22 patients tested had a concomitant EBV infection This study confirms earlier studies of the clinical spectrum caused by F necrophorum For Lemièrre’s syndrome the study adds to the knowledge on thromboembolic outcome demonstrating that jugular vein thrombosis may cause severe complications The time to treatment seems to be important for the risk of severe disease In this study concomitant EBV infection or underlying thrombophilia was uncommonThe authors wish to thank Dr Jonas Bläckberg for reading and commenting on the manuscript Dr Gunnel Henriksson for expertise on EBV serology Dr Johan Lundgren for discussion regarding one of the cases with complicated neurological symptoms Dr Bo Nilsson for expertise regarding MALDITOF and Daniel Butler for carrying out the MALDITOF analysis and PCR subtyping Professor Elisabeth Holst for expertise on anaerobic bacteria and finally all the Lemièrre’s syndrome patients who volunteered to donate blood and gave the authors an insight into the patients’ perspectives of this serious condition
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