Sore throat... don't forget Lemierre's syndrome.
Ontology highlight
ABSTRACT:
SUBMITTER: Crowley ND
PROVIDER: S-EPMC4289813 | biostudies-literature | 2015 Jan
REPOSITORIES: biostudies-literature
Publications
Sore throat... don't forget Lemierre's syndrome.
Crowley Niall D ND Verceles Avelino C AC Reed Robert M RM
BMJ case reports 20150109
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Project description:BackgroundThe national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline.MethodsA cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients.ResultsIn total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%).ConclusionDanish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.
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Project description:Lemierre's syndrome is a rare, life-threatening condition, which may be fatal if not properly treated. This disease refers to thrombophlebitis of the internal jugular vein, which is the result of bacterial sore throat infection (usually in the form of pharyngitis) that extends into the parapharyngeal space. However, it can result from other infective foci in the ear, nose, parotid glands, and paranasal sinuses. The bacteria typically responsible is Fusobacterium necrophorum. Here, we describe a case of Lemierre's syndrome that occurred in a 20-year-old female who presented with neurological deficits following a two-week history of upper respiratory tract infection. Our case displayed typical findings of this rare condition with a review of the previous literature and also to emphasize the importance of high index of suspicion to reduce the mortality of this disease.
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Project description:BackgroundHip osteoarthritis typically manifests with groin or thigh pain. Other atypical pain patterns, including knee pain, have been described. Except for 2 case reports, there is no literature on this subject.MethodsFrom our institutional database, between 2011 and 2016, we identified 21 patients who were referred for treatment of knee pain but ultimately diagnosed with hip pathology as the cause of their pain. This group was evaluated for duration of symptoms prior to diagnosis, previous interventions, presence of walking aids, and symptom resolution after treatment of the hip pathology.ResultsFifteen of the 21 patients were referred from musculoskeletal providers (12 from orthopaedic surgeons). Prior to diagnosis of the hip etiology, 16 patients were reduced to major assistive devices including wheelchairs. Twelve of 21 patients had undergone surgical knee interventions, including total knee arthroplasty, with minimal to no relief of their pain. Seventeen of 21 referred patients underwent total hip arthroplasty at our institution. Fourteen patients had complete resolution of knee pain after total hip arthroplasty.ConclusionsAlthough knee pain referred from hip disease may be considered a basic and common knowledge, it continues to be an overlooked phenomenon. Most of the cases were misdiagnosed by musculoskeletal providers including orthopaedic surgeons and this highlights the need for continued education and awareness of this clinical scenario.
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