ro13-9904 and Mediastinitis

Lemierre syndrome is a rare but serious illness that associates throat infection and thrombosis of the internal jugular vein (IJV) or one of its tributaries with subsequent distant septic emboli. The purpose of our study was to review the pathogenesis, clinical presentation, and treatment of this disease.. Patients with confirmed Lemierre syndrome were included in our retrospective monocentric study. All patients had bacteriologic analyses as well as radiologic imaging.. There were 11 patients in our study (from 1998-2012). Fusobacterium necrophorum was responsible for the infection in 45% of cases. Surgical drainage of pharyngeal, cervical, or mediastinal abscesses was carried out in 8 cases. All patients received broad-spectrum antibiotics. Six patients were admitted to the intensive care unit (ICU). One patient (9%) died.. Treatment with broad-spectrum antibiotics is the primary choice of treatment of Lemierre syndrome. Surgery is indicated in case of abscess formation.

Topics: Abscess; Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Cellulitis; Drainage; Female; Humans; Intensive Care Units; Lemierre Syndrome; Length of Stay; Male; Mediastinitis; Metronidazole; Middle Aged; Retrospective Studies; Tonsillitis; Young Adult

The most serious infection after coronary artery bypass grafting (CABG) is mediastinitis following deep sternal wound infection. Antibiotic prophylaxis for at least 48 hours has been recommended. In this trial 551 consecutive patients were randomized to receive ceftriaxone in a single dose or cefuroxime thrice daily until the end of the second postoperative day. The overall infection rate was 7.7% in the ceftriaxone and 8.3% in the cefuroxime group, and the incidence of deep sternal infection was 2.9% in both groups. Significant risk factors for such infection were chronic respiratory disease (p < 0.001) and diabetes (p < 0.01). The antibiotic prophylaxis had no harmful effects on the colonic flora in either group. Acquisition and delivery costs for the prophylactic agents were three times higher in the cefuroxime than in the ceftriaxone group. Both antibiotics are concluded to be equally safe and effective. Single-dose ceftriaxone prophylaxis is as effective as cefuroxime given for 48 hours postoperatively. Single-dose ceftriaxone is also simple to use.

Topics: Ceftriaxone; Cefuroxime; Coronary Artery Bypass; Drug Administration Schedule; Female; Humans; Incidence; Male; Mediastinitis; Middle Aged; Risk Factors; Surgical Wound Infection

Topics: Actinomyces; Actinomycosis; Adolescent; Biopsy, Fine-Needle; Ceftriaxone; Doxycycline; Humans; Male; Mediastinitis; Sclerosis; Superior Vena Cava Syndrome

Deep face and neck infections are potentially life threatening if they are not diagnosed in time and then treated quickly. This report describes a case of face and deep neck infection, associated with a semi-impacted and decayed wisdom tooth in a cardiopathic, immunosuppressed patient suffering from, diabetes, hypothyroidism, osteoporosis, breathlessness, chronic bronchitis, with oral, cutaneous and vaginal erythematous lichen, Cushing's Syndrome, penicillin allergy, subjected to past hypophysectomy. The swelling was, first of all, treated in urgency, with an intravenous antibiotic therapy and, immediately afterwards, the phlegmonous infiltration linked to the avulsion of the lower third molar was surgically drained. The patient was then treated with intravenous multiple antibiotics, with the aim of eradicating the predominating bacteria that was encountered in the microbiological culture test. A complete remission of the pathological picture was obtained .

Topics: Aged; Airway Obstruction; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Combined Modality Therapy; Comorbidity; Emergencies; Face; Female; Humans; Immunocompromised Host; Mediastinitis; Molar, Third; Myositis; Neck; Periodontal Abscess; Streptococcal Infections; Tooth Extraction; Tooth, Impacted

A 55 year old female was admitted as a case of pyrexia of unknown origin (PUO) of 2 months duration. She had developed throat ache, progressive dysphagia for both solids and liquids, dry cough and retrosternal pain for one week. Examination revealed fever, tachycardia, tachypnoea and a soft tissue warm tender, erythematous, non-fluctuant swelling in lower anterior neck with chest findings suggestive of bilateral pleural effusion. Plain X-rays of the neck and chest strengthened the clinical suspicion of cellulitis of lower neck with bilateral pleural effusion. CT scan confirmed the radiologic findings and also revealed pericardial effusion and thickening; small mediastinal lymphadenopathy and mediastinitis. Patient responded to parenteral antibiotics (ceftriaxone and metronidazole) and hydrocortisone with complete resolution in 10 days.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Female; Fever of Unknown Origin; Humans; India; Mediastinitis; Metronidazole; Middle Aged; Tomography, X-Ray Computed

To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases.. We describe a case of suppurative mediastinitis secondary to a retropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology, diagnosis, and treatment of this disease.. Prompt diagnosis, based on clinical, radiographic, and CT findings, followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14.. When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.

Topics: Ceftriaxone; Cephalosporins; Drainage; Female; Humans; Infant; Mediastinitis; Retropharyngeal Abscess; Staphylococcal Infections; Suppuration; Tomography, X-Ray Computed