Lemierre Syndrome: Two Cases and a Review Syed, Mohammed Iqbal; Baring, David; Addidle, Michael ...
The Laryngoscope,
September 2007, Volume:
117, Issue:
9
Journal Article
Peer reviewed
Objectives: Lemierre syndrome is usually caused by an acute oropharyngeal infection in previously healthy young adults, resulting in thrombophlebitis of the internal jugular vein, leading to ...metastatic septic embolization and bacteraemia. The usual organism is Fusobacterium necrophorum. Lemierre syndrome, not so long ago labeled as the “forgotten disease,” is on the rise. Today with increasing antibiotic‐resistant organisms, and decreasing awareness of the syndrome, subsequent re‐emergence of this “forgotten disease” is becoming more common in clinical settings. Lemierre syndrome has significant morbidity. Cranial nerve complications associated with the condition have been increasingly diagnosed in the last few years. Looking back at literature on Lemierre syndrome, there have been review articles in medical and microbiology journals but rarely in otolaryngology journals. By presenting our cases we demonstrate the diverse presentations and severity of the illness.
Methods: A review of the literature and a case report on two cases seen in our institution in the last year are presented. Each of these had varied presentations and neurologic complications—one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct among other multisystem complications.
Conclusions: Diagnosis of Lemierre syndrome is not always straightforward as clinical features are variable and blood cultures are often negative. Awareness of the syndrome and a high degree of suspicion are needed.
Universal hepatitis B vaccination has now been in place in New Zealand for 22 years. A retrospective laboratory data study has been carried out to give objective evidence of the impact that this is ...having on hepatitis B prevalence in the antenatal population.
A retrospective data search was performed of all antenatal hepatitis B surface antigen (HepBsAg) tests carried out at Pathlab Laboratories between 1997 and 2009.
When the change in prevalence with time is examined, there is a clear downwards trend in antenatal hepatitis B prevalence rates from 1997 to 2009. Dividing the antenatal population into different age groups, the downward trend is most marked for those aged =20 years.
The prevalence of hepatitis B infection in the antenatal population in the Midlands region of New Zealand is now declining and is likely to be as a result of the introduction of the hepatitis B vaccine onto the universal schedule throughout New Zealand in 1988. This would also explain why the decrease is most marked in antenatal women below the age of 20.
To audit key quality indicators for blood culture (BC) practices across Aotearoa New Zealand to facilitate national BC practice peer review and promote BC quality improvement interventions.
...Microbiology laboratories providing diagnostic services to district health board (DHB) hospitals were invited to participate. Practice was compared against published BC recommendations. Laboratories were required to submit data for BC positivity and contamination rates, BC bottle fill volume and the proportion of BC received as a single set.
Laboratories serving 15 of the 20 DHBs participated in the audit. Nine DHBs (60%) demonstrated a positivity rate within the target range of 8% to 15%. Eight DHBs (53%) reported a contamination rate lower than the accepted 3%, but seven (47%) DHBs exceeded this target and two reported a contamination rate greater than 5%. Mean BC bottle fill volumes were generally greater than the target of 8mL, but this volume was not reached by three DHBs and a further three were unable to provide fill volume data. No DHB met the audit standard for single-set BCs representing <20%, and for six DHBs single-set BC comprised more than half of all samples. No DHB failed all audit targets.
This audit demonstrates wide variation in BC performance across New Zealand. In most instances an inadequate volume of blood is being collected, lowering the chance of culturing a pathogen. A significant opportunity for improvement exists; clinical services and laboratories are encouraged to work together to implement targeted quality improvement processes to correct deficiencies in practice.
Abstract
Objectives
There is clinical uncertainty over the optimal treatment for penicillin-susceptible Staphylococcus aureus (PSSA) infections. Furthermore, there is concern that phenotypic ...penicillin susceptibility testing methods are not reliably able to detect some blaZ-positive S. aureus.
Methods
Nine S. aureus isolates, including six genetically diverse strains harbouring blaZ, were sent in triplicate to 34 participating laboratories from Australia (n = 14), New Zealand (n = 6), Canada (n = 12), Singapore (n = 1) and Israel (n = 1). We used blaZ PCR as the gold standard to assess susceptibility testing performance of CLSI (P10 disc) and EUCAST (P1 disc) methods. Very major errors (VMEs), major error (MEs) and categorical agreement were calculated.
Results
Twenty-two laboratories reported 593 results according to CLSI methodology (P10 disc). Nineteen laboratories reported 513 results according to the EUCAST (P1 disc) method. For CLSI laboratories, the categorical agreement and calculated VME and ME rates were 85% (508/593), 21% (84/396) and 1.5% (3/198), respectively. For EUCAST laboratories, the categorical agreement and calculated VME and ME rates were 93% (475/513), 11% (84/396) and 1% (3/198), respectively. Seven laboratories reported results for both methods, with VME rates of 24% for CLSI and 12% for EUCAST.
Conclusions
The EUCAST method with a P1 disc resulted in a lower VME rate compared with the CLSI methods with a P10 disc. These results should be considered in the context that among collections of PSSA isolates, as determined by automated MIC testing, less than 10% harbour blaZ. Furthermore, the clinical relevance of phenotypically susceptible, but blaZ-positive S. aureus, remains unclear.
Background
New Zealand's (NZ) complete absence of community transmission of influenza and respiratory syncytial virus (RSV) after May 2020, likely due to COVID‐19 elimination measures, provided a ...rare opportunity to assess the impact of border restrictions on common respiratory viral infections over the ensuing 2 years.
Methods
We collected the data from multiple surveillance systems, including hospital‐based severe acute respiratory infection surveillance, SHIVERS‐II, ‐III and ‐IV community cohorts for acute respiratory infection (ARI) surveillance, HealthStat sentinel general practice (GP) based influenza‐like illness surveillance and SHIVERS‐V sentinel GP‐based ARI surveillance, SHIVERS‐V traveller ARI surveillance and laboratory‐based surveillance. We described the data on influenza, RSV and other respiratory viral infections in NZ before, during and after various stages of the COVID related border restrictions.
Results
We observed that border closure to most people, and mandatory government‐managed isolation and quarantine on arrival for those allowed to enter, appeared to be effective in keeping influenza and RSV infections out of the NZ community. Border restrictions did not affect community transmission of other respiratory viruses such as rhinovirus and parainfluenza virus type‐1. Partial border relaxations through quarantine‐free travel with Australia and other countries were quickly followed by importation of RSV in 2021 and influenza in 2022.
Conclusion
Our findings inform future pandemic preparedness and strategies to model and manage the impact of influenza and other respiratory viral threats.
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