背景:坏死梭杆菌是一种厌氧菌,革兰氏阴性,不活动,丝状的,在口腔中发现的非孢子形成杆菌,胃肠道,和女性生殖道,导致了一种叫做Lemierre综合症的罕见疾病,以颈内静脉化脓性血栓性静脉炎为特征,这主要影响以前健康的青少年和年轻人;据报道,一些风险因素,如吸烟或原发性病毒或细菌感染导致粘膜破坏。该综合征通常起源于上呼吸道感染,如咽扁桃体炎,急性中耳炎,颈淋巴结炎,鼻窦炎,或者牙源性脓肿,并可能导致多器官转移,更经常导致肺部并发症,尤其是肺脓肿.
方法:我们描述了在三级护理中心评估的两名患有非典型Lemierre综合征的青少年患者,一个确诊为坏死梭杆菌感染,另一个根据临床特征进行推定诊断,患有肺脓肿的人需要延长抗生素疗程和住院治疗。感兴趣的,都是电子烟的使用者,配置可能的新风险因素。Lemierre综合征的正确诊断通常很难确定,所以需要高度怀疑,特别是在其他健康青少年的肺脓肿的情况下。
结论:本研究将有助于深入了解青少年Lemierre综合征的临床表现和管理,提高对一种罕见但可能致命的疾病的认识。此外,这表明Lemierre综合征与电子烟的使用之间可能存在关系,这应该由未来的研究进行调查。
BACKGROUND: Fusobacterium necrophorum is an anaerobic, gram-negative, non-motile, filamentous, non-spore forming bacillus found in the oral cavity, gastrointestinal tract, and female genital tract, responsible of a rare disease named Lemierre Syndrome, characterized by septic thrombophlebitis of the internal jugular vein, which mainly affects previously healthy adolescents and young adults; some risk factors are reported, as smoking or primary viral or bacterial infection leading to the disruption of mucosa. The syndrome originates commonly from an upper respiratory infection such as pharyngotonsillitis, acute otitis media, cervical lymphadenitis, sinusitis, or odontogenic abscess, and may result in multiorgan metastasis, more frequently leading to pulmonary complications, especially lung abscesses.
METHODS: We describe two cases of adolescents with atypical Lemierre Syndrome evaluated in a tertiary care center, one with a confirmed infection by Fusobacterium necrophorum and one with a presumptive diagnosis based on clinical features, who developed lung abscesses needing a prolonged antibiotic course and hospitalization. Of interest, both were user of electronic cigarette, configuring a possible new risk factor. The proper diagnosis of Lemierre Syndrome is often difficult to establish, so a high degree of suspicion is needed, especially in the
case of lung abscesses in otherwise healthy adolescents.
CONCLUSIONS: The current study will contribute to providing insight into Lemierre Syndrome clinical presentation and management in adolescents, promoting awareness for a rare but potentially fatal disease. Moreover, it suggests a possible relationship between Lemierre syndrome and the use of electronic cigarette, that should be investigated by future studies.