quote:

Originally posted by h2oys:
Thanks. Your ordeal must have been one heck of a roller coaster. I assume all is as well as it can be for you?

Thank you! As a matter of fact, I'm almost shocked how well things are recovering, and even improving.

I think I will even post a "silver lining" addendum to my own thread.

And of course, I wish the same luck for you as well, or even better,
Kevin

Wishing you a speedy recovery.

Found out about an hour ago I’m headed to surgery at 4pm. Wish me luck!

Ohmigosh...what type? Best of luck!!

quote:

I found myself at the emergency room on Sunday and was admitted. Apparently I have a blood clot near the jugular vein but they can’t figure out why I also have bad infections and also tremendous rib cage pain.

I hope your docs are screening for sepsis. Sepsis can cause clots, spread to large organ areas, result in shock. Ask me how I know.

Best wishes on a speedy diagnosis and recovery. Sounds like you have a good attitude.

The surgery went well. They removed a great deal of clotted blood fro my subclavian vein which leaded to the jugular vein. Bothe site of my DVT (deep vein thrombosis) and size thereof Were highly unusual. DVT is common in lowER and extremeties .

Overall I feel better, but somehow we forgot to start my pain med again. Hence the every 2 hour Of peeing has been an hour exquisite adventure.

Tg surgeon may next place a ballon in there vein and I’ll learn more about that tomorrow.

That is good news. Hang in there!

WOW! Just saw this...hang in there. Sounds like you found this in time.

You are in our thoughts and prayers.

Feel better soon.

quote:

Originally posted by h2oys:
Well, this one is my own personal quote...

“Don’t take your health for granted.”

Been there, done that. A pivotal point that has changed my life. As there are many here that have recently had their lives and plans altered by health issues, my heart goes out to them all. I wish you well and definitely will send up a prayer for your health and recovery.

quote:

Originally posted by h2oys:

That’s quite a cocktail they’ve mixed for you

Get well soon
T

Get well soon. Being laid up or injured isn't much fun.

quote:

Originally posted by TMats:
That’s quite a cocktail they’ve mixed for you
T

A similar story after I had some brain surgery a few years past. I had my "angel nurse" I called her, she would often come in and smile and say she brought in her special cocktail for me. After administration, one time I remembered that I looked at the walls and wondered to myself when I painted my walls light green?? I actually thought I was at home but was actually on a gurney in the hospital hallway

I now have a diagnosis.

The one doctor phrased it best: "This something you read about in a book and never expect to see a real live case thereof.

All spawned from a bacterium in the back of my mouth that found its way in my jugular vein:

https://en.wikipedia.org/wiki/Lemierre%27s_syndrome

Lemierre's syndrome
From Wikipedia, the free encyclopia
Lemierre's syndrome
Other names Septic phlebitis of the internal jugular vein, postanginal sepsis secondary to oropharyngeal infection, postanginal shock including sepsis, Lemierre's disease, human necrobacillosis

Fusobacterium novum 01.jpg
Fusobacterium necrophorum,the most common cause of Lemierre's syndrome
Specialty Infectious disease Edit this on Wikidata


Symptoms Early:Fever, sore throat, fatigue Later:Variable, Sepsis, vomiting, muscle pain, meningitis, hepatosplenomegaly
Complications Septic shock, kidney failure, liver failure, cerebral edema, organ failure[1]
Lemierre's syndrome refers to infectious thrombophlebitis of the internal jugular vein.[2] It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.

Lemierre's syndrome occurs most often when a bacterial (e.g., Fusobacterium necrophorum) throat infection progresses to the formation of a peritonsillar abscess. Deep in the abscess, anaerobic bacteria can flourish. When the abscess wall ruptures internally, the drainage carrying bacteria seeps through the soft tissue and infects the nearby structures. Spread of infection to the nearby internal jugular vein provides a gateway for the spread of bacteria through the bloodstream. The inflammation surrounding the vein and compression of the vein may lead to blood clot formation. Pieces of the potentially infected clot can break off and travel through the right heart into the lungs as emboli, blocking branches of the pulmonary artery that carry blood with little oxygen from the right side of the heart to the lungs.

Sepsis following a throat infection was described by Schottmuller in 1918.[3] However, it was André Lemierre, in 1936, who published a series of 20 cases where throat infections were followed by identified anaerobic sepsis, of whom 18 died.[4]


Contents
1 Signs and symptoms
2 Cause
3 Pathophysiology
4 Diagnosis
5 Treatment
6 Prognosis
7 Epidemiology
8 History
9 References
10 External links
Signs and symptoms
The signs and symptoms of Lemierre's syndrome vary, but usually start with a sore throat, fever, and general body weakness. These are followed by extreme lethargy, spiked fevers, rigors, swollen cervical lymph nodes, and a swollen, tender or painful neck. Often there is abdominal pain, diarrhea, nausea and vomiting during this phase. These signs and symptoms usually occur several days to 2 weeks after the initial symptoms. Symptoms of pulmonary involvement can be shortness of breath, cough and painful breathing (pleuritic chest pain). Rarely, blood is coughed up. Painful or inflamed joints can occur when the joints are involved.[citation needed]

Septic shock can also arise. This presents with low blood pressure, increased heart rate, decreased urine output and an increased rate of breathing. Some cases will also present with meningitis, which will typically manifest as neck stiffness, headache and sensitivity of the eyes to light.[citation needed]Liver enlargement and spleen enlargement can be found, but are not always associated with liver or spleen abscesses.[5][6]Other signs and symptoms that may occur:

Headache (unrelated to meningitis)
Memory loss
Muscle pain
Jaundice
Decreased ability to open the jaw
Crepitations are sometimes heard over the lungs
Pericardial friction rubs as a sign of pericarditis (rare)
Cranial nerve paralysis and Horner's syndrome (both rare)
Cause
The bacteria causing the thrombophlebitis are anaerobic bacteria that are typically normal components of the microorganisms that inhabit the mouth and throat. Species of Fusobacterium, specifically Fusobacterium necrophorum, are most commonly the causative bacteria, but various bacteria have been implicated. One 1989 study found that 81% of Lemierres's syndrome had been infected with Fusobacterium necrophorum, while 11% were caused by other Fusobacterium species.[7] MRSA might also be an issue in Lemierre infections.[8] Rarely Lemierre's syndrome is caused by other (usually Gram-negative) bacteria, which include Bacteroides fragilis and Bacteroides melaninogenicus, Peptostreptococcus spp., Streptococcus microaerophile, Staphylococcus aureus, Streptococcus pyogenes, and Eikenella corrodens.[7][9]

Pathophysiology
Lemierre's syndrome begins with an infection of the head and neck region. Usually this infection is a pharyngitis (which occurred in 87.1% of patients as reported by a literature review[6]), but it can also be initiated by infections of the ear, mastoid bone, sinuses, or saliva glands.

During the primary infection, F. necrophorum colonizes the infection site and the infection spreads to the parapharyngeal space. The bacteria then invade the peritonsillar blood vessels where they can spread to the internal jugular vein.[5] In this vein, the bacteria cause the formation of a thrombus containing these bacteria. Furthermore, the internal jugular vein becomes inflamed. This septic thrombophlebitis can give rise to septic microemboli[10] that disseminate to other parts of the body where they can form abscesses and septic infarctions. The first capillaries that the emboli encounter where they can nestle themselves are the pulmonary capillaries. As a consequence, the most frequently involved site of septic metastases are the lungs, followed by the joints (knee, hip, sternoclavicular joint, shoulder and elbow[11]). In the lungs, the bacteria cause abscesses, nodulary and cavitary lesions. Pleural effusion is often present.[6] Other sites involved in septic metastasis and abscess formation are the muscles and soft tissues, liver, spleen, kidneys and nervous system (intracranial abscesses, meningitis).[5]

Production of bacterial toxins such as lipopolysaccharide leads to secretion of cytokines by white blood cells which then both lead to symptoms of sepsis. F. necrophorum produces hemagglutinin which causes platelet aggregation that can lead to diffuse intravascular coagulation and thrombocytopenia.[12][13]

Diagnosis
Diagnosis and the imaging (and laboratory) studies to be ordered largely depend on the patient history, signs and symptoms. If a persistent sore throat with signs of sepsis are found, physicians are cautioned to screen for Lemierre's syndrome.

Laboratory investigations reveal signs of a bacterial infection with elevated C-reactive protein, erythrocyte sedimentation rate and white blood cells (notably neutrophils). Platelet count can be low or high. Liver and kidney function tests are often abnormal.

Thrombosis of the internal jugular vein can be displayed with sonography. Thrombi that have developed recently have low echogenicity or echogenicity similar to the flowing blood, and in such cases pressure with the ultrasound probe show a non-compressible jugular vein - a sure sign of thrombosis. Also color or power Doppler ultrasound identify a low echogenicity blood clot. A CT scan or an MRI scan is more sensitive in displaying the thrombus of the intra-thoracic retrosternal veins, but are rarely needed.

Chest X-ray and chest CT may show pleural effusion, nodules, infiltrates, abscesses and cavitations.

Bacterial cultures taken from the blood, joint aspirates or other sites can identify the causative agent of the disease.

Other illnesses that can be included in the differential diagnosis are:

Q fever
Tuberculosis
Pneumonia
Treatment
Lemierre's syndrome is primarily treated with antibiotics given intravenously. Fusobacterium necrophorum is generally highly susceptible to beta-lactam antibiotics, metronidazole, clindamycin and third generation cephalosporins while the other fusobacteria have varying degrees of resistance to beta-lactams and clindamycin.[13] Additionally, there may exist a co-infection by another bacterium. For these reasons is often advised not to use monotherapy in treating Lemierre's syndrome. Penicillin and penicillin-derived antibiotics can thus be combined with a beta-lactamase inhibitor such as clavulanic acid or with metronidazole.[5][9] Clindamycin can be given as monotherapy.

If antibiotic therapy does not improve the clinical picture, it may prove useful to drain any abscesses and/or perform ligation of the internal jugular vein where the antibiotic can not penetrate.[6][9][14] There is no evidence to opt for or against the use of anticoagulation therapy. The low incidence of Lemierre's syndrome has not made it possible to set up clinical trials to study the disease.[9]The disease can often be untreatable, especially if other negative factors occur, i.e. various diseases occurring at the same time, such as meningitis, pneumonia.[medical citation needed]

Prognosis
The mortality rate was 90% prior to antibiotic therapy. In the contemporary era, a mortality of 4% has been estimated.[15] Since this disease is not well known and often remains undiagnosed, mortality might be much higher. Approximately 10% of survivors suffer from clinical sequelae, including cranial nerve palsy and orthopaedic limitations.[15]

Epidemiology
Lemierre's syndrome is currently rare, but was more common in the early 20th century before the discovery of penicillin. The reduced use of antibiotics for sore throats may have increased the risk of this disease, with 19 cases in 1997 and 34 cases in 1999 reported in the UK.[16] The estimated incidence rate is 0.8 to 3.6 cases per million in the general population, but is higher in healthy young adults. The number of cases reported is increasing; however, because of its rarity, physicians may be unaware of its existence, possibly leading to underdiagnosis.[17]

History
Sepsis following from a throat infection was described by Scottmuller in 1918.[3] However, it was Andre Lemierre, in 1936, who published a series of 20 cases where throat infections were followed by identified anaerobic sepsis, of whom 18 patients died.[4]

Ah ha, sepsis. That's what it sounded like to me, having gone through it (though mine started from a leg).

Sepsis is extremely dangerous, esp. once it goes into septic shock. Thank God it was caught early.

Neat and spooky all at the same time. Glad you have been diagnosed, and are on the mend.

Good luck!

Prayer said for a SPEEDY recovery.

Wow! Never heard of this. Glad you had doctors with the right stuff!! Prayers sent for a full and complete recovery!!

Best wishes to you.

Isn't modern medicine amazing?
.