OBJECTIVES: The purpose of this in vivo study was to investigate the microbial diversity in symptomatic and asymptomatic canals with primary endodontic infections by using GS FLX Titanium pyrosequencing. MATERIALS AND METHODS: Sequencing was performed on 6 teeth (symptomatic, n = 3; asymptomatic, n = 3) with primary endodontic infections. Amplicons from hypervariable region of the small-subunit ribosomal RNA gene were generated by polymerized chain reaction (PCR), and sequenced by means of the GS FLX Titanium pyrosequencing. RESULTS: On average, 10,639 and 45,455 16S rRNA sequences for asymptomatic and symptomatic teeth were obtained, respectively. Based on Ribosomal Database Project Classifier analysis, pyrosequencing identified the 141 bacterial genera in 13 phyla. The vast majority of sequences belonged to one of the seven phyla: Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, Proteobacteria, Spirochetes, and Synergistetes. In genus level, Pyramidobacter, Streptococcus, and Leptotrichia constituted about 50% of microbial profile in asymptomatic teeth, whereas Neisseria, Propionibacterium, and Tessaracoccus were frequently found in symptomatic teeth (69%). Grouping the sequences in operational taxonomic units (3%) yielded 450 and 1,997 species level phylotypes in asymptomatic and symptomatic teeth, respectively. The total bacteria counts were significantly higher in symptomatic teeth than that of asymptomatic teeth (p < 0.05). CONCLUSIONS: GS FLX Titanium pyrosequencing could reveal a previously unidentified high bacterial diversity in primary endodontic infections.
Actinobacteria ; Bacteria ; Bacteroidetes ; Fusobacteria ; Genes, rRNA ; Leptotrichia ; Neisseria ; Polymers ; Propionibacterium ; Proteobacteria ; Spirochaetales ; Streptococcus ; Titanium ; Tooth

Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
Fasciitis, Necrotizing ; Lemierre Syndrome ; Fusobacterium necrophorum ; Klebsiella pneumoniae

Lemierre syndrome is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. The usual etiologic agent is Fusobacterium necrophorum. Lemierre syndrome was a common disease with a high mortality rate in the pre-antibiotic era. Since the advent of antibiotics and their widespread use for the treatment of pharyngeal infections, there has been a substantial decrease in the incidence of this malady and it has become a "forgotten disease". Prompt diagnosis and antibiotic therapy for Lemierre syndrome is essential to avoid morbidity and mortality. We describe here a case of Lemierre syndrome with multiple septic pulmonary emboli.
Anti-Bacterial Agents ; Diagnosis ; Fusobacterium necrophorum ; Incidence ; Jugular Veins ; Lemierre Syndrome* ; Mortality ; Pharynx ; Pulmonary Embolism* ; Thrombophlebitis

Humans ; Young Adult ; Fusobacterium necrophorum ; Pharyngitis/microbiology* ; Streptococcal Infections ; Sepsis/diagnosis*

Lemierre syndrome is caused by an infection in the oropharyngeal region with subsequent thrombophlebitis in the internal jugular vein. The thrombus from the thrombophlebitis can invade other vital organs, such as liver, lungs, or joints, resulting in secondary infection, which further exacerbates the fatal prognosis of this syndrome. Lemierre syndrome, also called postanginal sepsis or necrobacillosis, was first reported by Dr. Lemierre in 1936. In his report, Lemierre mentioned that out of 20 patients who suffered from this syndrome, only two survived. He also stated that all of the 20 patients complained of infections in the palatine tonsils and developed sepsis and thrombophlebitis in the internal jugular vein. Once called a "forgotten disease," this syndrome showed a very high mortality rate until usage of antibiotics became prevalent. In this case report, the authors present a 71-year-old female patient who suffered from Lemierre syndrome with thrombosis extended to the right sigmoid sinus.
Anti-Bacterial Agents ; Coinfection ; Colon, Sigmoid ; Female ; Fusobacterium Infections ; Fusobacterium necrophorum ; Humans ; Joints ; Jugular Veins ; Lemierre Syndrome ; Liver ; Lung ; Palatine Tonsil ; Prognosis ; Sepsis ; Thrombophlebitis ; Thrombosis

Lemierre's syndrome is characterized by anaerobic bacterial infection in the head and neck, causing thrombophlebitis of the jugular vein. This disease is usually associated with a history of pharyngitis. The most common pathogens are Fusobacterium species, particularly Fusobacterium necrophorum. Lemierre's syndrome is seen most commonly in teenagers and young adults. We present a case report of a 67-year-old man with an atypical clinical manifestation of an uncommon pathogen in Lemierre's syndrome with epilepsia partialis continua.
Adolescent ; Aged ; Bacterial Infections ; Epilepsia Partialis Continua ; Fusobacterium ; Fusobacterium necrophorum ; Head ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Neck ; Pharyngitis ; Thrombophlebitis ; Venous Thrombosis ; Young Adult

Lemierre syndrome is characterized by anaerobic bacterial infection in the head and neck and clinical or radiological evidence of internal jugular vein thrombophlebitis. The most common pathogens are Fusobacterium species, particularly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. The accurate diagnosis and treatment is important because it may be associated with a high mortality rate if untreated. We present a case of 28-year-old man with an atypical history for the diagnosis of Lemierre syndrome, which showed no definite evidence of internal jugular thrombophlebitis.
Adult ; Bacterial Infections ; Central Nervous System ; Diagnosis ; Empyema ; Fusobacterium ; Fusobacterium necrophorum ; Head ; Humans ; Jugular Veins ; Kidney ; Lemierre Syndrome* ; Liver ; Lung ; Mortality ; Neck ; Thrombophlebitis

Lemierre syndrome is a rare, but potentially life-threatening complication of oropharyngeal infection. This syndrome is characterized by oropharyngeal infection leading to internal jugular vein thrombosis and multiple pulmonary septic emboli. It is commonly caused by an anaerobic pathogen such as Fusobacterium necrophorum. Early diagnosis and appropriate antibiotic treatment make a world of difference in preventing fatal outcomes. Here we present the case of a 25-year-old man with acute tonsillitis that was complicated with Lemierre syndrome. Emergency physicians should consider the possibility of Lemierre syndrome in young patients with initial oropharyngeal infection with neck swelling and pulmonary symptoms.
Adult ; Early Diagnosis ; Emergencies ; Fatal Outcome ; Fusobacterium necrophorum ; Humans ; Jugular Veins ; Lemierre Syndrome ; Neck ; Palatine Tonsil ; Thrombophlebitis ; Thrombosis ; Tonsillitis

Lemierre syndrome or postanginal septicemia (necrobacillosis) is caused by an acute oropharygeal infection with secondary septic internal jugular vein thrombophlebitis and frequent metastatic infections. 17-aged girl visted emergency room with dyspnea. She had the symptoms of fever, sore throat and myalgia before 3 or 4 days. She had multiple septic emboli in both lung fields and septic thrombophlebitis of right internal jugular vein. Although Fusobacterium necrophorum is the most common pathogen isolated from the patients, The pathogen can not be confirmed. We experienced a case of Lemierre syndrome with septic embolism after fever, sore throat and myalgia. We present the case with the review of literature.
Dyspnea ; Embolism* ; Emergency Service, Hospital ; Female ; Fever* ; Fusobacterium necrophorum ; Humans ; Jugular Veins ; Lemierre Syndrome ; Lung ; Myalgia* ; Pharyngitis* ; Sepsis ; Thrombophlebitis

Lemierre syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of pathogens, mainly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. Before the advent of antibiotics, the disease used to be common, incurring a high mortality rate. The disease is less frequently seen nowadays, but it is still a life-threatening disease, requiring a high index of suspicion and prompt treatment. We report a case of Lemierre syndrome, which showed oropharyngeal infection, and internal jugular vein thrombosis.
Anti-Bacterial Agents ; Central Nervous System ; Fusobacterium necrophorum ; Jugular Veins ; Kidney ; Lemierre Syndrome ; Liver ; Lung ; Thrombophlebitis ; Thrombosis