title: Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review.
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus is a growing health concern. Lemierre's syndrome is a septic jugular thrombophlebitis that primarily affects young adults. This paper aimed to identify a possible sub-group of Lemierre's syndrome cases associated with community-acquired methicillin-resistant Staphylococcus aureus.
  
  
  METHODS
  This paper reports the case of a 16-year-old male who was admitted for increasing fever, tachycardia, tachypnoea and neck pain. The patient was diagnosed with methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome. A literature review was subsequently conducted.
  
  
  RESULTS
  Following intravenous antibiotic treatment and the sterilisation of blood cultures, the patient improved. The literature review indicated a rise in the past 2 years of Lemierre's syndrome associated with methicillin-resistant Staphylococcus aureus among patients less than 18 years of age.
  
  
  CONCLUSIONS
  Community-acquired methicillin-resistant Staphylococcus aureus bacteraemia can lead to pulmonary sequelae. When it is associated with pharyngitis, nasopharyngitis or parapharyngeal lymphadenitis, the affected patient may be predisposed to Lemierre's syndrome. As bacterial carriage is predominantly nasal, pharyngitis may not be present. Methicillin-resistant Staphylococcus aureus should be included as an offending bacterium where there is suspicion of Lemierre's syndrome. It is unclear whether anticoagulation alters the course of the bacterium, and surgery is probably contraindicated.
authors.affiliation: Department of Otolaryngology, St. Luke's-Roosevelt Hospital, New York, New York, USA. vkizhner@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Kizhner
authors.forename: G
authors.initials: G
authors.lastname: Samara
authors.forename: R
authors.initials: R
authors.lastname: Panesar
authors.forename: Y P
authors.initials: YP
authors.lastname: Krespi
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections; D006801:Humans; D057831:Lemierre Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D010372:Pediatrics; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents