scholarly journals Disseminated intravascular coagulation: enumerating studies of Lemierre’s syndrome and Covid19 to highlight the similarities between these diseases

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Blood Clot ◽  
Anaerobic Bacteria ◽  
Blood Stream ◽  
Clotting Factors ◽  
Lemierre’S Syndrome ◽  
Excessive Bleeding ◽  
Intravascular Coagulation ◽  
Blood Clots ◽  
Lemierre's Syndrome

Disseminated intravascular coagulation (DIC) is a serious disorder characterized by small blood clots de- veloping throughout the bloodstream, blocking small blood vessels, depleting platelets and clotting factors leading to excessive bleeding. Lately, it is been reported that Covid19 is more of a vascular problem, than one of the lungs. Here, I enumerate studies of Lemierre’s syndrome with DIC, and also papers highlighting the Covid19 cases - this is based on my hypothesis that Covid19 is very similar to Lemierre’s Syndrome, wherein an anaerobic bacteria is enabled by a virus (SARS-Cov2/EBV) to form an abscess, from which a blood clot (carrying the bacteria) disseminates through the blood stream [1].

Disseminated intravascular coagulation as a complication of ventricular catheter placement

1981 ◽  
Vol 54 (2) ◽  
pp. 264-267 ◽  
Author(s):  
Susan Shurin ◽  
Harold Rekate
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Early Recognition ◽  
Bleeding Complications ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
High Concentration ◽  
Clotting Factors ◽  
Excessive Bleeding ◽  
Content Type ◽  
Intravascular Coagulation

✓ A child who developed generalized bleeding immediately after placement of a ventriculoperitoneal shunt was found to have evidence of disseminated intravascular coagulation (DIC). Infusion of fresh frozen plasma was followed promptly by improvement in laboratory values and cessation of bleeding. Complications of the acute bleeding episode included intraventricular hemorrhage, loss of 50% of the red cell volume into subcutaneous tissues, and transient peritoneal irritation. Defibrination syndrome (that is, DIC) due to release of tissue thromboplastin is a recognized complication of trauma, particularly with brain injury. Defibrination can be induced in experimental systems with administration of very small amounts of thromboplastin, which is present in high concentration in brain tissue. This has not been described previously with minor neurosurgical procedures. The diagnosis of DIC should be considered if excessive bleeding occurs after any brain insult, since early recognition and restoration of normal hemostasis by replacement of clotting factors should prevent major complications due to ongoing hemorrhage.

Hemostasis and Homeostasis

1967 ◽  
Vol 18 (03/04) ◽  
pp. 552-564
Author(s):  
J Roskam
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Blood Clotting ◽  
Research Work ◽  
Blood Stream ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Hemostatic Factors ◽  
Blood Clotting Factors

IV. General Conclusions and Summary1. Normal hemostasis depends on the combined participation of 3 sorts of hemostatic factors: vascular (including its participation in local hemodynamics), platelet and blood clotting factors, the level of which when it can be assessed largely exceeds the requirements of the organism.2. Disordered hemostasis usually results from combined moderate deficiencies of at least 2 of these factors, i.e. from an “immediate” multi-causation.3. The mechanisms of homeostasis keeping hemostatic factors production at a suitable level are still unknown.4. Inversely we have a fairly good knowledge of the mechanisms neutralizing or removing from the blood stream activated blood clotting factors and hemostatic compounds released by platelets.5. When the latter mechanisms are defective and when concomitantly, blood clotting factors and platelets are sufficiently activated and/or endothelium is widely damaged, then disseminated intravascular coagulation occurs, which may lead to deficiencies of at least 2 hemostatic factors, and hence to a more or less severe bleeding tendency.6. Thus, just as such acute or subacute hemorrhagic syndromes complicating consumption coagulopathies are based upon an “immediate” multi-causation consisting of several defective hemostatic factors, they depend on a “remote” multi-causation with respect to the origin of these joint deficiencies.7. Between both of these multi-causations, immediate and remote, there is a single pathway : an important, continuous and sufficiently rapid thrombin formation.8. This explains why the best treatment of acute and subacute hemorrhagic disorders complicating disseminated intravascular coagulation is the administration of heparin.Spaet’s and our own views are only a beginning. Most of the problems concerning relations between hemostasis and homeostasis are still unsolved, for instance nature and origin of the vascular factor impeding the arrest of bleeding in idiopathic thrombocytopenic purpura, the pathogenesis of several chronic hemorrhagic conditions associated with disseminated vascular coagulation, the influence of the nervous system, catamenia, pregnancy, etc. on various hemorrhagic syndromes, etc., to say nothing of the effects of muscular exercise on von Willebrand’s disease. They deserve systematically conducted research work.

scholarly journals Metagenome of Covid19 patient from Bangladesh corroborates the anaerobic colonization enabled by SAR-Cov2 with a novel, hard to culture, bacteria - Lawsonella clevelandensis - that is implicated in disease by causing abscesses

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Septic Shock ◽  
Epstein Barr Virus ◽  
Jugular Vein ◽  
Bacterial Load ◽  
Anaerobic Bacteria ◽  
Lemierre’S Syndrome ◽  
Barr Virus ◽  
Blood Clots ◽  
Epstein Barr ◽  
Lemierre's Syndrome

I have hypothesized [1] that SARS-Cov2 [2,3] enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis. This finds resonance in the ‘forgotten disease’ Lemierre’s Syndrome [4–9,9,10], caused by anaerobic bacteria enabled by Epstein Barr Virus [11, 12]. Common symptoms include ARDS, septic shock, blood clots and arterial stroke [?,13–17]. A key difference is that Lemierre’s Syndrome originates in the jugular vein, while Covid19 starts from the lungs (possibly making it easier to treat).Here, metagenome from a Covid19 patient in Bangladesh Accid:PRJNA633241) is analyzed (Table 1). While, bacterial load is low (and this might be due to removal of reads), it corroborates the anaerobic domination with a novel anaerobic bacteria - Lawsonella clevelandensis - being implicated.

scholarly journals Prevotella/Streptococcus and other anaerobes colonize the metagenome (nasopharyngeal swab) submitted by Emory University School of Medicine, Georgia in Covid19 patient, corroborating the hypothesis that SARS-Cov2 is enabling anaerobes

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Bacterial Load ◽  
Anaerobic Bacteria ◽  
Nasopharyngeal Swab ◽  
Lemierre’S Syndrome ◽  
Barr Virus ◽  
School Of Medicine ◽  
Emory University ◽  
Blood Clots ◽  
Epstein Barr ◽  
Lemierre's Syndrome

The hypothesis [1] that SARS-Cov2 [2,3] enables anaerobic bacteria (Prevotella, et al) to colonize the lungs disrupting homeostasis finds resonance in the ‘forgotten disease’ Lemierre’s Syndrome [4–9,9,10]. Lemierre’s Syndrome is also caused by anaerobic bacteria enabled by Epstein Barr Virus [11,12]. Symptoms common to both diseases include ARDS, septic shock, blood clots and arterial stroke [?,13–17]. Covid19 starts from the lungs (possibly making it easier to treat), in contrast to Lemierre’s Syndrome that originates in the jugular vein.Nasopharyngeal swab(Accid:SRR11829376)Here, metagenome from a Covid19 patient in Emory University School of Medicine, Georgia is analyzed (Table 1). Prevotella/Streptococcus and other anaerobes colonize the metagenome, corroborating the hy- pothesis that SARS-Cov2 is enabling anaerobes [1]. The bacterial load is quite high, the first five species comprise 70% of the load.Gut metageome (Accid:SRR11827437)Another sample shows Enterococcus colonization, and although the source of the sample is mentioned as nasopharyngeal swab, most of the bacteria are gut related (Table 2).

scholarly journals Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 8S-28S ◽  
Author(s):  
Chrysoula Papageorgiou ◽  
Georges Jourdi ◽  
Eusebe Adjambri ◽  
Amanda Walborn ◽  
Priya Patel ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Bleeding Risk ◽  
Therapeutic Strategies ◽  
Phase Iii ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Positive Effects

Disseminated intravascular coagulation (DIC) is an acquired clinicobiological syndrome characterized by widespread activation of coagulation leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage. Disseminated intravascular coagulation is provoked by several underlying disorders (sepsis, cancer, trauma, and pregnancy complicated with eclampsia or other calamities). Treatment of the underlying disease and elimination of the trigger mechanism are the cornerstone therapeutic approaches. Therapeutic strategies specific for DIC aim to control activation of blood coagulation and bleeding risk. The clinical trials using DIC as entry criterion are limited. Large randomized, phase III clinical trials have investigated the efficacy of antithrombin (AT), activated protein C (APC), tissue factor pathway inhibitor (TFPI), and thrombomodulin (TM) in patients with sepsis, but the diagnosis of DIC was not part of the inclusion criteria. Treatment with APC reduced 28-day mortality of patients with severe sepsis, including patients retrospectively assigned to a subgroup with sepsis-associated DIC. Treatment with APC did not have any positive effects in other patient groups. The APC treatment increased the bleeding risk in patients with sepsis, which led to the withdrawal of this drug from the market. Treatment with AT failed to reduce 28-day mortality in patients with severe sepsis, but a retrospective subgroup analysis suggested possible efficacy in patients with DIC. Clinical studies with recombinant TFPI or TM have been carried out showing promising results. The efficacy and safety of other anticoagulants (ie, unfractionated heparin, low-molecular-weight heparin) or transfusion of platelet concentrates or clotting factor concentrates have not been objectively assessed.

scholarly journals A Case of Lemierre Syndrome Secondary to Otitis Media and Mastoiditis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Aynur Turan ◽  
Harun Cam ◽  
Yeliz Dadali ◽  
Serdar Korkmaz ◽  
Ali Özdek ◽  
...  
Keyword(s):  
Otitis Media ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Anaerobic Bacteria ◽  
Transverse Sinus ◽  
Lemierre’S Syndrome ◽  
Lemierre Syndrome ◽  
Mortality And Morbidity ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome

Lemierre’s syndrome is a rare clinical condition that generally develops secondary to oropharyngeal infection caused byFusobacterium necrophorum, which is an anaerobic bacteria. A 62-year-old patient with diabetes mellitus presented with internal jugular vein and sigmoid sinus-transverse sinus thrombophlebitis, accompanying otitis media and mastoiditis that developed after an upper airway infection. Interestingly, there were air bubbles in both the internal jugular vein and transverse sinus. Vancomycin and meropenem were started and a right radical mastoidectomy was performed. The patient’s clinical picture completely resolved in 14 days. High mortality and morbidity may be prevented with a prompt diagnosis of Lemierre’s syndrome.

scholarly journals Pathogenesis, diagnosis, prevention and treatment of disseminated intravascular coagulation syndrome in COVID-19 infection

2020 ◽  
Vol 92 (11) ◽  
pp. 51-56
Author(s):  
P. A. Vorobyev ◽  
A. P. Momot ◽  
L. S. Krasnova ◽  
A. P. Vorobiev ◽  
A. K. Talipov
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Fresh Frozen Plasma ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Prevention And Treatment ◽  
Fresh Frozen ◽  
Direct Anticoagulants ◽  
Frozen Plasma

Aim. Clinical characteristics of disseminated intravascular coagulation (DIC) in COVID-19 infection and assessment of the effectiveness of complex therapy for this syndrome at the stages of prevention and treatment of various complications. Materials and methods. The study of publications was carried out through search engines on the Internet using keywords. To diagnose the infection, the COVID-19 program was used on the MeDiCase platform, which is publicly available on www.medicase.pro, which suggests a diagnosis with a sensitivity of 89.47%. The study included 85 patients with acute COVID-19 with mild to moderate disease, aged 11 to 81 years. The presence of the pathogen was confirmed immunologically in 12% of patients; in other cases, the diagnosis was based on the results of an automated survey in the MeDiCase system. All patients, according to the MGNOT recommendations, were prescribed one of the oral direct anticoagulants - Eliquis at a dose of 5 mg 2 times a day, Ksarelto at a dose of 10 mg 2 times a day or Pradax at a dose of 110 mg 2 times a day for at least 2 weeks. All other drugs with antiviral, immunomodulatory effects, antibiotics were canceled. Results. The presence of DIC is substantiated by the morphological picture of changes in organs and tissues, clinical (hematoma-petechial type of bleeding in combination with thromboembolic syndrome and the presence of thrombovasculitis) and laboratory changes: an increase in the level of soluble fibrin-monomer complexes, D-dimer, hyperfibrinogenaemia, less often - thrombocytopenia, violation of fibrinolytic activity. The phenomenon of consumption of clotting factors and profuse bleeding are rare. Direct anticoagulants, fresh frozen plasma transfusions and plasmapheresis are used in the treatment of disseminated intravascular coagulation. The paper presents its own positive results of early prescription at the outpatient stage of direct oral anticoagulants in prophylactic doses (no case of disease progression), individual cases of the use of fresh frozen plasma and plasapheresis. Conclusion. DIC syndrome with the development of thrombovasculitis is the most important pathogenetic mechanism for the development of microthrombotic and hemorrhagic disorders in organs during infection with COVID-19, leading to dysfunction of the lungs, brain and other nerve tissues, kidneys, thromboembolic complications, etc. Many symptoms of the disease may be associated with a violation of the nervous regulation of the functions of organs and systems. Prevention of thrombovasculitis is effective already at the stage of the first manifestation of the disease with the outpatient use of direct anticoagulants (oral, low molecular weight heparins). In case of more severe manifestations (complications) of the disease, additional use of freshly frozen plasma and plasmapheresis is effective.

scholarly journals Metagenomic data of three Covid19 patients submitted by NIAID Bioinformatics and Computational Biosciences Branch is from the gut - and not the lungs (BALF) as stated: Muribaculum is an intestinal microbe

2020 ◽  
Author(s):  
Sandeep Chakraborty
Keyword(s):  
Anaerobic Bacteria ◽  
Metagenomic Data ◽  
Sequencing Data ◽  
Lemierre’S Syndrome ◽  
Lemierre's Syndrome ◽  
Registration Date ◽  
F 31

The Covid19 anaerobic hypothesis states that SARS-Cov2 is enabling anaerobic bacteria to colonize the lungs, leading to Lemierre’s syndrome like symptoms [1]. However, the metagenomic data from 3 Covid19 patients (age M=40, F=20, F=31) submitted by NIAID Bioinformatics and Computational Biosciences Branch (Accid:PRJNA631287) is from the gut - and not lungs (BALF) as stated (Table 1). The Registration date of this sequencing data is : 8-May-2020. Muribaculum is an intestinal microbe [2] - and the microbe composition can be seen to be completely different from that in the lungs.The data size is very small - 5000 reads per patient. So this should be very easy to verify.

scholarly journals Lemierre’s Syndrome: Recognising a Typical Presentation of a Rare Condition

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
James A. Coultas ◽  
Neena Bodasing ◽  
Paul Horrocks ◽  
Anthony Cadwgan
Keyword(s):  
Rare Complication ◽  
Anaerobic Bacteria ◽  
Anticoagulation Therapy ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Positive Outcome ◽  
Lemierre’S Syndrome ◽  
Delay In Diagnosis ◽  
Oropharyngeal Infection ◽  
Lemierre's Syndrome

Lemierre’s syndrome is a rare complication following an acute oropharyngeal infection. The aetiological agent is typically anaerobic bacteria of the genusFusobacterium. The syndrome is characterised by a primary oropharyngeal infection followed by metastatic spread and suppurative thrombophlebitis of the internal jugular vein. If left untreated, Lemierre’s syndrome carries a mortality rate of over 90%. Whilst relatively common in the preantibiotic era, the number of cases of Lemierre’s syndrome subsequently declined with the introduction of antibiotics. With the increase of antibiotic resistance and a greater reluctance to prescribe antibiotics for minor conditions such as tonsillitis, there are now concerns developing about the reemergence of the condition. This increasing prevalence in the face of an unfamiliarity of clinicians with the classical features of this “forgotten disease” may result in the misdiagnosis or delay in diagnosis of this potentially fatal illness. This case report illustrates the delay in diagnosis of probable Lemierre’s syndrome in a 17-year-old female, its diagnosis, and successful treatment which included the use of anticoagulation therapy. Whilst there was a positive outcome, the case highlights the need for a suspicion of this rare condition when presented with distinctive signs and symptoms.

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