May 18, Arbeit Thrombophlebitis, Author: Many cases present as benign, localized Arbeit Thrombophlebitis cords that resolve completely with minimal intervention. Some cases present as severe systemic infections culminating in profound shock that is refractory to aggressive management, including operative intervention and intensive care.
See Presentation and Prognosis. A number of distinct clinical conditions have been identified, depending on the vessel involved, Arbeit Thrombophlebitis all thrombophlebitides involve Ursachen von Ösophagusvarizen same basic pathophysiology. Thrombosis and infection within a vein can occur throughout the body and can involve superficial or deep vessels.
Notable examples are thrombophlebitis in the following see Etiology:. The approach to treatment of septic phlebitis depends on which structures are involved, the underlying etiology of the phlebitis, Arbeit Thrombophlebitis, the causative organisms, and the patient's underlying physiology.
See Treatment and Medication. Peripheral septic thrombophlebitis is a common problem that can develop spontaneously but more often is associated with breaks in the skin. Though most commonly caused by indwelling catheters, septic thrombophlebitis may also result from simple procedures such as venipuncture for phlebotomy and intravenous injection. While infection must always be considered, catheter-related phlebitis can result from sterile chemical or mechanical irritation.
Septic phlebitis of a superficial vein without frank purulence is known as simple phlebitis. Simple phlebitis is often benign, Arbeit Thrombophlebitis when it is progressive, it can cause serious complications, and even death. Suppurative superficial thrombophlebitis is a more serious condition that can lead to sepsis and death, even with appropriate aggressive intervention. Septic phlebitis of the deep venous system is a rare, but life-threatening, emergency that may fail to respond to even the most aggressive therapy.
Any vessel can theoretically be involved, but the more common entities Krampfadern an den Beinen geboren detailed below. Septic thrombophlebitis of the IVC or SVC is primarily the result of central venous catheter placement, with increased incidence in burn patients and those receiving total parenteral nutrition.
The mortality rate of these infections is high, but cases of successful treatment Arbeit Thrombophlebitis been reported. Lemierre syndrome is a suppurative thrombophlebitis of the internal jugular vein caused by oropharyngeal infections such as tonsillitis and dental infections. Spread of the infection into the parapharyngeal space that houses the carotid sheath leads to local inflammation and thrombosis of the jugular vein. Lemierre syndrome is easily missed and is more common than is generally appreciated, Arbeit Thrombophlebitis.
Less commonly, septic emboli may traverse a patent foramen ovale and cause distant metastatic infections such as septic arthritis, osteomyelitis, and hepatic abscesses. Septic pelvic thrombophlebitis and ovarian vein thrombophlebitis are seen principally as a complication of puerperal uterine infections, such as endometritis and septic abortion. In Arbeit Thrombophlebitis infections, such as appendicitis and diverticulitis, infection may spread to cause neighboring septic phlebitides.
Thrombophlebitis of the intracranial venous sinuses is a particularly serious problem and can involve the cavernous sinus, the lateral sinus, or the superior sagittal sinus. Cavernous sinus thrombophlebitis is caused by infection of the medial third of the face known as the "danger zone," ethmoid and sphenoid sinusitis, Arbeit Thrombophlebitis, and, occasionally, oral infections. Mastoiditis and otitis media are rarely associated with septic phlebitis of the lateral sinuses, while thrombophlebitis of the superior sagittal sinus is the rarest and is primarily associated with meningitis.
More than a third of cases of intracranial septic thrombophlebitis are fatal, Arbeit Thrombophlebitis. For patient education information, see Phlebitis. Placement of an intravascular catheter is the main causative factor in the development of phlebitis and septic thrombophlebitis. Infection can be introduced during the placement of the catheter or bacteria can colonize first the hub and then the lumen of the catheter before they gain access to the intravascular space.
Causative organisms are diverse and include skin and subcutaneous tissue pathogens, enteric bacteria, and flora causing infection in the genitourinary tract, Arbeit Thrombophlebitis. The most common infective organism is Staphylococcus aureus, but coagulase-negative staphylococci, enteric gram-negative bacilli, and enterococci are also frequently implicated, Arbeit Thrombophlebitis.
These infections are often polymicrobial. Septic pelvic and ovarian vein thrombophlebitides are often puerperal and typically occur within 3 weeks of delivery, Arbeit Thrombophlebitis. Damage to the intima of pelvic ileofemoral vessels during vaginal or cesarean delivery Arbeit Thrombophlebitis thought to contribute to the process of thrombosis.
Hypercoagulability secondary to pregnancy, as well as the venous stasis common in the peripartum state, also contribute. It may also be caused by other intra-abdominal infections drained by or contiguous with the portal vein. Bacteroides fragilis is the most common pathogen, Arbeit Thrombophlebitis other bacteria, such as Escherichia coliKlebsiella species, and other Bacteroides species, are also found. There has been a case report in which an IVC filter was found to be the nidus of a septic phlebitis.
Candida albicans is the most Arbeit Thrombophlebitis fungal pathogen, but cases have also been attributed to Candida glabrata. Like abdominal and pelvic thrombophlebitis, Arbeit Thrombophlebitis, Lemierre syndrome is characterized by the migration of bacteria through the deep tissues.
In this infection, pathogens translocate through the pharynx or are drained from the pharynx into the lateral pharyngeal space, where they come near to the internal Arbeit Thrombophlebitis vein.
Inflammation, Arbeit Thrombophlebitis, thrombosis, and infection may then ensue. Arbeit Thrombophlebitis predisposing infections that ultimately result in septic thrombosis of the dural venous sinuses are closely related to the venous anatomy of the face and head, Arbeit Thrombophlebitis.
Infections of the medial third of the face, involving the nose, periorbital regions, Arbeit Thrombophlebitis, tonsils, and soft palate, have long been recognized risk factors, since these areas drain directly into the cavernous sinus via the facial veins, pterygoid plexus, and ophthalmic veins.
Infections Arbeit Thrombophlebitis the sphenoid and ethmoid sinuses have been implicated, Arbeit Thrombophlebitis, with bacteria spreading directly through the lateral wall or via emissary veins. While extremely rare, septic thrombophlebitis of the superior sagittal sinus is caused by bacterial meningitis, Arbeit Thrombophlebitis, but frontal, ethmoid, and maxillary sinus infections and spread from infections in the lateral dural sinus have also been reported.
The microbiology of intracranial vascular infections depends in large part on the causative infective site. S aureus is by far the most common organism seen in cavernous sinus thrombosis and is responsible for all septic thromboses resulting from facial and sphenoid sinusitis, Arbeit Thrombophlebitis.
Streptococci, anaerobes, and occasionally fungi are also seen in cavernous sinus thrombosis. Organisms responsible for superior sagittal sinus thromboses include those responsible for meningitis, notably S pneumoniae, while pathogens more representative of chronic otitis, such as ProteusS aureusE coliand anaerobes, Arbeit Thrombophlebitis, were Kann ich die Pille mit Krampfadern to cause lateral sinus thrombophlebitis.
Arbeit Thrombophlebitis bloodstream infection is a common problem well recognized by the hospital community, and major efforts have been made to combat this problem. Ina French study found that 9. Similar rates have been noted for central venous catheters.
Given the rarity of pelvic, ovarian, jugular, portal, and dural vein septic thrombophlebitides, epidemiologic data describing their frequency are lacking. In general, however, incidences of these deep vein infections appear to be rising, likely owing in part to the increased use of sophisticated diagnostic imaging.
In an epidemiologic survey examining the frequency of septic pelvic thrombophlebitis, Arbeit Thrombophlebitis, an overall incidence of 1: Lemierre syndrome is also infrequent but is easily missed and likely underdiagnosed. Reports from Europe suggested a rate of 0. Extremes of age predispose patients to catheter-related septic thrombophlebitis, Arbeit Thrombophlebitis.
Vulnerability is also increased in elderly persons, likely secondary to concomitant illnesses and a nonspecific, age-related decline in immunologic function. Garrison et al reported increased Arbeit Thrombophlebitis for the development of major complications from intravenous catheter Arbeit Thrombophlebitis in patients aged 50 years and older, with an odds ratio of 4, Arbeit Thrombophlebitis.
Notable exceptions to the above age-related predispositions are Lemierre syndrome and septic pelvic and ovarian thrombophlebitides: Lemierre disease occurs in healthy, young adults with a mean age of onset of 20 years, [ 7 ] while septic pelvic and ovarian thrombophlebitides occur in women of childbearing age.
Septic thrombophlebitis is a relatively rare disease that encompasses an array Arbeit Thrombophlebitis clinical entities, so data on mortality rates are scarce. Needless to say, it is a serious and dangerous disease, since the infection takes root Arbeit Thrombophlebitis the central or peripheral venous system and can readily progress to sepsis and shock. Metastatic foci of infection are common, with septic pulmonary emboli, infective endocarditis, Arbeit Thrombophlebitis, septic emboli to the central nervous system, osteomyelitis, septic arthritis, and even arteritis all adding to the morbidity and mortality burden of this disease.
Serious complications in survivors include ocular palsies, hemiparesis, blindness, and pituitary insufficiency. Notably, however, pelvic and jugular thrombophlebitis appear to have become less deadly over the years.
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: Thrombophlebitis in the elderly. Diagnosis and treatment of cannula-related intravenous sepsis in burn patients. Candida septic thrombosis of the great central veins associated with central catheters. Clinical Arbeit Thrombophlebitis and management. Central venous septic thrombophlebitis--the role of medical therapy.
The evolution of Lemierre syndrome: Infect Dis Obstet Gynecol. Septic thrombosis of the dural venous sinuses, Arbeit Thrombophlebitis. Khardori Arbeit Thrombophlebitis, Yassien M. Biofilms in device-related infections, Arbeit Thrombophlebitis. Consequences of Behandlung von variköser Fußeinrichtung catheter sepsis.
Puerperal septic pelvic thrombophlebitis: Am J Obstet Gynecol. Septic thrombophlebitis of the portal vein pylephlebitis: Candida inferior vena cava filter infection and septic thrombophlebitis. A year-old man with fever and abdominal pain after Arbeit Thrombophlebitis peritonsillar abscess drainage, Arbeit Thrombophlebitis.
Am J Emerg Med. Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med. Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri. Prospective multicenter study of vascular-catheter-related complications and risk factors for Arbeit Thrombophlebitis central-catheter cultures in intensive care unit patients, Arbeit Thrombophlebitis. The risk of bloodstream infection in adults with Arbeit Thrombophlebitis intravascular devices: Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, Arbeit Thrombophlebitis, in Denmark Riordan T, Wilson M.
Cooley K, Arbeit Thrombophlebitis, Grady S. Minimizing catheter-related bloodstream infections: Guidelines for the diagnosis, treatment and prevention of postoperative infections.
Septic Thrombophlebitis Clinical Presentation: History, Physical Examination Arbeit Thrombophlebitis
May 18, Arbeit Thrombophlebitis, Author: Tenderness and erythema are often apparent at the initial site of infection. The original portal of entry Arbeit Thrombophlebitis become less obvious over time, as pain, tenderness, swelling, Arbeit Thrombophlebitis, and redness spread along the entire course of the infected vessel.
Thrombophlebitis in the deep veins is more insidious and typically presents with isolated fever, particularly in patients with catheter-related disease. Usually, there is no pain or swelling at the site of Arbeit Thrombophlebitis central venous catheter.
Thrombosis of intra-abdominal vessels may also present with abdominal pain and discomfort. Recent childbirth and recent pelvic surgery are important clues in the diagnosis of pelvic thrombophlebitis. While ovarian vein thrombophlebitis is usually diagnosed within 1 week of delivery, septic thrombophlebitis of the ileofemoral vessels is typically seen later, Arbeit Thrombophlebitis. The vast majority of patients with dural venous sinus thrombophlebitis present with severe headache.
Clues in the case of cavernous sinus thrombosis include facial or oropharyngeal infection and visual disturbances signifying cranial nerve involvement. The pain of cavernous sinus thrombosis is typically retroorbital in the region of the ophthalmic and maxillary branches of the fifth cranial nerve, and fever; periorbital swelling may also be noted by some patients.
Since lateral sinus thrombosis is generally a complication of middle ear and mastoid infection, most patients present with prolonged earache and fever. Profound headache becomes the predominant symptom once thrombosis ensues, Arbeit Thrombophlebitis. Nausea and vomiting are other nonspecific findings that can help guide the clinician, Arbeit Thrombophlebitis. Vertigo, diplopia, and photophobia are suggestive clues that sometimes occur.
Superior sagittal sinus thrombosis presents as profound and worsening headache in the setting of established bacterial meningitis. Local signs of phlebitis include the traditional cardinal signs of inflammation: Simple phlebitis may produce a painful cord, blanching erythema, and streaking along the venous channel.
Septic thrombophlebitis presents with the same symptoms plus fever. In contrast, Arbeit Thrombophlebitis line—associated deep vein phlebitis is often clinically occult, because the infected thrombus is located in the region of the catheter tip.
Occasionally, erythema, Arbeit Thrombophlebitis, purulence, or surrounding Aloe von venöser Ulzera at the insertion site is present and should alert the clinician to the possibility of septic thrombophlebitis in the deep vein.
Nonspecific findings in pelvic phlebitis, ovarian phlebitis, and pyelophlebitis include fever, abdominal tenderness, and vomiting. Patients often appear clinically ill, with sepsis sometimes apparent on presentation. Helpful, but less common, findings of pyelophlebitis include hepatomegaly Arbeit Thrombophlebitis jaundice, [ 15 ] while cervical motion tenderness and purulent cervical discharge are often discovered in patients with pelvic and ovarian vein disease.
Early clinical findings in Lemierre syndrome are indistinguishable from pharyngitis, consisting of fever and oropharyngeal pain. An exudative tonsillitis is common, but not invariably present, with pharyngeal pseudomembranes and ulceration occasionally noted.
A high degree of clinical suspicion is required, as some patients present with no pharyngeal findings at all. In fact, many Arbeit Thrombophlebitis may present with clinical signs indicative of metastatic disease, such as septic pulmonary emboli with hypoxemia and hemodynamic instability. Findings of septic arthritis and distant soft-tissue infections are also not uncommon. The physical findings of thrombophlebitis of the dural sinuses can be specific to the particular sinus involved, Arbeit Thrombophlebitis.
Other notable signs are lethargy; abnormal ear, nose, and throat ENT examination findings; and nuchal rigidity. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: Thrombophlebitis in the elderly. Diagnosis and treatment of cannula-related intravenous sepsis Arbeit Thrombophlebitis burn patients, Arbeit Thrombophlebitis. Candida septic thrombosis of the great central veins associated with central catheters.
Clinical features and management. Central venous septic thrombophlebitis--the role of medical therapy. The evolution of Lemierre syndrome: Infect Dis Obstet Gynecol. Septic thrombosis of the dural venous sinuses, Arbeit Thrombophlebitis. Khardori N, Yassien M, Arbeit Thrombophlebitis. Biofilms in device-related infections. Consequences of intravascular catheter sepsis. Puerperal septic pelvic thrombophlebitis: Am J Obstet Gynecol. Septic thrombophlebitis of the portal vein pylephlebitis: Candida inferior vena cava filter infection and septic thrombophlebitis.
A year-old man with fever Arbeit Thrombophlebitis abdominal pain after recent peritonsillar abscess drainage. Am J Emerg Med.
Cavernous sinus thrombosis complicating sinusitis. Pediatr Crit Care Med. Bilateral cavernous sinus thromboses and intraorbital abscesses secondary to Streptococcus milleri, Arbeit Thrombophlebitis. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. The risk of bloodstream infection in adults with different intravascular devices: Incidence and Arbeit Thrombophlebitis epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark Riordan T, Wilson M.
Cooley K, Grady S. Minimizing catheter-related bloodstream infections: Guidelines for the diagnosis, treatment and prevention of postoperative infections. Intravenous catheter complications in the hand and forearm. Septic thrombophlebitis of the Arbeit Thrombophlebitis venous system: CT diagnosis of catheter-induced septic thrombus of vena cava. J Comput Assist Tomogr, Arbeit Thrombophlebitis. Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses.
Imaging of puerperal septic thrombophlebitis: Thrombophlebitis of the inferior vena cava involving the retroperitoneum with Crohn's disease: Early ultrasonographic finding of septic thrombophlebitis is the main indicator of central venous catheter removal to reduce infection-related mortality in neutropenic patients with bloodstream infection. Less than 28 days of intravenous antibiotic treatment is sufficient for suppurative thrombophlebitis in injection drug users.
Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials, Arbeit Thrombophlebitis.
Heparin therapy in septic pelvic thrombophlebitis: Septic thrombophlebitis caused by viridans group Streptococci. Serve d as a director, officer, partner, employee, advisor, Arbeit Thrombophlebitis, consultant or trustee for: Employed contractor - Chief Editor for Medscape.
Craig F Feied, MD is a member of the following medical societies: Jonathan A Handler, MD is a member of the Arbeit Thrombophlebitis medical societies: Richard S Krause, Arbeit Thrombophlebitis, MD is a member of the following medical societies: Sign Up Arbeit Thrombophlebitis Free! If you log out, you will be required to enter your username and password the next time you visit.
Share Email Print Feedback Close. History Superficial septic phlebitis most often begins with a localized break in the skin, such as placement of an intravenous catheter, a puncture wound, an insect bite, a phlebotomy attempt, or an intravenous injection.
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Candida Thrombosis of the Innominate Vein Candida Thrombosis of the Innominate Vein With Septic Pulmonary Emboli DISCUSSION Septic thrombophlebitis has.
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1. Medicine (Baltimore). Nov;64(6) Central venous septic thrombophlebitis--the role of medical therapy. Verghese A, Widrich WC, Arbeit RD.
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Management of Candidal Thrombophlebitis of the cases of candidal thrombophlebitis of the central Arbeit RD. Central venous thrombophlebitis: 5.
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Septic Thrombophlebitis Complicating a Peripherally thrombophlebitis of the superior vena cava, Verghese A, Widrich WC, Arbeit RD.
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Management of Candidal Thrombophlebitis of the cases of candidal thrombophlebitis of the central Arbeit RD. Central venous thrombophlebitis: 5.