Fight Aging! Newsletter, July 25th 2022
This study further demonstrates that AMD is not a single condition or an isolated disease, but is often a signal of systemic malfunction which could benefit from targeted medical evaluation in addition to localized eye care." Microglia in the Aging Brain, Both Protective and Harmful https://www.fightaging.org/archives/2022/07/microglia-in-the-aging-brain-both-protective-and-harmful/ A growing body of evidence implicates the changing behavior of microglia in the aging of the brain and onset of neurodegeneration. Microglia are analogous to macrophages, innate immune cells unique to the central nervous sys...
Source: Fight Aging! - July 24, 2022 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

A Bacterial Species Involved in Gum Disease Provokes Neuroinflammation
Researchers here provide evidence for one particular oral bacterial species associated with gum disease to provoke changes in microglia population in the brain, leading to chronic inflammation and acceleration of neurodegenerative conditions. The correlation between periodontal disease and neurodegenerative diseases such as Alzheimer's disease is well known, and there are established pathways and mechanisms for oral bacteria to deliver pro-inflammatory compounds into the body. However, some studies suggest that the contribution of gum disease to the incidence of neurodegenerative conditions is modest at best, in comparison...
Source: Fight Aging! - July 19, 2022 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Ultrasound Case 097
Dr James Rippey Ultrasound Case 097 A 47 year old previously healthy man presents with sore throat / neck, dry cough and shortness of breath for 2 weeks. This had not improved despite inhalers and a course of antibiotics. He also describes widespread aches and pains including in both calves. There is some swelling in his right lower neck and you wonder whether it is lymphadenopathy, an abscess or something else. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - June 16, 2019 Category: Emergency Medicine Authors: Dr James Rippey Tags: TOP 100 Ultrasound André Lemierre André-Alfred Lemierre Armand Trousseau Fusobacterium necrophorum gastric malignancy Lemierre syndrome reniform Top 100 ultrasounds Trousseau syndrome visceral malignancy Source Type: blogs

Penicillin allergy, probably not
The current issue of JAMA has a wonderful review of penicillin allergy. This conclusion is important: Many patients report they are allergic to penicillin but few have clinically significant reactions. Evaluation of penicillin allergy before deciding not to use penicillin or other ?-lactam antibiotics is an important tool for antimicrobial stewardship. This concept has great importance. Almost every time I give a pharyngitis talk, someone asks me about second-line antibiotics for patients with “penicillin allergy”. Since penicillin (or amoxicillin) work well against group A strep, group C/G strep and Fus...
Source: DB's Medical Rants - January 20, 2019 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

If I were writing sore throat guidelines
Several tweets asked me to answer this question. How would I rewrite sore throat guidelines? Obviously I am biased. So this is my opinion and I am sticking to it! I would not change anything about pre-adolescents. Group A strep is the most important bacterial infection and using rapid tests with backup cultures makes sense.I would change the guidelines for adolescents and young adults. I would treat patients having Centor scores of 3 or 4 with either penicillin or amoxicillin (augmentin would be fine). I would probably treat some 2s if they looked very ill. I would never use macrolides. If the patient is truly penicilli...
Source: DB's Medical Rants - December 29, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

More evidence on suppurative complications from Fusobacterium necrophorum tonsillitis
This study adds to our clinical understanding of the devastating potential of this gram negative anaerobic bacteria. We have previously found that FN pharyngitis has the same clinical presentation as strep pharyngitis. Our microbiome study showed that patients with more severe clinical pharyngitis (defined as Centor scores of 3 or 4) differed between group A strep and Fusobacterium necrophorum. The tonsils with FN infection had a less bacterial diversity – this means that FN overwhelms the microbiome in many such patients. These findings suggest that FN more likely causes suppurative complications. We know from th...
Source: DB's Medical Rants - December 29, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Thoughts on a 23-year-old athlete dying from the Lemierre Syndrome
K-State football team to honor rower Samantha Scott, who died of Lemierre’s Syndrome  Every time I read such a story my heart breaks, a small piece each time. More physicians have become aware of the Lemierre syndrome. We must also educate patients and families that sore throats in adolescents and young adults can become life threatening. Why did she die?  The article does not have enough detail to develop a firm conclusion.  I can speculate on several reasons from multiple discussions with both survivors and families of adolescents who died.  We also have some unpublished survey data that informs my speculations. Wh...
Source: DB's Medical Rants - November 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

My approach to acute pharyngitis 2018
First, we must define acute pharyngitis – no more than 3-5 days of symptoms. Second, we should understand that pre-adolescent pharyngitis has major differences form adolescent/you adult pharyngitis.( Mitchell, M. S., Sorrentino, A., & Centor, R. M. (2011). Adolescent pharyngitis: a review of bacterial causes. Clinical Pediatrics, 50(12), 1091–1095. http://doi.org/10.1177/0009922811409571 )  Here are the differences: Pre-adolescent pharyngitis really is group A strep vs viral Adolescent pharyngitis has a much broader differential – GAS, Group C/G strep, Fusobacterium necrophorum, infectious mononucleosis...
Source: DB's Medical Rants - September 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Sore throats – #thefineprint
Saying that sore throats are simple has become a trope, as thus many physicians do not seem to have a thoughtful approach to adolescent/young adult pharyngitis.  As the author of the Centor Score, I would like you to consider these points when seeing sore throat patients. The most important use of the score involves identifying those who need neither diagnostic tests nor antibiotics.  Too many urgent cares run a group A rapid strep test on everyone with a sore throat. The score is meant for acute (3 day or less) sore throat symptoms. The score stratifies adolescent/young adults with bacterial pharyngitis – group A...
Source: DB's Medical Rants - June 18, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

The Fusobacterium story as of 2018 – a very long post
Conclusion:Fusobacterium necrophorum–positive pharyngitis occurs more frequently than group A ?-hemolytic streptococcal–positive pharyngitis in a student population, and F. necrophorum–positive pharyngitis clinically resembles streptococcal pharyngitis. Since Fusobacterium necrophorum recovery increased as the Centor score increased we argued that we had sufficient circumstantial evidence that this organism explained many of the 3s and 4s and that the score really reflected bacterial pharyngitis.  Our subsequent recently published paper on the pharyngitis microbiome strongly supports our contentions. So where ...
Source: DB's Medical Rants - February 11, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

The challenge of “ evidence based ” sore throat guidelines
CONCLUSION Although the evidence for the management of acute sore throat is easily available, national guidelines are different with regard to the choice of evidence and the interpretation for clinical practice. Also a transparent and standardized guideline development method is lacking. These findings are important in the context of appropriate antibiotic use, the problem of growing antimicrobial resistance, and costs for the community. We assume that the word “evidence” is all inclusive.  How can 9 guidelines on one subject differ significantly?  The first problem occurs in selecting the evidence.  Like ...
Source: DB's Medical Rants - October 23, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

FeverPAIN vs the Centor Score
On twitter this week, several British tweeters discussed whether they should use the FeverPAIN score or the Centor score.  Obviously I have a bias here, but I will try to discuss this issue dispassionately. So I downloaded the PRISM study, where the authors proposed FeverPAIN.  The goal of FeverPAIN is to increase the patient cohort not needing testing or antibiotics.  As I studied FeverPAIN I found one important advance, but another point of naïveté. To frame the discussion, the FeverPAIN study took all patients >3 years with sore throats.  They used positive testing for group A, C or G beta hemolytic streptococc...
Source: DB's Medical Rants - July 25, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Seal Finger in Canada
A recent case of “seal finger” in Canada complements an increasing number of zoonotic bacterial diseases associated with animal bites. The following list is extracted from Gideon www.GideonOnline.com (primary references available on request) :   Bacteroides pyogenes  – case of bacteremia following a cat bite. Bacteroides tectus –  cat bites Bergeyella zoohelcum –  dog-bite infection Bisgaard’s taxon 16 –  animal bite wounds Canibacter oris –  dog-bite infection Capnocytophaga canimorsus –  dog-bite infection Capnocytophaga cynodegmi –  dog-bite infec...
Source: GIDEON blog - May 26, 2017 Category: Databases & Libraries Authors: Dr. Stephen Berger Tags: General Source Type: blogs

15 years of blogging – a retrospective
May 19th, 2002 I wrote my first blog post.  Blogging had just become an interesting method for expressing opinions. Early in my blogging career I compared blogging to standing on a soap box in Hyde Park.  Bloggers had (and have) the freedom to express opinions.  Readers have the opportunity to comment, ignore or just read. I started blogging to “cure” writer’s block.  Blogging allowed me to try out ideas.  Some blog posts stimulated academic articles and research. One particular post, from September 2002, has led to my recent research into Fusobacterium necrophorum pharyngitis: Some sore throats are ...
Source: DB's Medical Rants - May 22, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Interpreting and evaluating the Centor score
In response to a twitter request,  this post will in detailed fashion discuss the score, how I recommend using it and how to evaluate it.  I will go into more detail than I generally do, because the questions require that detail. The original study, published in 1981 based on data collected in 1980, used logistic regression to evaluate predictors of positive group A beta hemolytic streptococcal cultures taken from adults (aged 16 and above) coming to an emergency department for a chief complaint of sore throat. We collected candidate symptoms and physical examination signs. The idea was always to use the resulting scores...
Source: DB's Medical Rants - April 23, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs