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PubMed1993

[Septic Campylobacter fetus thrombophlebitis: a new case].

The diagnosis of septic thrombophlebitis is difficult and often delayed, but it must be borne in mind in all cases of venous thrombosis accompanied by signs of local and/or systemic infection, or deteriorating under heparin therapy. We report a case of septic thrombophlebitis caused by Campylobacter fetus subspecies fetus. The characteristic features, obtained from the literature, of septic thrombophlebitis caused by Campylobacter spp are presented.

Campylobacter Infections↗

PubMed1998

Saphenous vein thrombophlebitis (SVT): a deceptively benign disease.

PURPOSE: The association between deep vein thrombosis (DVT) and the hypercoagulable state is a well-established entity. However, the association between saphenous vein thrombophlebitis and coagulation abnormalities has not been investigated. Although thrombosis of varicose veins typically runs a benign course, phlebitis of the saphenous system may propagate to the deep system or saphenofemoral junction that requires more aggressive therapy. Given the potential similarity in clinical outcome between saphenous vein thrombophlebitis (SVT) and DVT, we have investigated the coagulation profile of patients presenting with isolated SVT. METHODS: Seventeen consecutive patients who presented to our vascular laboratory with isolated SVT had a coagulation profile performed that included antithrombin III (AT III), protein C (PC), protein S (PS) antigen and activity levels, activated protein C (APC) resistance, factor V DNA mutation, and coagulation factors II and X. All patients had duplex scans performed on both the superficial and deep venous systems. Patients with SVT only were treated with nonsteroidal antiinflammatory drugs (NSAIDs) and warm soaks as outpatients, whereas those patients found to have DVT or a clot at the saphenofemoral junction were fully anticoagulated with heparin and coumadin therapy. All 17 patients had at least one repeat coagulation profile performed up to 5 months after their SVT occurrence to ensure that the results of hypercoagulability were not transient. RESULTS: Ten (59%) of the 17 patients with SVT had abnormal coagulation profiles on initial presentation. All 10 patients who were hypercoagulable had repeat tests and 6 (35%) remained abnormal. Four patients who had abnormal results converted to normal values. Seven patients with normal coagulation profiles on initial presentation had repeat tests and all remained normal. CONCLUSION: The incidence of the hypercoagulable state in patients with SVT is high. Thirty-five percent of patients with isolated SVT had consistently abnormal coagulation profiles. Patients with SVT may be prone to the development of DVT or saphenofemoral junction thrombophlebitis and should be closely followed after the initial diagnosis of hypercoagulability.

Adult↗

PubMed1999

[Post-partum suppurating thrombophlebitis of the ovarian vein presenting with pleuropulmonary manifestations].

Following a normal delivery, a 22-year-old primigravida experienced fever resistant to antibiotic therapy. On the tenth post partum day, thoracic pain and chest X-ray were in favour of acute pneumonitis of left inferior lobe. Considering the extension to the right lung and a normal bronchic fibrescopy, a computed tomography (CT) was performed which showed a right ovarian vein thrombophlebitis, right minor subpleural opacities and left pneumopathy. The final diagnosis was post partum ovarian vein suppurated thrombophlebitis with pulmonary septic metastases from haematogenic diffusion. Post partum thrombophlebitis is a rare event with an incidence of 1 per 2,000 deliveries. Pulmonary inaugurating symptoms result rather from pulmonary embolism than from septic metastases. Post partum persisting and unexplained fever should be explored with abdominal CT-scan.

Adult↗

PubMed1986

Candidal suppurative peripheral thrombophlebitis: recognition, prevention, and management.

Candida species are seldom considered as a cause of suppurative peripheral thrombophlebitis. During a 15-month period in a 291-bed acute-care hospital, candidal suppurative peripheral thrombophlebitis developed in seven patients. All patients had fever, a tender palpable cord, and Candida species isolated from resected veins and/or pus expressed at the catheter entrance site. Four patients had candidemia. None were neutropenic or recipients of corticosteroids. All had concomitant or preceding bacterial infections, and had received a median of 5 antibiotics (range 3 to 9) for at least 2 weeks. Five of seven had documented preceding candidal colonization associated with broad spectrum antibiotic therapy. Catheter sites had not been routinely rotated and local catheter site care was deficient. Risk factors of antibiotics and duration of hospitalization were fewer in patients with bacterial suppurative thrombophlebitis. Combined segmental venous resection and intravenous amphotericin B appears to be the most rational therapy for this nosocomial fungal infection.

Aged↗

PubMed1986

Suppurative thrombophlebitis: correlation between pathogen and underlying disease.

We identified 29 episodes of suppurative thrombophlebitis in 27 patients admitted to a large general hospital between May 1980 and May 1984. In 25 patients, the intravenous cannulae had been in place for more than 3 days. Streptococcus faecalis, Pseudomonas aeruginosa or one of the Enterobacteriaceae were implicated in 14 patients. All these patients had recently undergone abdominal surgery or had a major intra-abdominal inflammatory process at the time they developed thrombophlebitis. The remaining 13 patients were infected with Staphylococcus aureus, other gram-positive cocci or Candida species. Only two of these had an active abdominal process at the time of their infection (chi 2 = 16.08, P less than 0.001). There is an apparent association between phlebitis caused by enteric organisms and active intra-abdominal pathology. There were two deaths related to delayed or deferred surgery. Suppurative thrombophlebitis is a lethal, preventable nosocomial infection that requires urgent surgical intervention.

Abdomen↗

PubMed2001

[Diagnosis and therapy of progressive thrombophlebitis of epifascial leg veins].

INTRODUCTION: The thrombophlebitis is generally regarded as a harmless disease. However, the progressive varicophlebitis represents a subgroup of thrombophlebitis in which the proximal portion of the thrombus can ascend into the deep vein system with the complication of deep vein thrombosis or pulmonary embolism. PATIENTS AND METHODS: In a period of 15 months ten patients were operated upon in whom a progressive varicophlebitis was diagnosed with color-flow duplex scanning. Eight of them were men, two were women. The average age was 56 years. RESULTS: Nine patients had an ascending thrombosis of the greater saphenous vein. One patient had the origin of the thrombus in the shorter saphenous vein. In one patient the ascending thrombosis of the greater saphenous vein was the reason for a segmental pulmonary embolism. The indication for operation was given when the proximal portion of the thrombus was within 10 cm of the confluence to the deep vein system. The operative procedure comprised the ligature of the epifascial vein. CONCLUSION: The diagnosis of thrombophlebitis should not be restricted only to clinical examination. Color-flow duplex scanning is preferred to compression venous ultrasonography. The ascending contrast venography as invasive diagnostic procedure should only be performed for the clarification of further questions. In ascending varicophlebitis ligature of the confluence from the superficial to the deep vein system is a safe procedure to avoid a progression of the disease or embolism. In case of postoperative recanalisation of the superficial varicose vein a second operation with stripping of the vein can be performed.

Adult↗

PubMed1998

Management of candidal thrombophlebitis of the central veins: case report and review.

Candidemia and major organ candidiasis are problems that emerged in the past 2 decades and that are partially due to medical progress. Catheter-related thrombosis of the central veins is known to be a frequent but mostly subclinical complication of central venous lines. Although candidemia and catheter-related thrombosis are frequent, candida thrombophlebitis of the central veins is rarely reported. We recently successfully treated a 19-year-old polytrauma patient with candidal thrombophlebitis of the innominate vein. Despite catheter removal and therapy with amphotericin B, recurrent candidemia and signs of infection persisted, and a complete resection of the involved vein had to be performed. Only 16 well-documented cases of candidal thrombophlebitis of the central veins in adults have been reported over the past 20 years. An analysis of these 16 patients, together with our patient, is made in relation to risk factors, clinical features, diagnosis, therapy, and mortality.

Adult↗

PubMed1985

Thrombophlebitis and cellulitis due to Campylobacter fetus ssp. fetus. Report of four cases and a review of the literature.

Four cases of acute thrombophlebitis and cellulitis due to C. fetus ssp. fetus are reported, with a review of 18 previously reported cases. Vascular infection with thrombophlebitis due to C. fetus ssp. fetus occurred predominantly in adult male patients with underlying debilitating, immunocompromising illnesses resulting in a mortality rate of 32%. Although approximately one-third of the patients had exposure to known reservoirs of C. fetus ssp. fetus, none of the patients presented with diarrhea, and only one of the cases had C. fetus ssp. fetus recovered from stool culture. Diagnosis of C. fetus ssp. fetus thrombophlebitis or cellulitis is based on clinical suspicion and recovery of the agent from blood culture; the latter requires an average incubation period of 8 days. Empiric therapy with erythromycin, and an aminoglycoside or chloramphenicol is recommended in suspect patients pending results of blood cultures.

Adult↗

PubMed2005

Bilateral upper extremity thrombophlebitis related to intravenous amiodarone: a case report.

A 47-year-old male had bilateral upper extremity thrombophlebitis after use of intravenous amiodarone for sustained ventricular tachycardia complicating myocardial infarction. Intravenous amiodarone has been widely used since it was introduced 20 years ago for severe intractable arrhythmias. Superficial thrombophlebitis was frequently noted in the early case reports when high-dose intravenous amiodarone was used. Superficial thrombophlebitis could extend hospitalization and become a significant source of distress to our patients. Some authors recommend insertion of a central line to administer intravenous amiodarone especially with expected extended use of therapy. The treating physician should be vigilant and switch from intravenous therapy to oral therapy as soon as the patient's condition stabilizes and oral therapy can be started.

Amiodarone↗

PubMed1985

Prevention of infusion thrombophlebitis.

Thrombophlebitis is a frequent and discomforting complication following infusions into peripheral veins. In controlled clinical and animal experiments, it has also been shown that following factors reduce the risk of development of infusion thrombophlebitis: a short infusion time, neutralization of the acid glucose solutions, addition of heparine to sugar solutions, use of short and thin needles instead of plastic cannulae or 30 cm-teflon catheters, use of 5% glucose instead of more concentrated solutions and use of glucose in preference to fructose. The importance of in-line membrane filters is not convincing, and the addition of hydrocortisone and the effects of changing administration sets seem without clinical importance. In conclusion, it is possible in clinical praxis to follow principles, which minimize the risk of the unpleasant and long-lasting complication - infusion thrombophlebitis.

Carbohydrates↗

PubMed1989

Cannula thrombophlebitis: a study in volunteers comparing polytetrafluoroethylene, polyurethane, and polyamide-ether-elastomer cannulae.

Cannulae made of polytetrafluoroethylene (PTFE: n = 11), thermoplastic polyether-urethane (TPEU: n = 11), and a new test material, polyamide-ether-elastomer (XLON: n = 10) were inserted into the veins of the dorsum of the hand in 32 healthy volunteers (10 women and 22 men), 21-50 years old. The cannulae were intended to be left in place for 5 days. No infusion was given and the dressings were not exchanged. The resulting thrombophlebitis, defined as two or more of the symptoms pain, redness, oedema and hardness, was estimated on a scale which took into account the incidence, location, intensity, and duration of the symptoms. Except for one volunteer in the XLON group, all the volunteers developed thrombophlebitis, generally observed on the third day of cannulation, and being more frequent and intense over the cannulae (P less than 0.001) and at the tip (P less than 0.01) than at the insertion sites. Pain and oedema were, on the whole, the most frequent and severe symptoms during the period of indwelling. After withdrawal, hardness was the most intense, and together with pain, the most long-lasting (up to 10 days) symptom. The differences between the materials in thrombophlebitis incidence and intensity were statistically significant only when each symptom was analysed separately. Thus, the PTFE cannulae caused more pain and hardness (probably because of greater platelet adhesion and a relatively greater stiffness), while the TPEU and XLON cannulae produced more periphlebitis (redness and oedema), probably because of potentially irritant and antigenic substances leaking from them (polyurethane oligomers and polyamide/polyethyleneglycol oligomers).

Adult↗

PubMed1999

[Campylobacter fetus bacteremia and thrombophlebitis in a patient with Waldenstrom's macroglobulinemia].

We report a 67-year-old male with Waldenstrom's macroglobulinemia who developed Campylobacter fetus subspesis fetus (C. fetus) bacteremia and thrombophlebitis. The patient developed a fever and pain in his left lower limb, and could not walk because of the pain. Radioisotopic venography showed thrombophlebitis in his left lower limb. His blood culture grew C. fetus. After starting intravenous PAPM/BP, his symptoms resolved promptly. In contrast to Campylobacter jejuni which is a common cause of infectious diarrhea, C. fetus infection has distinct clinical features showing systemic illness such as bacteremia and thrombophlebitis mainly occurring in immunocompromized patients. This organism should be considered as one of the possible pathogenes in the infectious complications of the immunocompromized patients.

Aged↗

PubMed1976

Comparison of thrombophlebitis associated with three cephalosporin antibiotics.

A double-blind study with volunteers was performed to determine the incidence and severity of thrombophlebitis associated with cephalothin, cephapirin, cefamandole, and a water control. Although there were no statistical differences in the incidence of thrombophlebitis, cephalothin resulted in significantly more severe thrombophlebitis compared with the other agents.

Cephalosporins↗

PubMed1980

Thrombophlebitis migrans: a further systemic complication of ulcerative colitis.

Thrombophlebitis migrans complicating ulcerative colitis has been reported only once previously when it occurred in a patient with chronic and extensive bowel disease. This report describes the occurrence of thrombophlebitis before any bowel upset in a patient who proved to have only a mild colitis, and no laboratory evidence of hypercoagulability. It seems that thrombophlebitis migrans is a further systemic complication of ulcerative colitis, and that its occurrence may precede overt bowel disease.

Adult↗

PubMed1983

Contrast agent-induced thrombophlebitis following leg phlebography: meglumine loxaglate versus meglumine lothalamate.

A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine ioxaglate) and a low-osmolality contrast medium (Hexabrix 59%, meglumine iothalamate). In 30 patients with varicose veins, Conray was injected into one leg and Hexabrix into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomized, double-blind study. There was significantly less thrombophlebitis with Hexabrix than with Conray and the authors conclude that Hexabrix is safer for phlebography. Hexabrix is also stable in solution, only slightly more expensive than Conray, and one fifth the cost of metrizamide.

Adult↗

PubMed2001

Superficial thrombophlebitis and anticardiolipin antibodies--report of association.

The aim of this study was to determine a possible association between recidivist superficial thrombophlebitis and anticardiolipin antibodies. Forty-five patients with two or more episodes of superficial thrombophlebitis in lower limbs (33 women and 12 men with ages ranging from 17 to 60 years, average: 39.8) were studied. The control group was formed by 100 voluntary donors from the blood bank (83 men and 17 women, age range: 21 to 59 years, average: 35.4). Anticardiolipin antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA). For semiquantitative detection in human sera with use of QUANTA Lite ACA IgG/IgM--INOVA Diagnostic, Inc., and positive values were considered as 15 GPL units/mL and 12.5 MPL units/mL for immunoglobulin G (IgG) and IgM, respectively, as recommended by the test. The Odds Ratio method was chosen for statistical analysis with a confidence interval (CI) of 95%. In 15 patients (33.3%) anticardiolipin antibody positivity was detected, whereas in 12 patients (26.7%) it occurred as immunoglobulin M (IgM) anticardiolipin and in 3 (6.7%) as immunoglobulin G anticardiolipin. In the control group, positivity was found in 7 patients (7%) for those antibodies. Furthermore, the Odds Ratio = 6.64 with CI = 95% and values ranging from 2.48 to 17.82 (p < 0.05) were significant, as well as for IgM/IgG anticardiolipin proportion with Odds Ratio = 5.09, C = 95% and values varying from 1.33 to 19.54 (p < 0.05). The authors conclude that there is a correlation between the presence of anticardiolipin antibodies and recurrent superficial thrombophlebitis.

Adult↗

PubMed1979

Thrombophlebitis associated with vitamin E therapy. With a commentary on other medical side effects.

I have encountered 50 patients with clinical thrombophlebitis involving the lower extremites, with or without associated edema and pulmonary embolism, in whom longstanding self-medication with large amounts of vitamin E appeared to be a significant factor. The majority improved following cessation of vitamin E. In view of the epidemic nature of thrombophlebitis and deep vein thrombosis in the United States, the presumed innocuousness of vitamin E therapy requires reevaluation. Other clinical side effects also have been noted in patients receiving large doses of vitamin E. They include breast tenderness, elevation of blood pressure, a fatigue syndrome, myopathy, intestinal cramps, urticaria, and the possible aggravation of diabetes mellitus. The influence of concomitant metabolic, endocrine, and cardiovascular disorders on the thrombogenic potential of vitamin E is raised, and several possible mechanisms conducive to thrombophlebitis are reviewed.

Adult↗

PubMed1979

Transcutaneous electrical nerve stimulation in the symptomatic management of thrombophlebitis.

Transcutaneous electrical nerve stimulation (TENS) afforded significant relief of the pain associated with acute and recurrent thrombophlebitis in 90% of 39 patients so treated. The method is simple to administer, noninvasive, and apparently free of side effects. It can be self-administered by the patient after appropriate instruction. TENS can be given in conjunction with analgesics, anticoagulant therapy, and other supportive measures to achieve greater relief and mobility in patients with thrombophlebitis whose occupations and other activities are severely limited by their pain. Further clinical trials involving larger numbers of patients, and clarification of the analgesic mechanisms involved, are warranted because of the magnitude of this problem. TENS therapy can be uniquely beneficial in certain clinical situations. They include the contraindication of conventional treatments for the pain of thrombophlebitis, pelvic vein phlebitis, and the presence of concomitant painful orthopedic and neurologic disorders.

Adult↗