PMC8188389_01
Axial view of CT neck with and without IV contrast. White arrow showing completely occluded right internal jugular vein, secondary to thrombosis.
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CT neck with and without IV contrast revealed a completely occluded right internal jugular vein secondary to thrombosis (Fig. 1).
a and b. Axial views of CT neck with and without IV contrast. a) White arrow showing extension of right internal jugular vein thrombus into the retromandibular vein. b) White arrow showing a right sided supparative lymph node, measuring 2 cm, surrounded by extensive fluid in the retropharyngeal and parapharyngeal space and inflammatory stranding.
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The thrombus extended into the retromandibular vein (Fig. 2a) and was surrounded by extensive fluid in the retropharyngeal space with associated inflammatory stranding and suppurative lymphadenopathy (Fig. 2b).
Axial view of CT chest without contrast. White arrow demonstrating one of multiple subpleural nodules, consistent with septic emboli of the patient's Lemierre's syndrome.
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Repeat CT imaging of the neck showed unchanged features of LS, and CT chest revealed multiple small subpleural nodules, consistent with septic emboli (Fig. 3).
Taxonomic allocation of the analyzed genome (ER17974_3A_016564) using average nucleotide identity (ANI) analysis. The comparison included a set of 11 high quality genomes of the genus Klebsiella, widely used for comparative pathogenomic studies (http://www.mgc.ac.cn/cgi-bin/VFs/v5/main.cgi?func=VFanalyzer). ANI analysis was performed and visualized using pyANI (https://github.com/widdowquinn/pyani). An ANI result >= 95% indicates that two genomes belong to the same species. White cells correspond to comparisons just in the threshold (95%), while red cells correspond to comparison with results higher that 95%. Blue cells correspond to genomes do not belong to the same species. Colour intensity fades as the comparisons approach 95% ANI sequence identity. Clustering of the ANI results is graphically represented in a two-dimensional dendrograms inferred from linkage of ANI percentage identities.
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The results are graphically represented in Fig. 4.
Phylogenetic reconstruction based on the concatenated sequences alignment for the seven housekeeping genes used for K. pneumoniae MLST scheme of the total number of reported sequence types 'STs' (n = 4,841). The tree was constructed using FastTree double precision version 2.1.10 and visualized in the interactive tool Tree Of Life V4 (http://itol.embl.de). Green dots represent well-supported nodes (Bootstraps >= 95.0). The location of the ST-65, to which the genome of interest belongs, is indicated by a red arrow.
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Tree Of Life V4 tool (http://itol.embl.de) (Fig. 5). The observed topology confirms the existence of 3 phylogroups, with ST-65 associated with the predominant Phylogroup, which is consistent with the information presented above (phylogroup from ST: Kp1).