Lemierre's syndrome

Background

  • Also known as "Lemierre's disease" and "postanginal shock including sepsis" and "human necrobacillosis"
  • Is a form of thrombophlebitis[1]
  • Usually caused by Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium (F. nucleatum, F. mortiferum and F. varium etc.) or MRSA
  • Usually affects young, healthy adults, most often developing after Strep Pharyngitis causing peritonsilar abscess
    • Anerobic Bacteria grow in the peritonsilar abscess and penetrate into the neighboring jugular vein causing thrombophlebitis and bacteremia and septic emboli and occassionally pneumonia and sepsis

Epidemiology

  • Very rare, incidence rate of 0.8 cases per million in the general population[2]
  • When diagnosed, mortality is 4.6%[3]

Clinical Features

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Evaluation

Workup

  • CTA of neck
  • Point of care ultrasound may reveal IJ thrombus
  • Blood Cultures

Evaluation

Diagnostic criteria:

  • History of oropharynx pain within last 4 wks
  • Evidence of IJV thrombophlebitis/carotid sheath
  • Isolation of F. necrophorum from blood
  • Evidence of metastatic infection in another site (lungs)

Management

  • Antibiotics (coverage of F. necrophorum, strep, bacteroides) - Unasyn, Zosyn, or carbapenem for at least 3-4 wks
    • IV Antibiotics
  • Drainage of abscess
  • Consider ligation of the internal jugular vein where antibiotic can not penetrate.[6]
  • No evidence for or against anticoagulation[7]

Disposition

  • Admit

See Also

Video

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References

  1. "Lemierre syndrome" at Dorland's Medical Dictionary
  2. Sibai K, Sarasin F (2004). "Lemierre syndrome: a diagnosis to keep in mind". Revue médicale de la Suisse romande (in French) 124 (11): 693–5. PMID 15631168.
  3. Centor RM. "Expand the Pharyngitis Paradigm for Adolescents and Young Adults." Ann Intern Med. 2009;151(11):812-815. doi:10.7326/0003-4819-151-11-200912010-00011
  4. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  5. http://www.thepocusatlas.com/soft-tissue-vascular/
  6. Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.
  7. Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.
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