Lemierre's syndrome: A systematic review

Department of Otolaryngology, Liverpool University Hospitals, United Kingdom.
The Laryngoscope (Impact Factor: 2.14). 08/2009; 119(8):1552-9. DOI: 10.1002/lary.20542
Source: PubMed


Lemierre's syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly Fusobacterium necrophorum. It was once called the forgotten disease because of its rarity, but it may not be that uncommon after all. This review aims to provide physicians with an update on the etiology, management, and prognosis of Lemierre's syndrome.
Systematic review using the terms: Lemierre's syndrome, postanginal septicemia, fusobacterium, internal jugular vein thrombosis. Inclusion criteria: English literature; reviews, case reports, and case series. Exclusion criteria: variants or atypical Lemierre's syndrome cases, negative fusobacteria cultures, and papers without radiological evidence of thrombophlebitis.
Eighty-four studies fulfilled our inclusion criteria. The male to female ratio was 1:1, 2, and the ages ranged from 2 months to 78 years (median, 22 years). Main sources of infection were tonsil, pharynx, and chest. Most common first clinical presentation was a sore throat, followed by a neck mass and neck pain. The most common offending micro-organism was F. necrophorum. Treatment modalities used were antimicrobial, anticoagulant, and surgical treatment. Morbidity was significant with prolonged hospitalization in the majority of patients. The overall mortality rate was 5%.
Lemierre's syndrome may not be as rare as previously thought. This apparent increase in the incidence may be due to antibiotic resistance or changes in antibiotic prescription patterns. Successful management rests on the awareness of the condition, a high index of suspicion, and a multidisciplinary team approach.

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    • "Lemierre ' s disease may be increasing in incidence , although this is perhaps merely reflective of reporting bias ( Ramirez et al . , 2003 ; Riordan , 2007 ) . This has prompted speculation that the increase could be due to changing prescribing habits away from empirical antibiotic use for patients presenting with pharyngitis ( Karkos et al . , 2009 ) . However , considering the low incidence of septic thrombophlebitis , this is not a valid excuse to abandon antibiotic stewardship pro - grammes , which are attempting to slow the increase in antimicrobial resistance ( Huttner et al . , 2014 ) ."
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    ABSTRACT: Introduction: Treatment of septic thrombophlebitis of the jugular vein may include both medical and surgical interventions. Historically, the goal of surgical interventions was not the restoration of blood flow through the affected vessel. Case presentation: We present a case of a 19-year-old male with septic thrombophlebitis who, despite appropriate antibiotic treatment, experienced symptomatic thrombus progression. Percutaneous thrombolytic procedures were performed, successfully restoring blood flow without triggering clinically significant bacteraemia or septic emboli. Conclusion: Thrombolysis may have a role in select patients, especially those with co-existent thrombophilia or progressive thrombus development despite medical treatment. [full text available at ]
    01/2015; 2(1):e000008-e000008. DOI:10.1099/jmmcr.0.000008
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    • "At the same time, some authors have noticed an increase of severe infections caused by F. necrophorum (Lemièrre syndrome) [15] [16]. This conclusion is not, however, generally accepted [17], as the increase may be due to publication bias [18] [19]. The studies focusing on F. necrophorum as a throat pathogen have, so far, been based on routine clinical microbiology data and have focused on the presence of this bacterium only [12] [14] [15]. "
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    ABSTRACT: Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of a limited number of pathogens. The aim of the present study was to investigate the presence of a wide range of bacteria and viruses, including Fusobacterium necrophorum, in patients with pharyngotonsillitis and in asymptomatic controls. A prospective case control study was performed in primary healthcare in Kronoberg County, Sweden. Patients (n=220) aged 15 to 45 years with a suspected acute pharyngotonsillitis, and controls (n=128), were included. Nasopharyngeal and throat swabs were analysed for β-hemolytic streptococci, F. necrophorum, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and 13 respiratory viruses. Serum samples were analysed for antibodies to Epstein-Barr virus. The patient history and symptoms, including Centor score, were analysed in relation to pathogens. In 155/220 (70.5%) of the patients, as compared to 26/128 (20.3%) of the controls (p <0.001), at least one microorganism was found. Group A streptococci, F. necrophorum, and influenza B virus were the three most common findings, and all significantly more common in patients than in controls (p <0.001, p 0.001, and p 0.002, respectively). Patients with F. necrophorum only (n=14) displayed a lower Centor score than patients with Group A streptococcus only (n=46), but a higher score than patients with influenza B, other viruses, or no potential pathogen (Kruskal-Wallis p <0.001). A pathogen was detected in 70% of the patients, displaying a wide range of pathogens contributing to the aetiology of pharyngotonsillitis. This study supports F. necrophorum as one of the pathogens to be considered in the aetiology of pharyngotonsillitis. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Clinical Microbiology and Infection 10/2014; 40(3). DOI:10.1016/j.cmi.2014.08.020 · 5.77 Impact Factor
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    • "Despite reports of human illnesses caused by what is now known as F. necrophorum appearing within early 20th Century literature, the consensus definition of Lemierre’s syndrome remains unclear [5,77]. The authors undertook a literature review to further clarify these diagnostic criteria. "
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    ABSTRACT: Lemierre's disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701-3, 1936. Clin Microbiol Rev 20(4):622-59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre's disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre's disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre's disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre's.
    World Journal of Emergency Surgery 05/2014; 9(1):38. DOI:10.1186/1749-7922-9-38 · 1.47 Impact Factor
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