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.
"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 ) ."
[Show abstract][Hide abstract] 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 http://jmmcr.sgmjournals.org/content/2/1/e000008.full.pdf+html?sid=bf4cebbf-80cd-4d42-b93d-da763769cf16 ]
"At the same time, some authors have noticed an increase of severe infections caused by F. necrophorum (Lemièrre syndrome)  . This conclusion is not, however, generally accepted , as the increase may be due to publication bias  . 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   . "
"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. "
[Show abstract][Hide abstract] 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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