Lemierre's syndrome: current perspectives on diagnosis and management.
This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection withFusobacterium necrophorum.We found a total of 137 cases of LS, of which 47 were infected withF. necrophorumand others withStaphylococcusandStreptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4-6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.
Department of Lung Medicine, Naestved Hospital, Naestved.
Katrine M
KM
Johannesen
Department of Lung Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense; Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark.
Uffe
U
Bodtger
Lemierre’s syndrome; fusobacteria; postanginal sepsis
Am J Emerg Med. 2013 Jan;31(1):274.e5-7
22809766
Am J Emerg Med. 2013 Jan;31(1):268.e5-7
22795989
Scott Med J. 2013 Feb;58(1):e24-7
23596035
J Emerg Med. 2012 May;42(5):573-5
21035986
Auris Nasus Larynx. 2013 Oct;40(5):493-6
23084837
BMJ Case Rep. 2013 Jan 31;2013:null
23376662
Am J Emerg Med. 2015 Sep;33(9):1319
26099786
J Laryngol Otol. 2015 Jan;129 Suppl 1:S60-2
25292182
Laryngoscope. 2015 Apr;125(4):863-8
25387698
J Microbiol Immunol Infect. 2015 Apr;48(2):238-9
24388576
Ann R Coll Surg Engl. 2012 Apr;94(3):e132-3
22507711
QJM. 2014 Sep;107(9):759-61
22267575
Emerg Med Australas. 2012 Dec;24(6):673-6
23216731
Pediatr Infect Dis J. 2013 Nov;32(11):1301-2
24141806
Am J Emerg Med. 2015 May;33(5):733.e3-4
25455045
J Am Board Fam Med. 2015 May-Jun;28(3):425-30
25957375
J Clin Neurosci. 2014 Feb;21(2):346-8
24060623
Intern Med. 2013;52(2):285-8
23318865
World J Pediatr. 2014 Aug;10(3):281-3
24668238
Intern Med. 2012;51(11):1419-23
22687854
Chest. 2014 Apr;145(4):e10-3
24687725
Indian J Pediatr. 2013 Dec;80(12):1059-61
23275185
N Engl J Med. 2015 Feb 5;372(6):581-2
25651266
J Gen Intern Med. 2014 Oct;29(10):1414-8
24841558
BMJ Case Rep. 2013 Apr 23;2013:null
23616317
CMAJ. 2015 Nov 3;187(16):1229-31
26261192
Br J Nurs. 2013 Oct 10-23;22(18):1075-8
24121852
J Microbiol Immunol Infect. 2012 Feb;45(1):72-4
22154996
Eur Spine J. 2015 May;24 Suppl 4:S502-7
25245891
Jpn J Infect Dis. 2014;67(6):488-9
25410567
J Emerg Med. 2013 Feb;44(2):e177-82
22989693
Laryngoscope. 2009 Aug;119(8):1552-9
19554637
J Thromb Thrombolysis. 2014 Apr;37(3):246-8
23686643
Ann Acad Med Singapore. 2013 Jan;42(1):52-4
23417592
Int J Clin Pharm. 2012 Dec;34(6):818-21
22899236
J Formos Med Assoc. 2012 Jul;111(7):403-5
22817819
Am J Crit Care. 2014 Mar;23 (2):176-9
24585168
J Emerg Med. 2012 Apr;42(4):e77-80
19327936
Br J Neurosurg. 2012 Jun;26(3):426-8
22077587
J Formos Med Assoc. 2014 Oct;113(10):762-3
25240308
Acta Radiol. 2013 Jul;54(6):622-7
23528567
J Emerg Med. 2012 Oct;43(4):671-3
20566261
Postgrad Med J. 2004 Jun;80(944):328-34
15192164
J Assoc Physicians India. 2012 Mar;60:60-3
22799122
Head Neck. 2014 Jul;36(7):1044-51
23784917
Rheumatol Int. 2013 Mar;33(3):817-8
22190274
West J Emerg Med. 2014 Mar;15(2):125-6
24672595
Braz J Infect Dis. 2013 Jul-Aug;17 (4):507-9
23797007
Heart Lung. 2013 Jan-Feb;42(1):74-6
22464641
Thorac Cardiovasc Surg. 2013 Dec;61(8):754-7
23564539
Am J Emerg Med. 2013 Feb;31(2):460.e1-3
23041486
Emerg Med J. 2015 Aug;32(8):625, 646
26195474
Intern Med. 2015;54(14):1803-8
26179541
Turk J Pediatr. 2012 Sep-Oct;54(5):528-31
23427519
BMJ Case Rep. 2013 Jan 22;2013:null
23345481
Indian J Pediatr. 2011 Dec;78(12):1536-42
21625832
BMJ Case Rep. 2015 Jan 09;2015 :null
25576526
BMC Res Notes. 2015 Mar 03;8:65
25889618
Neuropediatrics. 2014 Apr;45(2):120-2
24227208
Korean J Ophthalmol. 2013 Jun;27(3):219-23
23730118
J Oral Maxillofac Surg. 2013 Feb;71(2):310-5
22835986
ANZ J Surg. 2011 Jun;81(6):488-9
22295363
Am J Emerg Med. 2013 Feb;31(2):458.e1-3
23407038
J Fam Pract. 2014 Apr;63(4):193-6
24905121
Infection. 2012 Aug;40(4):477-8
22527877
J Microbiol Immunol Infect. 2013 Jun;46(3):237-40
22487510
Hawaii J Med Public Health. 2015 Aug;74(8):260-6
26279962
BMJ Case Rep. 2013 Apr 29;2013:null
23632177
BMJ Case Rep. 2013 Nov 28;2013:null
24287482
Braz J Otorhinolaryngol. 2015 Sep-Oct;81(5):568-70
26324201
J AAPOS. 2011 Dec;15(6):587-9
22153405
Neurology. 2013 Sep 24;81(13):1179-80
24062342
Semin Roentgenol. 2012 Apr;47(2):103-5
22370188
J Assoc Physicians India. 2013 Oct;61(10):754-7
24772738
Scand J Rheumatol. 2013;42(2):167-8
23311933
Aust Dent J. 2013 Jun;58(2):246-9
23713647
Clin Microbiol Rev. 2007 Oct;20(4):622-59
17934077
Am J Otolaryngol. 2012 Jan-Feb;33(1):159-62
21345516
Intensive Care Med. 2015 Feb;41(2):329-30
25274006
Int J Pediatr Otorhinolaryngol. 2013 Sep;77(9):1585-8
23845534
Pan Afr Med J. 2014 Aug 04;18:275
25489369
J Med Microbiol. 2011 Sep;60(Pt 9):1391-4
21546562
Intern Med J. 2013 Jun;43(6):728-30
23745997
Eur Clin Respir J. 2016 May 10;3:30287
27171316
Eur J Clin Microbiol Infect Dis. 2008 Sep;27(9):779-89
18330604
Infection. 2013 Aug;41(4):889-92
23435719
J Clin Microbiol. 2012 Sep;50(9):3144-5
22760040
J Orthop Sci. 2012 Sep;17(5):663-6
21643795
Anaerobe. 2013 Aug;22:118-20
23664903
Chin Med J (Engl). 2013 Jan;126(2):391-2
23324298
Med J Malaysia. 2012 Jun;67(3):340-1
23082433
Am J Emerg Med. 2012 Oct;30(8):1658.e5-7
22033390
PLoS Med. 2009 Jul 21;6(7):e1000097
19621072