Lemierre Syndrome: A Meta-analysis

Abstract

Introduction Lemierre syndrome, or postpharyngitis anaerobic sepsis, is an infrequent but life-threatening infection that often involves thrombosis of the internal jugular vein. The role of anticoagulation in addition to antibiotics and surgical treatment remains uncertain. Objectives 1) To perform a meta-analysis on outcomes and treatment of Lemierre syndrome; and 2) to evaluate the effect of anticoagulation in Lemierre syndrome on vessel recanalization and on mortality. Data Synthesis A Pubmed database search was conducted using the keywords Lemierre syndrome. A total of 427 studies were identified and reviewed. Data were extracted on patient demographics, treatment type including use and type of anticoagulation, type of antibiotics, presence and location of vessel thrombosis, presence of cranial neuropathies, recanalization of thrombosed vessels on follow-up imaging, organisms isolated on wound or blood cultures, and mortality. The primary outcome variables examined were the effect of anticoagulation on vessel recanalization and mortality. After the review, 359 studies totaling 394 patients between 1990 and 2017 had partial or complete data that could be analyzed. In total, 50 patients had sufficient data on the effect of anticoagulation on vessel recanalization, and 194 had sufficient data on the effect of anticoagulation on mortality. The odds ratio for anticoagulation and vessel recanalization was 1.6 (95% confidence interval = 0.3 to 9.4; p = 0.6). The odds ratio for anticoagulation and death was 0.6 (95% confidence interval = 0.1 to 2.9; p = 0.5). Conclusion The present meta-analysis did not demonstrate a statistically significant effect on vessel recanalization or mortality for patients treated with anticoagulation versus patients not anticoagulated in the Lemierre syndrome literature.

Pharyngeal abscess complicated by Lemierre’s syndrome: Identification of an atypical germ

“…According to a recent meta-analysis, Lemierre's syndrome preferentially affects men (60 %) with an average age of 28.8 [ 18 ]. The mortality rate is estimated at 4.1 %.…”

“…The mortality rate is estimated at 4.1 %. Pulmonary septic embolisms are common (37.6 %) while cerebral embolisms are more rare (3%) [ 18 ]. Because of the seriousness of this condition, antibiotic treatment combining Betalactamine or Cephalosporin and Metronidazole must be started immediately after diagnosis.…”

The challenges of a Lemierre’s syndrome in COVID-19 times

“…Recent studies have examined the role of anticoagulants in the treatment of Lemierre's syndrome, but there is no consensus on the role of anticoagulation and its effect on vessel recanalization. 7,8 There are no data to support the idea that the recanalization of the IJV was an advantage and lowered morbidity and mortality. 9 The anticoagulant therapy was not contemplated in our patient as the thrombus was stable with no signs of progression and also there was no thrombophilia or antiphospholipid antibodies.…”

Lemierre's Syndrome: A Case of a Large Inflammatory Neck Mass with Internal Jugular Vein Thrombosis and Literature Review of Its Surgical Intervention

“…In an 8-year Swedish nationwide retrospective study, three patients with peritonsillitis were surgically treated by tonsillectomy [11]. In the latest meta-analysis of 394 patients in 2020, only 10 patients underwent IJV ligation/excision, only 1 patient underwent ligation/excision of the thrombosed external carotid artery, 3 underwent endoscopic sinus surgery and 11 underwent mastoidectomy [12]. In the latest systematic review, which included the most LS cases reported, surgical procedures were performed in 101 patients, and 31 patients underwent IJV ligation/embolectomy [13].…”