Doctor, I have a sore throat

Sore throat is a common complaint, generally thought to be viral in origin, for which there may be a reluctance to prescribe antibiotics. This, combined with the emergence of antibiotic resistance, may explain the recent rise in the number of reports of Lemierre's syndrome (LS). LS characterises a postanginal septicaemia that is associated with significant morbidity and mortality if not recognised and treated early. This article describes the management of a 17-year-old boy diagnosed with LS to illustrate its classical presentation, common pitfalls in diagnosis and optimal management.

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Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

151

160

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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 with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. 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.

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Doctor, I have a sore throat

Cited by 4 publications

References 10 publications

Lemierre's syndrome: Acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with pulmonary septic emboli

Lemierre's syndrome: Acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with pulmonary septic emboli

Lemierre's syndrome: the importance of early detection

Lemierre’s syndrome: current perspectives on diagnosis and management

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Doctor, I have a sore throat

Cited by 4 publications

References 10 publications

Lemierre's syndrome: Acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with pulmonary septic emboli

Lemierre's syndrome: Acute oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein with pulmonary septic emboli

Lemierre's syndrome: the importance of early detection

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

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Lemierre’s syndrome: current perspectives on diagnosis and management