Lemierre's Syndrome: A Lethal Complication of Acute Tonsillitis

Abstract

Tonsillitis is a condition involving the infection of the lymphoid tissue of the tonsils. This pathology of the tonsils is frequently reported as a childhood illness in children of school-going age. The leading causative agent which is associated with tonsillitis is Group A and B Haemolytic Streptococcus and Staphylococcus and Haemophilus influenzae. With rapid and correct treatment and management with antibiotics and analgesics, it can be resolved, and the patient can be free of the symptoms such as sore throat, dysphagia, pain over the throat, and fever. Though in the minority of cases the diseases can progress and can result in multiple complications which sometimes can be lethal and extremely serious. These can be rheumatic fever, acute glomerulonephritis, or tonsillar cyst. One of the sporadic but equally important and grave syndromes is Lemierre's syndrome, which unfortunately has been labelled as a forgotten disease due to the development of antibiotic therapy and management of the disease. The mortality of the disease was extremely high in the pre-antibiotic era. This disease presents the following findings, such as thrombophlebitis of the internal jugular vein, which usually occurs after the presentation of pharyngeal infection. Which in later stages also gives rise to thrombi that advance and extend throughout the body, in the form of septic emboli. The important microorganism which is isolated and associated with the Lemierre's is Fusobacterium necrophorum, a strict gram-negative anaerobe. This article emphasizes and discusses the pathophysiology, and microbiology of Lemierre's syndrome. It also focuses on the clinical symptoms that include the appropriate and timely diagnosis and treatment of this deadly and fatal syndrome, together with the complications that arise with Lemierre's syndrome as the presenting problem.

Lemierre’s syndrome: A rare complication of acute bacterial pharyngitis

“…The pathophysiology of LS is poorly understood, but it is postulated that bacteria invade the pharyngeal mucosa and spread to the peritonsillar and IJVs resulting in septic thrombosis. 3 , 7 Patients with LS may present with pharyngitis, tonsillitis and a tender mass over the angle of the mandible because of cervical vein thrombosis referred to as ‘Cord’s sign’. 7 A diagnosis of LS is usually based on a triad of recent oropharyngeal infection, thrombosis of the IJV and complications of septic emboli.…”

“…3 , 7 Patients with LS may present with pharyngitis, tonsillitis and a tender mass over the angle of the mandible because of cervical vein thrombosis referred to as ‘Cord’s sign’. 7 A diagnosis of LS is usually based on a triad of recent oropharyngeal infection, thrombosis of the IJV and complications of septic emboli. 10 Septic pulmonary emboli (PE) were noted in 37.6% of patients with LS in a recent metanalysis.…”

“… 2 Less common complications of embolism include septic arthritis, osteomyelitis, pericarditis, brain emboli and meningitis. 2 , 3 , 7 …”

“… 5 However, other bacteria including streptococcal species, Staphylococcus aureus , bacteroides, lactobacillus, peptostreptococcus and Eikenella corrodens , have been reported. 2 , 6 , 7 Mortality from LS has declined from 90% in the pre-antibiotic era to 4% – 10% currently but still causes significant morbidity because of its elusive nature and increased antibiotic resistance. 2 , 6 , 7 …”

“… 2 , 6 , 7 Mortality from LS has declined from 90% in the pre-antibiotic era to 4% – 10% currently but still causes significant morbidity because of its elusive nature and increased antibiotic resistance. 2 , 6 , 7 …”