Lemierre's syndrome (necrobacillosis)

Abstract

SummaryLemierre's syndrome or postanginal septicaemia (necrobacillosis) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Fusobacterium necrophorum is the most common pathogen isolated from the patients. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. The most common sites of septic embolisms are the lungs and joints, and other locations can be aVected. A high degree of clinical suspicion is needed to diagnose the syndrome. Computed tomography of the neck with contrast is the most useful study to detect internal jugular vein thrombosis. Treatment includes intravenous antibiotic therapy and drainage of septic foci. The role of anticoagulation is controversial. Ligation or excision of the internal jugular vein may be needed in some cases.

Successful Treatment of Recurrent Candidemia due to Candidal Thrombophlebitis Associated with a Central Venous Catheter Using a Combination of Fosfluconazole and Micafungin

“…Heparin has been used in cases of bacterial thrombophlebitis (20), but appears to have no additional beneficial effect (18). Some medical professionals favor anticoagulation only if there is evidence for an extension of the thrombus (21). In this case, a tube was inserted into the common bile duct and the initiation of anticoagulant therapy was abandoned.…”

Lemierre Syndrome Following Oropharyngeal Infection: A Case Series

“…6,8,12 Patients most often present with high fever and rigors within 1 week of onset of a sore throat. 13 Other symptoms include neck pain, swelling along the sternocleidomastoid, and dysphagia, which result from thrombophlebitis, but can also signal a local abscess. Septic emboli to the lungs occur in 79% to 100% of cases and manifest with cough, dyspnea, pleuritic chest pain, and hemoptysis.…”

Non-Thrombotic Pulmonary Embolism

“…The ensuing bacteremia is complicated by septic emboli to a range of sites such as lung, joints, and bones. Pulmonary involvement in Lemierre's syndrome has been reported in up to 97% with SPE, lung abscesses and empyema (Golpe et al, 1999;Riordan & Wilson, 2004;Sinave et al, 1989). The causative organisms of Lemierre's syndrome include the anaerobic gram-negative Fusobacterium species, and also Eikenella, Porphyromonas, Streptococci and Bacteroides.…”