Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

Abstract

Background. Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. Methods. In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. Results. The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during inhospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26

Anticoagulation Contributes to Antimicrobial Treatment of Lemierre Syndrome: A Case Report

“…A recent European collaborative study performed an individual patient-level analysis of 712 cases published globally from 2000 to 2017 1 . The authors could not nd disease-speci c elements regarding anticoagulation therapy safety and drew the conclusion that therapeutic anticoagulation is indicated for LS if there are no contraindications.…”

“…Despite its nonnegligible annual morbidity of 1/100 000, Lemierre syndrome (LS) often goes undiagnosed due to nonspeci c symptoms 1,2 . The most accurate de nition of LS should include 1) opportunistic infection that originates in the oropharynx, mastoiditis, oral cavity and sinusitis, 2) isolation of Fusobacterium necrophorum and 3) thrombophlebitis of the internal jugular vein producing disseminated emboli to the periphery (often septic pulmonary emboli) [2][3][4] .…”

Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry

“…only represented approximately half of the observed spectrum of the syndrome; Fig. 2 [18]. Therefore, the clinical definition of Lemierre syndrome may be considered a specific manifestation of the continuum represented by bacterial thrombophlebitis, which includes conditions associated with diverse primary infections caused by several microbiological agents [17].…”

“…Until recently, the claims of an increasing incidence were difficult to substantiate, as they were mainly based on the number of absolute reports in the scientific literature, single-centre series, or epidemiological studies of necrobacillosis (septicemia from Fusobacterium necrophorum) rather than Lemierre syndrome [26]. However, since 2000, the number of reported cases or publications also increased as a proportion of all scientific publications (as estimated by those reported on the Medline repository) [18]. The most recent nationwide study of Fusobacterium-associated cases confirmed an increasing trend from 2010 to 2017 in Sweden [22].…”

“…However, neither sepsis nor neck-specific signs and symptoms are highly sensitive or specific. Moreover, multi-organ involvement is already present at diagnosis, with over 80% of patients displaying septic embolism, especially pulmonary, musculoskeletal, or intracranial [18]. As a consequence, differential diagnosis is usually complex; depending on the dominant features at presentation, it may include conditions ranging from relatively common conditions such as streptococcal pharyngitis, viral infection (infectious mononucleosis, CMV), septic arthritis, meningitis, or community-acquired pneumonia [27,28] Frequently, the diagnosis is only considered after the incidental isolation of Fusobacterium necrophorum, which may lead to potentially clinically relevant delay of the appropriate management [33].…”