The long shadow of Lemierre’s syndrome

Osowicki, Joshua; Kapur, Sarah; Phuong, Linny Kimly; Dobson, Simon

doi:10.1016/s0163-4453(17)30191-3

Cited by 55 publications

(70 citation statements)

References 73 publications

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“…[1] Controversy exists as to whether there is a true increase in incidence related to a reduction in antibiotic use for respiratory tract infections, or that improved microbiological detection techniques are facilitating diagnosis. [2][3][4] F. necrophorum possess virulence factors which promote local extension of infection and invasion into surrounding tissues and structures predisposing to intracranial complications and Lemierre's syndrome. [2,3] Intracranial complications secondary to F. necrophorum head and neck infection occur more frequently in infants and young toddlers [1,6] and include meningitis, epidural or brain abscesses and cerebral sinovenous thrombosis (CSVT).…”

Section: Discussionmentioning

confidence: 99%

Complicated Fusobacterium necrophorum mastoiditis – More than meets the eye

Fuller

Kaddour

Phuong

et al. 2020

DCC

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Otitis media is common in children and Fusobacterium species are an emerging causative pathogen. These species have virulence factors which increase the risk of complicated otitis media. We discuss a case of F. necrophorum infection resulting in significant intracranial disease to highlight the epidemiology of these infections, risk factors for complicated disease and signs and symptoms to guide diagnosis and investigation.

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Section: Discussionmentioning

confidence: 99%

Complicated Fusobacterium necrophorum mastoiditis – More than meets the eye

Fuller

Kaddour

Phuong

et al. 2020

DCC

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“…In 1936, André Lemierre, described a disease complex that combined anaerobic and septic bacterial infections after tonsillitis. [7][8][9][10] Lemierre's illustration focused on septicemia after angina caused by Fusobacterium necrophorum, describing a progression from suppurative peritonsilar infection, through thrombophlebitis of the internal jugular vein, to septic embolization of distant sites, such as the lungs. 11 The most common site of infection is the palatine tonsils (87.1% of cases).…”

Section: Discussionmentioning

confidence: 99%

“…Edema and pain at the angle of the mandible or anterior and parallel to the sternocleidomastoid muscle indicate involvement of the parapharyngeal space (26 to 45% of cases). 6,10 Respiratory problems are present in the majority of cases. 6 In atypical presentations, the patient may not have fever and LS may even not be preceded by pharyngitis.…”

Section: Discussionmentioning

confidence: 99%

“…The first line treatment for LS is intravenous antimicrobial therapy, 4 with coverage for anaerobic microbes. 6,10,13 Response to antibiotics is slow and the average time between start of treatment and resolution of fever varies from 8 to 12 days. 9,10 Surgical exploration with ligature and excision of thee internal jugular vein is rarely necessary, but may be indicated in cases with persistent septic emboli or for surgical drainage of abscesses or pulmonary empyema.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,13 Response to antibiotics is slow and the average time between start of treatment and resolution of fever varies from 8 to 12 days. 9,10 Surgical exploration with ligature and excision of thee internal jugular vein is rarely necessary, but may be indicated in cases with persistent septic emboli or for surgical drainage of abscesses or pulmonary empyema. 6,9,11,14 The role of anticoagulation is still controversial and there are no randomized trials that support its use.…”

Section: Discussionmentioning

confidence: 99%

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Síndrome de Lemierre: relato de caso

et al. 2018

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Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein, after an oropharyngeal infection, with septic embolization to the lungs or other organs. This case report describes a 37-year-old female patient who presented with edema and pain in the right hemiface with onset 3 days previously and progressive fatigue and dyspnea since the previous day. She had had tooth 48 extracted 3 days previously. Physical examination at admission found tachypnea, with 60% saturation (in room air), edema at the angle of the right mandible, diffuse reduction of vesicular murmur, and calves free from clubbing. Angiotomography of the chest and laboratory tests were compatible with septic emboli, and cervical computed tomography confirmed a diagnosis of septic thrombophlebitis of the internal jugular vein. She was managed with antibiotics and given treatment for her symptoms. Lemierre syndrome most often occurs in young men and there is embolization to the lungs in up to 97% of cases. Rarely, the etiology of this syndrome may be tooth extraction. Computed tomography is the imaging method most often used for diagnosis and treatment is basically antibiotic. Surgery is thus rarely necessary.A síndrome de Lemierre caracteriza-se pela tromboflebite séptica da veia jugular interna, após uma orofaringite, com embolização séptica para o pulmão ou outros órgãos. Neste relato de caso, apresentamos uma paciente feminina, 37 anos de idade, com história de edema e dor em hemiface direita há três dias, associada a fadiga e dispneia progressiva há um dia. História de extração dentária do elemento 48 há três dias. No exame físico admissional, apresentava-se taquipneica, saturando 60% (em ar ambiente), com edema em ângulo da mandíbula direita, redução difusa do murmúrio vesicular e panturrilhas sem empastamento. Angiotomografia de tórax e exames laboratoriais foram compatíveis com quadro de embolia séptica, e tomografia computadorizada da cervical corroborou o diagnóstico de tromboflebite séptica da veia jugular interna. Foi tratada com antibióticos e sintomáticos. A síndrome de Lemierre afeta mais homens jovens e tem embolização para o pulmão em até 97% dos casos. Extrações dentárias raramente podem ser a etiologia dessa síndrome. A tomografia computadorizada é o método de imagem mais utilizado no diagnóstico, e o tratamento é, essencialmente, com antibióticos; portanto, a abordagem cirúrgica é raramente necessária.Palavras-chave: síndrome de Lemierre; extração dentária; tromboflebite; embolia pulmonar. Lemierre syndrome: case report 338 338/340 J Vasc Bras. 2018, Out.-Dez.; 17(4):337-340

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A teenager with fever, chest pain, and respiratory distress during the coronavirus disease 2019 pandemic: a lesson on anchoring bias

et al. 2020

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Symptoms of coronavirus disease 2019 overlap with other important illnesses affecting young adults. We report a case of a 17‐year old male presenting to the emergency department in the midst of a pandemic with symptoms of coronavirus disease 2019. He had fever, dyspnea, chest pain, and myalgias, with bilateral infiltrates on chest radiograph, and developed septic shock secondary to infectious thromboembolic events. However, his blood cultures grew group G streptococcus secondary to his oropharyngeal infection, and he experienced an infectious thrombus in the internal jugular vein, consistent with the rare but well‐described Lemierre's syndrome. This case report calls attention to the importance of maintaining differential diagnoses and thereby minimizing the biases and assumptions that come with clinical care during a pandemic.

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The long shadow of Lemierre’s syndrome

Cited by 55 publications

References 73 publications

Complicated Fusobacterium necrophorum mastoiditis – More than meets the eye

Complicated Fusobacterium necrophorum mastoiditis – More than meets the eye

Síndrome de Lemierre: relato de caso

A teenager with fever, chest pain, and respiratory distress during the coronavirus disease 2019 pandemic: a lesson on anchoring bias

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