LEMIERRE’S SYNDROME: A FORGOTTEN COMPLICATION OF OROPHARYNGEAL INFECTION
AbstractBackground: Lemierre's syndrome (postanginal sepsis) usually complicates an oropharyngeal infection as septicemia, septic thrombophlebitis of the internal jugular vein, and metastatic lesions, most frequently in the lungs. Fusobacterium necrophorum is the usual etiologic agent. Lemierre's syndrome is not widely known by clinicians. This study aims at creating awareness amongst the clinicians of existence of this potentially fatal but curable clinical entity. Methods: All the patients admitted in the ENT department of Ayub Teaching Hospital, during the period of January 2000 to December 2002, for the treatment of acute oropharyngeal infection, were critically assessed by consultants, for features of Lemierre’s syndrome, and investigated further, accordingly. Results: 156 patients were admitted with acute oropharyngeal infection. Two patients (1.28%) had features suggestive of Lemierre’s syndrome. A male and a female, 25 and 28 years old respectively, had a history of a preceding sore throat for a variable duration followed by complications. Attempts were made to make the diagnosis of Lemierre’s syndrome and they were treated appropriately, as per recommendations, to a successful outcome. Conclusions: Widespread use of antibiotics for pharyngeal infections has significantly reduced the incidence. Rare and a forgotten complication, Lemierre's syndrome is potentially fatal. Early diagnosis and prolonged treatment with appropriate antibiotics are usually curative. A high degree of clinical suspicion is necessary for diagnosis. Modern day clinician should be aware of this potentially life threatening clinical entity that may complicate a trivial oropharyngeal infection.Keywords: Lemierre's syndrome; Fusobacterium necrophorum; oropharynx; septicemia;
Schottmuller H. Ueber die Pathogenität anaërober Bazillen. Dtsch Med Wochenschr 1918;44:1440.
Lemierre A. On certain septicemias due to anaerobic organisms. Lancet 1936;1: 701-3.
Hagelskjaer LH, Prag J, Malczynski J, Kristenson JH. Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990-1995. Eur J Clin Microbiol Infect Dis 1998;17(8):561-5.
Stahlman GC, DeBoer DK, Green NE. Fusobacterium osteomyelitis and pyarthrosis: a classic case of Lemierre's syndrome. J Pediatr Orthop 1996;16(4):529-32
Alston JM. Necrobacillosis in Great Britain. Br Med J 1955;(4955):1524-8.
Ma M, Jauch EC, Johnson MC. A case of Lemierre's syndrome. Eur J Emerg Med 2003;10(2):139-42
Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine 1989;68(2):85-94.
Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ. The Evolution of Lemierre Syndrome: Report of 2 Cases and Review of the Literature. Medicine 2002; 81(6):458-65
Shetty AK, Begue RE, Coffman K, White-Sims ST, Steele RW. Lemierre's Syndrome Following Mastoiditis. Infect Med 1998;15(5):323-32
Alvarez A, Schreiber JR. Lemierre's syndrome in adolescent children - anaerobic sepsis with internal jugular vein thrombophlebitis following pharyngitis. Pediatrics 1995;96:354-9.
Golpe R, Marin B, Alonso M. Lemierre's syndrome (necrobacillosis). Postgrad Med J 1999; 75:141-4
Lee BK, Lopez F, Genovese M, Loutit JS. Lemierre's syndrome. South Med J 1997; 90(6):640-3
Blomquist IK, Bayer AS. Life-threatening deep fascial space infections of the head and neck. Infect Dis Clin North Am 1988;2(1):237-64
Nakamura S, Sadoshima S, Doi Y, Yoshioka M, Yamashita S, Gotoh H, et al. Internal jugular vein thrombosis, Lemierre's syndrome; oropharyngeal infection with antibiotic and anticoagulation therapy--a case report. Angiology 2000;51(2):173-7.
Moore BA, Dekle C, Werkhaven J. Bilateral Lemierre's syndrome: a case report and literature review. Ear Nose Throat J 2002;81(4):234-6
Finegold SM, Wexler HM. Therapeutic implications of bacteriologic findings in mixed aerobic-anaerobic infections. Antimicrob Agents Chemother 1988;32:611-6
Goldhagen J, Alford BA, Prewitt LH, Thompson L, Hostetter MK. Suppurative thrombophlebitis of the internal jugular vein: report of three cases and review of the pediatric literature. Pediatr Infect Dis J 1988;7(6):410-4