Lemierre's syndrome: Two cases of postanginal sepsis

Lustig, Lawrence R.; Cusick, Brian C.; Cheung, Steven W.; Lee, Kelvin C.

doi:10.1016/s0194-5998(95)70192-3

Cited by 126 publications

(137 citation statements)

References 18 publications

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“…Advocates of systemic anticoagulation cite the potential for faster resolution of the thrombophlebitis and bacteremia, limiting the development of new metastatic foci. 8,28 Controlled studies that assess the value of anticoagulation in thrombophlebitis of the jugular venous system have not been conducted.…”

Section: Discussionmentioning

confidence: 99%

Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital

et al. 2003

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ABSTRACT. Objective. To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children's hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites.Methods. Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children's Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002.Results. During the 7-year period of the study, there was an increase in the isolation of Conclusions. The cause for the recent increase in the number of serious infections caused by F necrophorum infection diagnosed at our institution is unclear but does not seem to be related to changes in microbiologic techniques or patient demography. We speculate that it could be attributable, in part, to alterations in antibiotic usage patterns in our region. Clinicians need to be aware of the increasing clinical importance of F necrophorum infections and the life-threatening nature of LS. Pediatrics 2003;112:e380 -e385. URL: http://www.pediatrics.org/cgi/ content/full/112/5/e380; Fusobacterium necrophorum, Lemierre syndrome, peritonsillar abscess, thrombophlebitis, pulmonary emboli.

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Section: Discussionmentioning

confidence: 99%

Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital

et al. 2003

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“…It has been postulated that the restricted use of antibiotics prescribed for the treatment of sore throats and tonsillitis that present to general practitioners (GPs) may account for an increase in the number of cases of Lemierre's disease [10,11]. Certainly, general practitioners in England and Wales, under guidance from such reports as`The Path of Least Resistance' [13] and other material issued by the Department of Health in England, have recently been advised to reduce their prescribing of antibiotics for conditions believed to be primarily of viral aetiology, such as sore throats.…”

Section: Discussionmentioning

confidence: 99%

Fusobacterium necrophorum infections in England and Wales 1990–2000

Brazier¹,

Hall²,

Yusuf

et al. 2002

Journal of Medical Microbiology

141

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In response to a marked increase in both the number of Fusobacterium necrophorum bacteraemia reports to the PHLS Communicable Disease Surveillance Centre and the number of F. necrophorum isolates referred to the PHLS Anaerobe Reference Unit in 1999, the data from both sources on F. necrophorum infections were reviewed for the decade 1990±2000. There were 208 reports of F. necrophorum bacteraemia (average 19=year; range 14±34=year) with a peak in incidence in the late winter months; 68% were from male patients and the peak age range was 16±23 years. Of 205 referred isolates of F. necrophorum, 122 (59%) were from blood cultures and these represented 58% of the bacteraemia reports; the others were from brain and soft tissue abscesses, pleural and joint¯uids, eyes, ears and lymphatic tissue. The average number of referrals was 19=year (range 9±37=year). The peak year for bacteraemia reports (34) and isolate referrals (37) was 1999; this increase was not sustained in 2000. All isolates were susceptible to metronidazole, but 2% were resistant to penicillin and 15% to erythromycin. F. necrophorum continues to be a regular but uncommon cause of bacteraemia and metastatic abscesses following an acute sore throat, especially in young, otherwise healthy adults.

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“…12,13 ED diagnosis and treatment is traditionally limited to a high clinical index of suspicion, early empiric antibiotic administration and subsequent imaging; however, emergency physicians skilled in ultrasound evaluation may be able to improve diagnostic performance and rapidly confirm Lemierre syndrome by identifying internal jugular thrombosis on rapid ED scans. 14 Initial treatment involves high-dose IV penicillin and metronidazole, or IV clindamycin monotherapy, with conversion to 2-6 weeks of oral therapy after the patient's clinical condition has stabilized. 8 Heparin is given only in cases where retrograde propagation of thrombosis to the cavernous sinus has occurred, since heparin may actually disseminate the infection.…”

Section: Discussionmentioning

confidence: 99%

Lemierre syndrome in a child with recent pharyngitis

Busko

Triner²

2004

CJEM

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A 14-year-old boy presented with fever and progressive respiratory distress, one week after an episode of pharyngitis. Although there was a concern about pulmonary embolism secondary to a lower extremity fracture, his presentation was most consistent with Lemierre syndrome. This syndrome is an uncommon but potentially lethal complication of otolaryngological infections. Early recognition and aggressive antibiotic therapy are critical elements in reducing mortality. Emergency physicians should be aware of this syndrome because its incidence appears to be increasing. RÉSUMÉUn adolescent âgé de 14 ans s'est présenté à l'urgence avec de la fièvre et une détresse respiratoire progressive, une semaine après un épisode de pharyngite. Bien qu'une embolie pulmonaire découlant d'une fracture à une extrémité inférieure ait été évoquée, les symptômes de présenta-tion étaient plus évocateurs du syndrome de Lemierre. Ce syndrome est une complication peu courante mais potentiellement fatale des infections oto-laryngologiques. Son identification pré-coce et une antibiothérapie agressive sont des éléments cruciaux dans la réduction de la mortalité. Les médecins d'urgence doivent être sensibilisés à ce syndrome, car son incidence semble être en hausse.

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Lemierre's syndrome: Two cases of postanginal sepsis

Cited by 126 publications

References 18 publications

Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital

Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital

Fusobacterium necrophorum infections in England and Wales 1990–2000

Lemierre syndrome in a child with recent pharyngitis

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