Lemierre syndrome – a forgotten complication of acute tonsillitis

Koay, C. B.; Heyworth, T.; Burden, Patricia

doi:10.1017/s0022215100130956

Cited by 51 publications

(43 citation statements)

References 18 publications

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“…[13][14][15] Recently, there has been an increase in reports of sporadic cases of LS. 9,10,13,15,18,25,28 At our institution, we have seen a marked increase in the diagnosis of this unusual condition. The cause of this apparent increase is uncertain.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…Consequently, LS has been called the "forgotten disease." [12][13][14][15] Within a 12-month period, we treated 5 children at the Children's Hospital of Wisconsin (CHW) with LS. Therefore, we reviewed microbiology laboratory and hospital records at our institution from January 1995 to January 2002 searching for other cases of F necrophorum infection and LS.…”

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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 suggested that ultrasound should be utilized as an initial adjunct to CT scan to periodically follow the development and resolution of the thrombus and to diagnose suspected hepatosplenic abscesses (4, 11). However, Koay et al argue that imaging for IJV thrombophlebitis should not be used as it does not alter therapy unless IJV ligation or use of anticoagulation is considered or unless it is used as an aid in the diagnosis of a suspected abscess (8). High-resolution chest CT scan or chest radiography can identify a pulmonary abscess or emboli (4).…”

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confidence: 99%

Unusual Presentation of Lemierre's Syndrome Due to Fusobacterium nucleatum

2003

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We report a case of Lemierre's syndrome due to Fusobacterium nucleatum in a previously healthy 19-year-old male. This is the first case report of Lemierre's syndrome due to thrombophlebitis of the external jugular vein. The patient had a rapid clinical response to anticoagulation and antibiotics, as supported by anecdotal evidence. CASE REPORTA 19-year-old African-American male presented in the emergency room complaining of a 5-day history of fever, rigors, sore throat, pleuritic chest pain, and productive cough with blood-tinged sputum and a 2-day history of nausea and vomiting. One day prior to admission, the patient had presented in the emergency room with the same complaints. He was treated intravenously with ketorolac (60 mg) for his pain and discharged to his home with a course of amoxicillin for a presumptive case of pharyngitis. The patient had otherwise been healthy, and past medical history was remarkable for treatment of gonorrhea and chlamydia 1 month prior. Review of symptoms was negative for headache, photophobia, and dysuria, and the patient had no history of recent travel, tick exposure, or intravenous drug use.On presentation, the patient had scleral icterus and was obviously uncomfortable. Vital signs included a temperature of 39.1°C, a regular pulse of 105 beats per minute, a respiratory rate of 20 breaths per minute, and supine blood pressure of 130 over 60. Oral examination demonstrated erythema and swelling of the posterior pharyngeal mucosa and tonsils, yet without exudates. The neck was diffusely tender to palpation. Multiple, nontender posterior cervical lymph nodes were palpable bilaterally, which the patient stated had been the case for several years. The lungs were clear to auscultation; however, the patient complained of diffuse chest tenderness to palpation. Cardiac exam results were significant for tachycardia, but no murmurs, rubs, or gallops were detected by auscultation. Abdominal exam results were negative for tenderness and for hepatosplenomegaly and other masses. Skin showed no rashes or petechiae, and the neurologic exam results were normal.Laboratory data were significant for the following: leukocyte count, 12,600/mm 3 (93% granulocytes, 2.8% lymphocytes); platelet count, 41,000/mm 3 ; sodium, 127 mmol/liter; potassium, 3.1 mmol/liter; chloride, 87 mmol/liter; bicarbonate, 29 mmol/liter; blood urea nitrogen, 26 mg/dl; creatinine, 1.4 mg/ dl; total bilirubin, 4.0 mg/dl; and lactate dehydrogenase, 260 U/liter. Hemoglobin level and hematocrit were normal at 14.0 g/dl and 41.7%, respectively. Specimens for a human immunodeficiency virus enzyme-linked immunoassay, a monospot, a hepatitis panel, and a drug screen and three sets of cardiac enzymes were drawn, and results were later returned as normal. Electrocardiogram results were significant for sinus tachycardia and high QRS voltage in chest leads V1 to V5.

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“…Our patient's presentation and development are supported by a review by Chirinos et al (2002), which indicated that the more common presentation of Fusobacterium sepsis is with pharyngitis, a tender or swollen neck and noncavitating pulmonary infiltrates. Indeed, the complication rates from this disease have fallen, as have the mortality rates, which were over 90 % in the preantibiotic era but are approximately 5 % in the present day (Chirinos et al, 2002;Koay et al, 1995).…”

Section: Discussionmentioning

confidence: 99%

Severe pneumonia and jaundice in a young man: an atypical presentation of an uncommon disease

Wingfield

Blanchard

Ajdukiewicz

2011

Journal of Medical Microbiology

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We present a patient with an atypical presentation of Fusobacterium infection, the genus responsible for Lemierre's syndrome. This syndrome, which often affects healthy, young people and can be fatal if not recognized and treated early, is defined as a history of recent oropharyngeal infection with clinical or radiological evidence of internal jugular vein thrombosis and isolation of anaerobic pathogens, mainly Fusobacterium necrophorum. The history, presentation, investigations and management of the patient are described and then contrasted with the existing literature surrounding Lemierre's syndrome, once termed the 'forgotten disease'. Case reportA previously fit and well 26-year-old male presented to hospital with a 3-day history of severe sore throat, general malaise, non-bloody diarrhoea, vomiting, fever and headache. He had no significant past medical history, did not take any medications and had no known allergies. He was an electric engineer who worked with air conditioning units and was an occasional drinker, a non-smoker and lived with his fiancé, their two children and a dog. He had no history of foreign travel and no risk factors for blood-borne viruses.On initial examination, the patient was clammy and febrile with jaundiced sclera. He had pharyngeal erythema and decreased air entry in the right lung base. Heart sounds were normal. He was tachycardic at 150 beats min 21 but normotensive. He was tender in the right upper quadrant and right lower quadrant with a 3 finger breadth palpable smooth liver edge. Neurological examination was normal.Initial blood tests revealed acute kidney injury with an estimated glomerular filtration rate of 32 ml min 21 , creatinine 207 mmol l 21 , urea 13.8 mmol l 21 and bicarbonate of 19 mmol l 21 . Leukocytes were raised with a neutrophilia and C-reactive protein was 258 mg l 21 . Haemoglobin was 14.9 g dl 21 , platelets 79610 9 l 21 and international normalized ratio 1.2. He had deranged liver function tests with a bilirubin level of 91 mmol l 21 , alanine aminotransferase 50 U l 21 , albumin 35 g l 21 and alkaline phosphatase of 128 U l 21 . Glucose was normal and blood cultures were sent. A chest radiograph showed patchy linear opacities in the right lower zone. An electrocardiogram showed sinus tachycardia.The initial diagnosis was community-acquired pneumonia. He was admitted under the medical team and treatment with intravenous fluids, co-amoxiclav and clarithromycin was initiated.The following day, the patient continued to be pyrexial, his oxygen requirements increased and he was referred to the Infectious Diseases team. On review, he had a PaO 2 of 10.14 kPa on 35 % FiO 2 with normal PCO 2 and pH, indicating type 1 respiratory failure with a wide arterial-alveolar gradient. Temperature was 40 u C and he remained tachycardic at 140 beats min 21 . He was noted to have pain in the right side of the neck with ipsilateral swelling on examination. Legionella and pneumococcal urinary antigen were negative. Renal function was improving but leukocytes and C-reactive pr...

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Lemierre syndrome – a forgotten complication of acute tonsillitis

Cited by 51 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

Unusual Presentation of Lemierre's Syndrome Due to Fusobacterium nucleatum

Severe pneumonia and jaundice in a young man: an atypical presentation of an uncommon disease

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