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Review
. 2016 Sep 14:9:221-227.
doi: 10.2147/IDR.S95050. eCollection 2016.

Lemierre's syndrome: current perspectives on diagnosis and management

Katrine M Johannesen  1 , Uffe Bodtger  2
Affiliations
Review

Lemierre's syndrome: current perspectives on diagnosis and management

Katrine M Johannesen et al. Infect Drug Resist. .

Abstract

This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4-6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.

Keywords: Lemierre’s syndrome; fusobacteria; postanginal sepsis.

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Figures

Figure 1
Figure 1
Lemierre’s syndrome review: study inclusion and exclusion flow diagram. Notes: Figure created using PRISMA 2009 flow diagram software from Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097 doi: 10.1371/journal.pmed.1000097. For more information, visit www.prisma-statement.org.
Figure 2
Figure 2
Distribution of bacterial agent. Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.
See this image and copyright information in PMC

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