Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar;289(3):325-339.
doi: 10.1111/joim.13114. Epub 2020 Jun 18.

Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

L Valerio  1 , F Zane  2 , C Sacco  3 , S Granziera  4 , T Nicoletti  5 , M Russo  1 , G Corsi  6 , K Holm  7 , M-A Hotz  8 , C Righini  9 , P D Karkos  10 , S H Mahmoudpour  1   11 , N Kucher  12 , P Verhamme  13 , M Di Nisio  14 , R M Centor  15 , S V Konstantinides  1   16 , A Pecci  17 , S Barco  1   12
Affiliations
Free article
Review

Patients with Lemierre syndrome have a high risk of new thromboembolic complications, clinical sequelae and death: an analysis of 712 cases

L Valerio et al. J Intern Med. 2021 Mar.
Free article

Abstract

Background: Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era.

Methods: In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae.

Results: The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26 died (4.0%; 2.7-5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2-13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19).

Conclusions: Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.

Keywords: Fusobacterium necrophorum; Lemierre syndrome; anticoagulation; pulmonary embolism; septic embolism; venous thromboembolism.

PubMed Disclaimer

Comment in

References

    1. Sacco C, Zane F, Granziera S et al. Lemierre syndrome: clinical update and protocol for a systematic review and individual patient data meta-analysis. Hamostaseologie2021; 39: 76-86.
    1. Batty A, Wren MW. Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci 2005; 62: 66-70.
    1. Centor RM, Atkinson TP, Ratliff AE et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med 2015; 162: 241-7.
    1. Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Significant pathogens in peritonsillar abscesses. European J Clin Microbiol Infect Dis 2011; 30: 619-27.
    1. Atkinson TP, Centor RM, Xiao L et al. Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity. PLoS One 2018; 13: e0189423.

Publication types

LinkOut - more resources