Lemierre syndrome, also known as postanginal sepsis, is a very rare complication of acute tonsillitis, as yet undescribed in adult patients with Fontan circulation. It is usually caused by the anaerobic bacteria Fusobacterium necrophorum , part of the normal flora. Although the term Lemierre syndrome has been applied to different clinical situations, 1,2 it is characterized by thrombophlebitis of the internal jugular vein and distal septic emboli following acute tonsillitis. We present the case of a teenage boy with complex congenital heart disease with Fontan circulation who developed multiorgan failure and multiple metastatic septic emboli.
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These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional. Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy.
If you do not want your question posted, please let us know. National Institutes of Health. COVID is an emerging, rapidly evolving situation. Menu Search Home Diseases Lemierre syndrome. You can help advance rare disease research! Title Other Names:. Bacterial infections. Summary Summary. Cause Cause. Lemierre syndrome most often results from a complication of a bacterial throat infection, but it has also been reported to result from infections involving other areas of the head and neck, including the ears, salivary glands parotitis , sinuses, and teeth.
The bacteria most commonly responsible for Lemierre syndrome is Fusobacterium necrophorum F. This bacteria is normally present in healthy people in various parts of the body including the throat, digestive tract, and female genitals. The bacteria may cause invasive disease by releasing toxins into surrounding tissue. It has also been speculated that in some cases, other bacteria or a virus may be responsible for the initial infection prior to the onset of Lemierre syndrome, leading to conditions that favor the growth and invasion of F.
Bacteria other than F. Do you have updated information on this disease? We want to hear from you. Diagnosis Diagnosis. Lemierre syndrome may be diagnosed based on signs and symptoms, as well as a variety of blood tests and imaging studies. Blood cultures should be collected, and the results commonly indicate that the blood is infected with the F. In some cases, blood cultures are negative due to difficulties that can be associated with culturing anaerobic bacteria.
Magnetic resonance venography MRV has the highest sensitivity for detecting internal jugular thrombosis. Treatment Treatment. Treatment recommendations for Lemierre syndrome primarily are based on clinical experience and in vitro studies and are supported by limited data from observational studies and case reports.
The main components of treatment include intravenous antibiotic therapy and drainage at the sites of infection. A combination is used because some bacteria produce an enzyme called beta-lactamase, which makes them resistant to beta-lactam antibiotics.
Antibiotic therapy typically is continued for up to 6 weeks in order to allow the medication to penetrate infected clots. Prognosis Prognosis. Advanced Lemierre syndrome is a life-threatening condition. Learn More Learn More. In-Depth Information The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health.
Visit the website to explore the biology of this condition. Access to this database is free of charge. PubMed is a searchable database of medical literature and lists journal articles that discuss Lemierre syndrome.
Click on the link to view a sample search on this topic. Have a question? References References. Lemierre Syndrome. StatPearls [Internet]. Lemierre's syndrome: An often missed life-threatening infection. Indian J Crit Care Med. Lemierre syndrome: not so forgotten!. Am J Crit Care. Brook I. Fusobacterial head and neck infections in children.
Int J Pediatr Otorhinolaryngol. July, ; 79 7 James A. Case Reports in Infectious Diseases. The long shadow of Lemierre's syndrome. J Infect. June, ; 74 Suppl 1:SS Connors NJ. Septic Thrombophlebitis. Medscape Reference. Li RM, Kiemeney M. Infections of the Neck. Emerg Med Clin North Am. February, ; 37 1 Rev Med Interne. May, ; 39 5 Lemierre syndrome associated with 12th cranial nerve palsy--a case report and review. September, ; 77 9 Johannesen KM, Bodtger U.
Lemierre's syndrome: current perspectives on diagnosis and management. Infect Drug Resist. September 14, ; Do you know of a review article? Share this content:. Close Copy Link. You May Be Interested In. How to Find a Disease Specialist.
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Lemierre's syndrome or postanginal septicaemia necrobacillosis is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Fusobacterium necrophorum is the most common pathogen isolated from the patients. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. The most common sites of septic embolisms are the lungs and joints, and other locations can be affected. A high degree of clinical suspicion is needed to diagnose the syndrome. Computed tomography of the neck with contrast is the most useful study to detect internal jugular vein thrombosis. Treatment includes intravenous antibiotic therapy and drainage of septic foci.
These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional. Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. National Institutes of Health.
Lemierre's syndrome (necrobacillosis)
Lemierre's syndrome refers to infectious thrombophlebitis of the internal jugular vein. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli. Lemierre's syndrome occurs most often when a bacterial e. Deep in the abscess, anaerobic bacteria can flourish. When the abscess wall ruptures internally, the drainage carrying bacteria seeps through the soft tissue and infects the nearby structures. Spread of infection to the nearby internal jugular vein provides a gateway for the spread of bacteria through the bloodstream. The inflammation surrounding the vein and compression of the vein may lead to blood clot formation.