Lemierre's syndrome: Difference between revisions
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**IV [[Antibiotics]] | **IV [[Antibiotics]] | ||
*Drainage of abscess | *Drainage of abscess | ||
*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref | *Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref> | ||
*No evidence for or against anticoagulation<ref name="Puymirat"/> | *No evidence for or against anticoagulation<ref name="Puymirat"/> | ||
Revision as of 02:06, 19 March 2014
Background
- Also known as "Lemierre's disease" and "postanginal shock including sepsis" and "human necrobacillosis"
- Is a form of thrombophlebitis[1]
- Usually caused by Fusobacterium necrophorum, and occasionally by other members of the genus Fusobacterium (F. nucleatum, F. mortiferum and F. varium etc.) or MRSA
- Usually affects young, healthy adults, most often developing after Strep Pharyngitis causing Peritonsilar Abscess
- Anerobic bacteria grow in the PTA and penetrate into the neighboring jugular vein causing thrombophlebitis and bacteremia and septic emboli and occassionally pneumonia and sepsis
Epidemiology
Very rare, incidence rate of 0.8 cases per million in the general population[2]
Diagnosis
- Persistent sore throat, fever, and general weakness
- 2 days - 2 weeks after initial symptoms:
- lethargy, fevers, lymphadenopathy, painful neck
- Often abdominal pain, diarrhea, nausea and vomiting
- May lead to:
- Pneumonia
- Septic Arthritis
- Meningitis
- Sepsis
Differential Diagnosis
Workup
- CTA of neck
- Blood Cultures
Management
- Antibiotics
- IV Antibiotics
- Drainage of abscess
- Consider ligation of the internal jugular vein where antibiotic can not penetrate.[3]
- No evidence for or against anticoagulation[4]
Disposition
- Admit
- When diagnosed, mortality is 4.6%[5]
See Also
Sources
- ↑ "Lemierre syndrome" at Dorland's Medical Dictionary
- ↑ Sibai K, Sarasin F (2004). "Lemierre syndrome: a diagnosis to keep in mind". Revue médicale de la Suisse romande (in French) 124 (11): 693–5. PMID 15631168.
- ↑ Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.
- ↑ Cite error: Invalid
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<ref>tag; no text was provided for refs namedSign In — Ann Intern Med