Otolaryngology Book


Lemierre Syndrome

Aka: Lemierre Syndrome, Fusobacterium Pharyngitis, Fusobacterial Necrotizing Tonsillitis, Fusobacterium Necrophorum, Septic Thrombophlebitis of Internal Jugular Vein, Internal Jugular Vein Suppurative Thrombophlebitis, Postanginal Sepsis
  1. See Also
    1. Pharyngitis
    2. Pharyngitis Causes
    3. Dysphagia
    4. Tonsillitis
    5. Group A Streptococcal Pharyngitis
    6. Peritonsillar Abscess
    7. Retropharyngeal Abscess
    8. Lemierre Syndrome
    9. Chronic Pharyngeal Carriage of Streptococcus pyogenes
    10. Tonsillectomy Indications
  2. Epidemiology
    1. Adolescents and young adults make up majority of cases
  3. Pathophysiology
    1. First described by Andre Lemierre in 1936
    2. Infection by Fusobacterium necrophorium (Lemierre Syndrome)
      1. Responsible for 10% of acute Pharyngitis cases in young adults and adolescents
    3. Occurs with contiguous infection from Pharyngitis (typically) or Dental Infection to lateral pharyngeal space
    4. Results in Septic Thrombophlebitis of Internal Jugular Vein
      1. Fusobacterium promotes Platelet aggregation without lysis
  4. Causes: Septic Thrombophlebitis of Internal Jugular Vein
    1. Infection by Fusobacterium necrophorium (Lemierre Syndrome)
    2. Jugular Central Line infection (Staphylococcus aureus)
    3. Septic emboli (e.g. Lung Abscess, Osteomyelitis)
  5. Signs
    1. Fever
    2. Tonsillar exudates
    3. Anterior Cervical Lymphadenopathy
    4. Cough absent
  6. Differential Diagnosis
    1. Peritonsillar Abscess
    2. Retropharyngeal Abscess
    3. Dental Infection (e.g abscessed tooth, Retromolar abscess)
    4. Epiglottitis
    5. Mononucleosis
  7. Management: Consider empiric treatment
    1. Emergent ENT Consultation for surgical drainage
    2. Antibiotics: Fusobacterium necrophorium (Lemierre Syndrome)
      1. Metronidazole 500 mg IV and Ceftriaxone 2 g IV every 24 hours OR
      2. Piperacillin-Tazobactam (Zosyn) 4.5 g IV every 6 hours OR
      3. Carbapenem (e.g. Imipenem, meropenem or ertapenem) OR
      4. Clindamycin 900 mg IV every 8 hours (risk of resistance)
      5. Other antibiotics with coverage: Amoxicillin-Clavulanate (resistance risk) and Cefoxitin
      6. Avoid Macrolides (Fusobacterium resistance)
    3. Antibiotics: Staphylococcus aureus (infected Internal Jugular Central Line source)
      1. Vancomycin
    4. Duration Antibiotics: 3-6 weeks
  8. Complications
    1. High morbidity and mortality
    2. Metastatic infection
    3. Septic pulmonary emboli
    4. Carotid Artery erosion (with life-threatening bleeding)
  9. References
    1. (2018) Sanford Guide, accessed on IOS 1/13/2020
    2. Edson (2011) Internal Medicine, Mayo Conference, Kauai
    3. Guess and Pittman (2022) Crit Dec Emerg Med 36(7): 12-4
    4. Centor (2010) Ann Intern Med 152(7): 477-8 [PubMed]
    5. Kuppalli (2012) Lancet Infect Dis 12(10):808-15 [PubMed]

Fusobacterium necrophorum (C0016880)

Definition (NCI) A species of anaerobic, Gram-negative, rod shaped bacteria in the phylum Fusobacteria. This species is non-spore forming, does not hydrolyze dextran and is superoxide dismutase and lysine decarboxylase negative. F. necrophorum is found in the intestinal tract of humans and animals, but is more likely to be associated with infections in animals.
Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Fusobacterium necrophorum.
Definition (MSH) A species of gram-negative, non-spore-forming bacteria isolated from the natural cavities of man and other animals and from necrotic lesions, abscesses, and blood.
Concepts Bacterium (T007)
MSH D005675
SnomedCT 27274008, 302562006
English Sphaerophorus necrophorus, Bacteroides necrophorus, FUSOBACT NECROPHORUM, Fusobacterium necrophorum (Flugge 1886) Moore and Holdeman 1969, Fusobacterium necrophorum Biovar B, Fusobacterium necrophorum, fusobacterium necrophorum, sphaerophorus necrophorus, Acinomyces pseudonecrophorus, Bacillus necrophorus, Bacillus necroseos, Bacillus necrosus, Bacterium necrophorum, Corynebacterium necrophorum, Fusibacterium necrophorum, Fusiformis hemolyticus, Fusiformis necrophorus, Necrobacterium necrophorus, Proactinomyces necrophorus, Sphaerophorus pseudonecrophorus, Streptothrix necrophorus, Streptothrix necuphtora, Bacteroides necrophorus (organism), FUSOBACTERIUM NECROPHORUM, Actinomyces necrophorus, Fusobacterium necrophorum (organism)
French Sphaerophorus necrophorus, Fusobacterium necrophorum
Swedish Fusobacterium necrophorum
Czech Fusobacterium necrophorum
Spanish Sphaerophorus necrophorus, Bacteroides necrophorus, Actinomyces necrophorus, Bacteroides necrophorus (organismo), Fusobacterium necrophorum (organismo), Fusobacterium necrophorum
Finnish Fusobacterium necrophorum
Japanese 壊死桿菌, フソバクテリウム・ネクロフォラム, フソバクテリウム・ネクロフォーラム, 壊死杆菌
Italian Sphaerophorus necrophorus, Fusobacterium necrophorum
Polish Fusobacterium necrophorum
Norwegian Sphaerophorus necrophorus, Fusobacterium necrophorum
German Fusobacterium necrophorum, Sphaerophorus necrophorus
Dutch Fusobacterium necrophorum, Sphaerophorus necrophorus
Portuguese Fusobacterium necrophorum, Sphaerophorus necrophorus
Derived from the NIH UMLS (Unified Medical Language System)

Lemierre Syndrome (C0343525)

Definition (MSH) A superinfection of the damaged oropharyngeal mucosa by FUSOBACTERIUM NECROPHORUM leading to the secondary septic THROMBOPHLEBITIS of the internal jugular vein.
Concepts Disease or Syndrome (T047)
MSH D057831
SnomedCT 186387001, 240444009
English Fusobact necrotic tonsillitis, Lemierre's Disease, Lemierre Syndrome, Disease, Lemierre's, Lemierres Disease, Sepses, Postanginal, Postanginal Sepsis, Lemierres Syndrome, Syndrome, Lemierre, Sepsis, Postanginal, Disease, Lemierre, Syndrome, Lemierre's, Postanginal Sepses, Lemierre Disease, Lemierre's Syndrome, Lemierre Syndrome [Disease/Finding], Fusobacterial necrotising tonsillitis (disorder), Fusobacterial necrotizing tonsillitis (diagnosis), tonsillitis fusobacterial necrotizing, Fusobacterial necrotizing tonsillitis, Fusobacterial necrotising tonsillitis, Lemierre's syndrome, Fusobacterial necrotizing tonsillitis (disorder), Lemierre syndrome
Dutch syndroom van Lemierre
Japanese レミエール症候群, レミエールショウコウグン, Lemierre症候群
French Thrombophlébite septique de la veine jugulaire interne, Sepsis post-angine, Syndrome de Lemierre, Maladie de Lemierre, Septicémie post-angineuse, Septicémie postangineuse
German Lemierre-Syndrom, Lemierre-Krankheit, Postanginasepsis, Postanginöse Sepsis, Postanginoese Sepsis
Czech Lemierrův syndrom, Lemierrova nemoc, postanginózní sepse
Italian Malattia di Lemierre, Sindrome di Lemierre
Spanish Síndrome de Lemierre, amigdalitis necrosante fusobacteriana (trastorno), amigdalitis necrosante fusobacteriana, síndrome de Lemierre
Portuguese Síndrome de Lemierre
Hungarian Lemierre-syndroma
Polish Choroba Lemierre`a, Zespół Lemierre`a
Norwegian Lemierres sykdom, Postanginasepsis
Derived from the NIH UMLS (Unified Medical Language System)

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