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Lemierre Syndrome

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Lemierre Syndrome, Fusobacterium Pharyngitis, Fusobacterial Necrotizing Tonsillitis, Fusobacterium Necrophorum, Septic Thrombophlebitis of Internal Jugular Vein, Internal Jugular Vein Suppurative Thrombophlebitis

  • Pathophysiology
  1. Infection by Fusobacterium necrophorium (Lemierre Syndrome)
    1. Responsible for 10% of acute Pharyngitis cases in young adults and adolescents
  2. Occurs with contiguous infection from Pharyngitis (typically) or Dental Infection to lateral pharyngeal space
  3. Results in Septic Thrombophlebitis of Internal Jugular Vein
  • 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)
  • Epidemiology
  1. Adolescents and young adults make up majority of cases
  • 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 OR
    4. Clindamycin 900 mg IV every 8 hours
    5. Avoid Macrolides (Fusobacterium resistance)
  3. Antibiotics: Staphylococcus aureus (infected Internal Jugular Central Line source)
    1. Vancomycin
  4. Duration Antibiotics: 3-6 weeks
  • Complications
  1. High morbidity and mortality
  2. Metastatic infection
  3. Septic pulmonary emboli
  4. Carotid Artery erosion (with life-threatening bleeding)
  • References
  1. (2018) Sanford Guide, accessed on IOS 1/13/2020
  2. Edson (2011) Internal Medicine, Mayo Conference, Kauai
  3. Centor (2010) Ann Intern Med 152(7): 477-8 [PubMed]
  4. Kuppalli (2012) Lancet Infect Dis 12(10):808-15 [PubMed]