Lemierre's syndrome: Difference between revisions
No edit summary |
No edit summary |
||
| Line 7: | Line 7: | ||
===Epidemiology=== | ===Epidemiology=== | ||
Very rare, incidence rate of 0.8 cases per million in the general population<ref>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.</ref> | *Very rare, incidence rate of 0.8 cases per million in the general population<ref>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.</ref> | ||
*When diagnosed, mortality is 4.6%<ref>Centor RM. "Expand the Pharyngitis Paradigm for Adolescents and Young Adults." Ann Intern Med. 2009;151(11):812-815. doi:10.7326/0003-4819-151-11-200912010-00011</ref> | |||
== | ==Clinical Features== | ||
*Persistent sore throat, [[fever]], and general weakness | *Persistent sore throat, [[fever]], and general weakness | ||
*2 days - 2 weeks after initial symptoms: | *2 days - 2 weeks after initial symptoms: | ||
| Line 37: | Line 38: | ||
* Heerfordt's syndrome (small percentage of sarcoidosis) | * Heerfordt's syndrome (small percentage of sarcoidosis) | ||
==Diagnosis== | |||
==Workup== | ==Workup== | ||
*CTA of neck | *CTA of neck | ||
| Line 50: | Line 52: | ||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
==See Also== | ==See Also== | ||
*[[Peritonsilar | *[[Peritonsilar abscess]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 10:56, 17 August 2015
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 peritonsilar abscess 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]
- When diagnosed, mortality is 4.6%[3]
Clinical Features
- 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
- Intracranial complications (6%)
- Diagnostic criteria
- Hx of oropharynx pain within last 4 wks
- Evidence of IJV thrombophlebitis/carotid sheath
- Isolation of F. necrophorum from blood
- Evidence of metastatic infection in another site (lungs)
Differential Diagnosis
- Q fever
- Tuberculosis
- Pneumonia
- Viral pharyngitis
- Mononucleosis-like illnesses (EBV, CMV, acute HIV)
- PTA vs. RA vs. Ludwig's
- Mumps
- Sjogren's
- Heerfordt's syndrome (small percentage of sarcoidosis)
Diagnosis
Workup
- CTA of neck
- Blood Cultures
Management
- Antibiotics (coverage of F. necrophorum, strep, bacteroides) - Unasyn, Zosyn, or carbapenam for at least 3-4 wks
- IV Antibiotics
- Drainage of abscess
- Consider ligation of the internal jugular vein where antibiotic can not penetrate.[4]
- No evidence for or against anticoagulation[5]
Disposition
- Admit
See Also
References
- ↑ "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.
- ↑ Centor RM. "Expand the Pharyngitis Paradigm for Adolescents and Young Adults." Ann Intern Med. 2009;151(11):812-815. doi:10.7326/0003-4819-151-11-200912010-00011
- ↑ 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.
- ↑ Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.