Suppurative thrombophlebitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Suppurative thrombophlebitis is a life threatening condition characterized by the presence of venous thrombosis along with inflammation and bacteremia.[1] Suppurative thrombophlebitis usually occur in the setting of an intravascular catheter, and suspected in patients with radiographic evidence of thrombosis and persistent bacteremia after 72 hours of appropriate antimicrobial therapy.
Historical Perspective
Pelvic thrombophlebitis was discovered by the end of the 19th century when von Recklinhausen described an entity in which pelvic infection was characterized by thrombosis of one or both ovarian veins while the remaining pelvis was normal, proposing surgical excision as the therapeutic approach.[2] Sepsis following from a throat infection was first described by Scottmuller in 1918. In 1936, André Lemierre published a series of 20 cases where throat infections were followed by identified anaerobic septicemia, of whom 18 patients died. This disease came to be known as Lemierre syndrome.[3]
Classification
Suppurative thrombophlebitis may be classified into many subtypes according to the vein involved. Subtypes of suppurative thrombophlebitis include peripheral vein, internal jugular vein, vena caval, portal vein, and pelvic vein suppurative thrombophlebitis.
Pathophysiology
Causes
Differentiating Suppurative thrombophlebitis from other Diseases
Peripheral suppurative thrombophlebitis should be differentiated from cellulitis and deep venous thrombosis; while abdominal and pelvic vein suppurative thrombophlebitis must be differentiated from septic abortion, acute appendicitis, cholangitis, and other genitourinary infections. Lemierre disease must be differentiated from peritonsillar abscess, pharyngitis, and soft tissue neck abscess.
Risk Factors
Common risk factors in the development of suppurative thrombophlebitis are the use of intravenous catheters, intravenous drug use, hypercoagulable states, burns, pharyngitis, and tonsillitis.
Epidemiology and Demographics
Lemierre’s syndrome is now a rare condition with an incidence of 0.36 cases per 100,000 individuals annually. Lemierre’s syndrome is primarily a disease of previously healthy children, adolescents and young adults.[4] Extremes of age also predispose the occurrence of septic thrombophlebitis, due to the increased risk of infections by catheters in multiple health issues. Pylephlebitis is slightly more common in males.[5]
Natural History, Complications and Prognosis
History and Symptoms
When obtaining a history from a patient with suspected suppurative thrombophlebitis, specific areas of focus include a history of an intravenous catheter, a phlebotomy attempt, and intravenous injections. Common symptoms of superficial vein thrombophlebitis include fever, erythema, and tenderness and purulent drainage at the site of the involved vessel.[6][7] Symptoms of Lemierre syndrome include fever, rigors, localized neck pain, and erythema, tenderness, swelling, and induration overlying the jugular vein.[8]
Laboratory Findings
Medical Therapy
Surgery
References
- ↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMID 19489710.
- ↑ Garcia J, Aboujaoude R, Apuzzio J, Alvarez JR (2006). "Septic pelvic thrombophlebitis: diagnosis and management". Infect Dis Obstet Gynecol. 2006: 15614. doi:10.1155/IDOG/2006/15614. PMC 1581461. PMID 17485796. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Lemierre Syndrome. Wikipedia (2015). https://en.wikipedia.org/wiki/Lemierre%27s_syndrome Accessed on October 15, 2015
- ↑ Eilbert W, Singla N (2013). "Lemierre's syndrome". Int J Emerg Med. 6 (1): 40. doi:10.1186/1865-1380-6-40. PMC 4015694. PMID 24152679.
- ↑ Wong K, Weisman DS, Patrice KA (2013). "Pylephlebitis: a rare complication of an intra-abdominal infection". J Community Hosp Intern Med Perspect. 3 (2). doi:10.3402/jchimp.v3i2.20732. PMC 3716219. PMID 23882407.
- ↑ Baker CC, Petersen SR, Sheldon GF (1979). "Septic phlebitis: a neglected disease". Am J Surg. 138 (1): 97–103. PMID 464215. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Khan EA, Correa AG, Baker CJ (1997). "Suppurative thrombophlebitis in children: a ten-year experience". Pediatr Infect Dis J. 16 (1): 63–7. PMID 9002104. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Sinave CP, Hardy GJ, Fardy PW (1989). "The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection". Medicine (Baltimore). 68 (2): 85–94. PMID 2646510. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help)