Lemierre's Syndrome
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Overview
Lemierre’s Syndrome refers to human necrobacillosis (infections with F. necrophorum) with primary foci in the head (oropharynx, face, ears, mastoid, teeth), often with septic thrombophlebitis of the internal jugular vein.
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Epidemiology and Demographics
- Rare
- Previously healthy persons without underlying diseases:
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Risk Factors
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Screening
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Pathophysiology & Etiology
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Molecular Biology
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Genetics
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Natural History
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Diagnosis
Differential Diagnosis
- Descending necrotizing mediastinitis
- Meningitis (mostly in children with otitis media
- Beware false positive chlamydia PCR
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History and Symptoms
- Intense rigors and high fever within 1 week after primary local infection
- Leukocytosis
- Subclincical hyperbilirubinemia (50%)
- Mild DIC (23%)
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Physical Examination
Appearance of the Patient
Eyes
Ear Nose and Throat
- Ipsilateral neck tenderness parallel with sternocleidomastoid muscle
Heart
Lungs
- Metastatic abscesses mainly to lungs (85%), but also joints (26%)
Abdomen
- Abdominal pain 2nd to microabscesses vs. thrombophlebitis of abdomino- pelvic veins
Extremities
Neurologic
Other
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Laboratory Findings
Electrolyte and Biomarker Studies
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Electrocardiogram
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Chest X Ray
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MRI and CT
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Echocardiography or Ultrasound
- Unilateral suppurative thrombophlebitis of IJ: Ultrasound, CT, MRA
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Other Imaging Findings
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Other Diagnostic Studies
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Risk Stratification and Prognosis
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Treatment
Pharmacotherapy
Acute Pharmacotherapies
- Penicillin + Flagyl vs. Clindamycin ?
- Debridement of necrotic tissues
- Anticoagulation normally not advised unless clot propagates towards cavernous sinus
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Chronic Pharmacotherapies
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Surgery and Device Based Therapy
Indications for Surgery
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Pre-Operative Assessment
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Post-Operative Management
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Transplantation
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Primary Prevention
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Secondary Prevention
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Cost-Effectiveness of Therapy
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Future or Investigational Therapies
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Suggested Revisions to the Current Guidelines
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Acknowledgements
The content on this page was first contributed by: Stephen Wiviott, M.D.
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
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