Suppurative thrombophlebitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Lemierre syndrome
Lemierre's syndrome is initiated by an infection of the head and neck region. During the primary infection, F. necrophorum colonizes the infection site and the infection spreads to the parapharyngeal space. The bacteria then invade the peritonsillar blood vessels where they can spread to the internal jugular vein. In this vein, the bacteria cause the formation of a thrombus containing these bacteria. Furthermore, the internal jugular vein becomes inflamed. This septic thrombophlebitis can give rise to septic microemboli that disseminate to other parts of the body where they can form abscesses and septic infarctions. The first capillaries that the emboli encounter where they can nestle themselves are the pulmonary capillaries. As a consequence, the most frequently involved site of septic metastases are the lungs, followed by the joints (knee, hip, sternoclavicular joint, shoulder and elbow). In the lungs, the bacteria cause abscesses, nodulary and cavitary lesions. Pleural effusion is often present. Other sites involved in septic metastasis and abscess formation are the muscles and soft tissues, liver, spleen, kidneys and nervous system (intracranial abscesses, meningitis). Production of bacterial toxins such as lipopolysaccharide leads to secretion of cytokines by white blood cells which then both lead to symptoms of sepsis. F. necrophorum produces hemagglutinin which causes platelet aggregation that can lead to diffuse intravascular coagulation and thrombocytopenia.[1]
Pelvic Thrombophlebitis
The pathogenesis is thought to include injury to the intima of the pelvic vein caused by a spreading uterine infection, bacteremia, and endotoxins, which can also occur secondary to the trauma of delivery or surgery. In this setting, Virchow’s triad is completed due to the contribution of pregnancy as a well-known hypercoagulable state, and the reduction of blood flow in dilated uterine and ovarian veins during the postpartum period which causes venous stasis.[2] Pelvic infection leads to infection of the vein wall and intimal damage, leading to thrombogenesis. The clot is then invaded by microorganisms.[3]
Pylephlebitis
Pylephlebitis is due to an abdominal infection that drains into the portal venous system. The most commonly isolated organism is Bacteroides fragilis, which facilitates coagulation via the capsular and surface components. Capsular polysaccharides activate macrophages therefore initiating the clotting cascade while the surface component accelerates fibrin cross-linking.[4]
References
- ↑ Lemierre Syndrome. Wikipedia. https://en.wikipedia.org/wiki/Lemierre%27s_syndrome#Pathophysiology Accessed on October 19, 2015
- ↑ 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.
- ↑ Septic pelvic thrombophlebitis. Wikipedia. https://en.wikipedia.org/wiki/Septic_pelvic_thrombophlebitis Accessed on October 19, 2015
- ↑ 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.