In response to Lemierre's Syndrome: A Systematic Review

Abstract

We thank Dr. Syed and his colleagues for their useful comments regarding our recent systematic review article on Lemierre's syndrome.1 We agree with most points raised by the authors. In general, the amount of data included in a systematic review or meta-analysis article depends on the inclusion criteria set by the authors of each article. So, given our different inclusion/exclusion criteria, it is hardly surprising that we had identified a different number of pooled studies than Syed et al. did in their 2007 case series and review.2 In particular, we opted to exclude “variants or atypical Lemierre's syndrome cases, negative fusobacteria cultures, and papers without radiological evidence of thrombophlebitis.” Clinical evidence alone of internal jugular vein thrombosis is, in our opinion, easy to miss especially in the presence of a large neck abscess, hence the need for some form of urgent radiological investigation. From the clinical practice point of view, when faced with a suspected Lemierre's syndrome case, we agree that it is preferable to expand the defining criteria to include patients with negative fusobacteria providing that the remaining criteria are fulfilled. The final point raised by the authors, with regard to the primary care, is very important, particularly in the current climate of the H1N1 virus outbreak. Not every sore throat is Lemierre's syndrome, and increased awareness and/or higher index of suspicion of the latter should not lead to overprescribing of antibiotics. Petros D. Karkos AFRCS, PhD, MPhil*, Christos D. Karkos FRCS, PhD*, Samuel C. Leong MRCSEd, DO-HNS , * Department of Otolaryngology, Liverpool University Hospitals, Liverpool, United Kingdom, Department of Surgery, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece.