Lemierre's Syndrome Research Articles

From rare to aware: confronting Lemierre syndrome.

Lemierre syndrome is a life-threatening condition characterized by an acute head/neck bacterial infection due to anaerobes (namely Fusobacterium necrophorum), local septic vein thrombosis and distance septic embolism...

Lemierre syndrome due to Klebsiella pneumoniae: a rare case report with review of literature

Lemierre’s syndrome, a forgotten clinical entity, is characterised by septic thrombophlebitis of the internal jugular vein due to oropharyngeal infection. In the past, it was mainly associated with Fusobacterium necrophorum infections. We present a unique case report of Lemierre’s syndrome due to Klebsiella pneumoniae. Patient reported with progressive swelling involving right side of the neck that eventually increased in size. After confirming the diagnosis through CECT, patient was managed through combined medical and surgical therapy in the form of incision and drainage, targeted antibiotic therapy, glycaemic control and anticoagulation therapy. This case report highlights the association of poor glycaemic control in the pathogenesis and the isolation of Klebsiella pneumoniae as the rare organism of Lemierre’s syndrome.

Sore throat with septic complications

Ayoung man presented with exertional dyspnea and thoracic pain following pharyngitis. The findings included pulmonary melting, left-sided pleural empyema and spondylitis. Cultures for detection of the pathogen were negative and sequencing for bacterial DNA was additionally carried out resulting in detection of Fusobacterium necrophorum that is typical for oropharyngeal infections. Furthermore, environmental diagnostics revealed two infected molars as apossible source of the infection and ajugular vein thrombosis. The results were compatible with Lemierre syndrome. This case highlights the potential of molecular diagnostics of pathogens.

Endogenous endophthalmitis secondary to Lemierre’s Syndrome originating from pharyngotonsillitis

PurposeThe purpose of this article is to report a case of Lemierre’s Syndrome producing unilateral endogenous endophthalmitis in a healthy, young woman with a history of tonsillitis.Case report/observationsA 17-year-old healthy woman developed fever after a few days of sore throat. She later developed pneumonia with septic signs, leading to admission to the Intensive Care Unit. Lemierre Syndrome was diagnosed due to multiple septic pulmonary emboli and signs of sepsis following a recent episode of tonsillitis. During hospitalization, the patient complained of decreased visual acuity and floaters in her left eye. Ophthalmological examination revealed papillary edema, vitritis, foci of chorioretinitis in the macula and Roth’s spots, confirming the diagnosis of endogenous endophthalmitis. Subsequently, she underwent appropriate treatment, progressing satisfactorily.Conclusion and importanceAlthough ophthalmological manifestations are rare, due to the pathophysiological characteristics of Lemierre’s Syndrome, all patients should underwent standard ophthalmologic assessment, even in the absence of ophthalmic symptoms or visible findings, as part of a multidisciplinary management approach.

Identification of linear B cell epitopes on the leukotoxin protein of Fusobacterium necrophorum

ObjectiveFusobacterium necrophorum can casuse Lemierre's syndrome in humans and a range of illnesses, including foot rot and liver abscesses, in animals. The main virulence factor released by F. necrophorum is leukotoxin, which has been shown to have a strong correlation with the severity of the disease. Leukotoxin is commonly employed as the key antigen in the formulation of subunit vaccines. Therefore, identification of the B-cell epitope of F. necrophorum leukotoxin is necessary. MethodsIn this research, we utilized lymphocyte hybridoma technology to develop a monoclonal antibody (mAb), 3D7, targeting the F. necrophorum leukotoxin protein. Identification of B-cell epitopes recognized by 3D7 mAb was achieved through Western blot, ELISA and dot blots using leukotoxin-truncated recombinant proteins and peptides, and through SWISS-MODEL homology modeling and PyMOL visualization. ResultsThe 3D7 mAb was identified as belonging to the IgG1 subclass with a κ-chain light chain. It demonstrated reactivity with the natural leukotoxin. The results showed that the 3D7 mAb recognizes a B-cell epitope of the F. necrophorum leukotoxin protein, I2168SSFGVGV2175 (EP-3D7). Sequence comparison analysis showed that EP-3D7 was highly conserved in F. necrophorum strains, but less conserved in other bacteria, indicating the specificity of EP-3D7. EP-3D7 is present on the surface of leukotoxin proteins in a β-folded manner. ConclusionsIn summary, these results establish EP-3D7 as a conserved antigenic epitope of F. necrophorum leukotoxin. It could be valuable in the development of vaccines and diagnostic reagents for F. necrophorum epitopes.

Lemierre's Syndrome: a not-so-forgotten disease

Lemierre's Syndrome: a not-so-forgotten disease

Lemierre’s syndrome as a rare cause of septic pulmonary embolism (case report)

Objectives. The purpose of this work is to provide a clinical case study of Lemierre’s syndrome (LS) in order to raise awareness amongst doctors of various medical specialties regarding this rare cause of septic pulmonary embolism (SPE).Materials and methods. The patient in clinical case is a 25-year-old female who was hospitalized due to SPE, which had been complicated by respiratory distress, pneumothorax and septic shock. The initial source of embolus lung damage was the septic thrombosis of both the internal and external jugular veins. This thrombosis occurred against the backdrop of a carbuncle of the lower lip, an inflammatory infiltrate at the bottom of the mouth, an abscess in the soft tissue of the chin and neck cellulitis, which correspond to the diagnostic criteria for Lemierre Syndrome.Results. The literature data of the epidemiology, etiology, pathogenic mechanisms of the venous thrombosis, embolic and septic complications among patients with LS are presented. The article discusses the clinical features and course of the disease, as well as key aspects of diagnosis, including current diagnostic criteria, with regard to the typical and atypical variants of LS. The principles of antibiotic therapy and the possibility of anticoagulation therapy in cases of septic pulmonary emboli associated with head and neck vein thrombosis are also considered.Conclusion. LS is a rare, but clinically significant condition characterized by the development of septic thrombosis in the internal jugular vein in response to acute suppurative inflammation of the head and neck. In typical cases, the causative organism is Fusobacterium necrophorum, or other anaerobic bacteria. This pathological condition is often accompanied by multiple other septic complications, with the most significant being the development of septic pulmonary embolism. Clinical observation indicates the necessity for including LS in the differential diagnosis among causes of the septic pulmonary embolism, and for adopting a multidisciplinary approach in the treatment of these patients in a specialized multifield hospital. Identification and diagnosis of Lemierre Syndrome can be challenging due to its low incidence and variable clinical presentation. Although the condition is not widely recognized among physicians, an understanding of the basic principles of its diagnosis and management can significantly improve treatment outcomes and patients prognosis.

Point‐of‐care ultrasound for Lemierre's syndrome during the COVID‐19 pandemic: A case report

AbstractLemierre's syndrome is a fatal condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Early diagnosis of Lemierre's syndrome in primary care remains challenging because of its rarity and common initial symptoms like fever and sore throat. The COVID‐19 pandemic has increased the difficulty of diagnosis, along with many diagnostic delays. Herein, we report a case in which an IJV thrombus was detected using point‐of‐care ultrasound (POCUS), leading to the diagnosis of Lemierre's syndrome. During the COVID‐19 pandemic, POCUS was a simple and noninvasive technique for screening Lemierre's syndrome without radiation and low droplet exposure.

Epstein-Barr virus as promoter of Lemierre syndrome: systematic literature review

PurposeTo investigate a possible link between acute Epstein-Barr virus infection and Lemierre syndrome, a rare yet life-threatening infection.MethodsA systematic review was conducted adhering to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnosis criteria for Lemierre syndrome were established, and data extraction encompassed demographic data, clinical, and laboratory information.ResultsOut of 985 initially identified papers, 132 articles were selected for the final analysis. They reported on 151 cases of Lemierre syndrome (76 female and 75 male patients with a median of 18 years) alongside interpretable results for Epstein-Barr virus serology. Among these, 38 cases (25%) tested positive for acute Epstein-Barr virus serology. There were no differences in terms of age, sex, or Fusobacterium presence between the serologically positive and negative groups. Conversely, instances of cervical thrombophlebitis and pulmonary complications were significantly higher (P = 0.0001) among those testing negative. The disease course was lethal in one case for each of the two groups.ConclusionsThis analysis provides evidence of an association between acute Epstein-Barr virus infection and Lemierre syndrome. Raising awareness of this link within the medical community is desirable.

The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis.

Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography. CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group). Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly). In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.

Lemierre&amp;apos;s Syndrome and Nasopharyngitis in Children: DIAGNOSIS and Treatment

Introduction: Lemierre’s syndrome (LS) is a rare but serious infectious emergency. It can be life threatening. It is a sepsis difficult to recognize and most often due to Fusobacterium necrophorum. The purpose of this case report was to discuss the diagnosis and treatment of Lemierre syndrome in children. Observation: A three-year-old child consulted for rhinopharyngitis complicated by an abscessed cervical adenophlegmon. The symptomatology had been evolving for 7 days with a notion of self-medication. The blood cell count showed hyperleukocytosis at 14.06.10&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;, anemia at 8.2.10&amp;lt;sup&amp;gt;6&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;, and platelets at 102.10&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;. CRP was 258.5 mg/dL. HIV serology was negative. Bacteriological culture of the biological fluids collected (abscess pus, blood and joint fluid) was sterile. The CT scan revealed a collection of abscesses in the right sub-angulo-mandibular region. It was associated with thrombophlebitis of the internal jugular vein, as well as pulmonary and joint infections. The diagnosis of Lemierre syndrome was done. Cervicotomy allowed drainage of the abscess. A triple parenteral antibiotic therapy (Ceftriaxone, Metronidazole, Gentamycin) with per-os relay by Amoxicillin + Clavulanic Acid allowed to obtain the cure in one month of treatement without complications. Conclusion: LS is difficult to diagnose due to its non-specific clinical presentation and low incidence. Early clinical and imaging diagnosis guarantees a good outcome by allowing adequate treatment.

Septic Thrombophlebitis of the Internal Jugular Vein due to Blastomycosis Mastoiditis Resulting in Lemierre Syndrome: A Case Report (P7-5.013)

Septic Thrombophlebitis of the Internal Jugular Vein due to Blastomycosis Mastoiditis Resulting in Lemierre Syndrome: A Case Report (P7-5.013)

Pediatric Lemierre's Syndrome: A Comprehensive Literature Review.

Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. Lemierre syndrome has been called "the forgotten disease," with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease's treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

Lemierre’s syndrome in pediatric population

Introduction: Lemierre’s syndrome is a rare, potentially fatal complication of upper respiratory tract infections, occurring mainly in young, previously healthy individuals. It is defined as postanginal septicaemia accompanied by thrombosis of the internal jugular vein and formation of abscesses in distant organs. Characteristic symptoms include deterioration of patient’s condition on the 4th–7th day of the management of primary infection, with the recurrence of fever and unilateral swelling and painfulness of the neck. Aims: The analysis of pediatric cases of Lemierre’s syndrome as described in the literature over the last 30 years; presentation of own experience and clinical observations in pediatric patients receiving treatment for Lemierre’s syndrome. Material and methods: A search of the literature available through the PubMed platform was carried out using the query terms “Lemierre syndrome” and “children”. A total of 73 pediatric cases reported on in papers published in English literature within the time span of 1980 through 2023 were included in the analysis. Results: As shown by the analysis of the 73 pediatric cases of Lemierre’s syndrome, the most common causes of the disease were acute pharyngitis and acute otitis media. The presence of the bacterial species Fusobacterium necrophorum was established in the blood cultures of more than one half of the patient group. Distant complications were most frequently observed in the lungs while the most common locations of thrombosis included the internal jugular vein and the sigmoid sinus. Intravenous antibiotic therapy was delivered to all patients, many of whom required additional surgical intervention and/or anticoagulation treatment. Conclusions: In most cases, Lemierre’s syndrome is a complication of acute pharyngitis and acute otitis media. Despite the presence of severe distant organ complications and extensive thrombotic lesions within the venous vessels, complete recovery is achieved in most cases in the pediatric population. The treatment of Lemierre’s syndrome is based primarily on broad-spectrum antibiotic therapy, with surgical interventions and/or anticoagulant therapy being also required in some cases. As of the present, no uniform guidelines have been established for the use of anticoagulant therapy, particularly in the pediatric population.

Un imprevisto tra capo e collo: la sindrome di Lemierre

A healthy 15-year-old boy was hospitalized due to the persistence of lateral cervical swelling associated with fever and worsening of headache. He underwent a neck and facial mass CT scan showing a thrombophlebitis of the internal jugular vein extended to the intracranial sinuses. The diagnosis of Lemierre syndrome (LS) was formalized with positive blood colture for Fusobacterium necrophorum. Intravenous antibiotic therapy associated with anticoagulant therapy was started with complete clinical recovery after 4 weeks of treatment. A close clinical-instrumental follow-up was set up. Lemierre syndrome is a thrombophlebitis of the internal jugular vein, that in this case was extended to the intracranial sinuses. It is a rare condition, secondary to the extension of an infectious process starting from the oropharynx. The clinical picture is characterized by high fever, persistent pharyngitis followed by sepsis, pneumo-nia or atypical laterocervical pain. Fusobacterium necrophorum, a gram-negative anaerobe bacteriu,, is the responsible pathogen in most of the cases (&gt;90%). The antibiotic treatment is prolonged (at least 4-6 weeks); occasionally a parallel surgical approach is necessary. The start of anticoagulant thera-py for internal venous thrombosis associated with LS is still matter of debate.

Proteomic Characterization of Plasma in Lemierre's Syndrome.

The underlying mechanisms of thrombosis in Lemierre's syndrome and other septic thrombophlebitis are incompletely understood. Therefore, in this case control study we aimed to generate hypotheses on its pathogenesis by studying the plasma proteome in patients with these conditions. All patients with Lemierre's syndrome in the Skåne Region, Sweden, were enrolled prospectively during 2017 to 2021 as cases. Age-matched patients with other severe infections were enrolled as controls. Patient plasma samples were analyzed using label-free data-independent acquisition liquid chromatography tandem mass spectrometry. Differentially expressed proteins in Lemierre's syndrome versus other severe infections were highlighted. Functions of differentially expressed proteins were defined based on a literature search focused on previous associations with thrombosis. Eight patients with Lemierre's syndrome and 15 with other severe infections were compared. Here, 20/449 identified proteins were differentially expressed between the groups. Of these, 14/20 had functions previously associated with thrombosis. Twelve of 14 had a suggested prothrombotic effect in Lemierre's syndrome, whereas 2/14 had a suggested antithrombotic effect. Proteins involved in several thrombogenic pathways were differentially expressed in Lemierre's syndrome compared to other severe infections. Among identified proteins, several were associated with endothelial damage, platelet activation, and degranulation, and warrant further targeted studies.

339 - A pain in the neck: a dramatic presentation of lemierre syndrome

339 - A pain in the neck: a dramatic presentation of lemierre syndrome

Retraction: Lemierre's Syndrome: A Case of Life-Threatening Infection From Family Medicine Practice.

[This retracts the article DOI: 10.7759/cureus.20684.].

Lemierre's Syndrome with a Palmar Lesion.

Lemierre's syndrome can be fatal if diagnosed late or not treated appropriately. We herein report a 40-year-old woman with a fever and pain with tenderness in her palms after the administration of antibiotics for pharyngotonsillitis. She was diagnosed with Lemierre's syndrome, and her symptoms improved after the administration of intravenous ampicillin-sulbactam. In this case, the palmar lesions indicated septic emboli and were an important finding in recognizing Lemierre's syndrome. Lemierre's syndrome should be considered in the differential diagnosis of patients with a persistent fever following oropharyngeal infection, even if they have received antimicrobial therapy, resolved pharyngeal symptoms, and negative culture results.

Isolated Facial Vein Thrombosis in a Case of Lemierre's Syndrome

Lemierres disease is an anaerobic post-anginal sepsis presenting in the form of septic thrombosis of internal jugular vein. A 13-year old boy presented with high fever delirium trismus parotid edema and thrombophlebitis of facial vein. Causative agent was Streptococcus intermedius. The condition responded to metronidazole and linezolid. This case is reported due to its rarity.nbsp