Lemierre's syndrome - Revision history

Rossdonaldson1: /* Video */

2024-04-17T20:12:55Z

Video

← Older revision		Revision as of 20:12, 17 April 2024
Line 64:		Line 64:
	*[[Peritonsillar abscess]]		*[[Peritonsillar abscess]]
	*[[Sepsis]]		*[[Sepsis]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=-UOjKNn-xqA}}~~

	==References==		==References==

Ostermayer: /* Background */

2021-09-18T21:41:43Z

Background

← Older revision		Revision as of 21:41, 18 September 2021
Line 1:		Line 1:
	==Background==		==Background==
	*Also known as "Lemierre's disease" and "postanginal shock including sepsis" and "human necrobacillosis"		*Also known as "Lemierre's disease" and "postanginal shock including sepsis" and "human necrobacillosis"
	*Is a form of [[thrombophlebitis]]<ref>"Lemierre syndrome" at Dorland's Medical Dictionary</ref>		*Is a form of [[thrombophlebitis]]<ref>"Lemierre syndrome" at Dorland's Medical Dictionary</ref> and defined by a history of recent oropharyngeal infection, clinical or radiological evidence of IJ venous thrombosis and anaerobic bacteremia caused primarily by [[Fusobacterium necrophorum]]
	*Usually caused by ''[[Fusobacterium necrophorum]]'', and occasionally by other members of the genus ''Fusobacterium'' (''F. nucleatum, F. mortiferum and F. varium'' etc.) or [[MRSA]]		*Usually caused by ''[[Fusobacterium necrophorum]]'', and occasionally by other members of the genus ''Fusobacterium'' (''F. nucleatum, F. mortiferum and F. varium'' etc.) or [[MRSA]]
	*Usually affects young, healthy adults, most often developing after [[Strep Pharyngitis]] causing [[Peritonsilar Abscess\|peritonsilar abscess]]		*Usually affects young, healthy adults, most often developing after [[Strep Pharyngitis]] causing [[Peritonsilar Abscess\|peritonsilar abscess]]

Ostermayer: /* Management */

2021-09-18T21:32:22Z

Management

← Older revision		Revision as of 21:32, 18 September 2021
Line 56:		Line 56:
	*Drainage of [[abscess]]		*Drainage of [[abscess]]
	*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>		*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>
	*No evidence for or against anticoagulation<ref>Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.</ref>		*No evidence for or against anticoagulation<ref>Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.</ref><ref>Hoehn KS. Lemierre’s syndrome: the controversy of anticoagulation. Pediatrics. 2005;6(5):1415–1416.</ref>

	==Disposition==		==Disposition==

Ostermayer: /* Management */

2021-09-18T21:31:19Z

Management

← Older revision		Revision as of 21:31, 18 September 2021
Line 53:		Line 53:
	==Management==		==Management==
	*Antibiotics (specifically anaerobic coverage of [[F. necrophorum]] PLUS [[strep]], AND [[bacteroides]])		*Antibiotics (specifically anaerobic coverage of [[F. necrophorum]] PLUS [[strep]], AND [[bacteroides]])
	*[[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks		**[[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks
	*Drainage of [[abscess]]		*Drainage of [[abscess]]
	*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>		*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>

Ostermayer: /* Management */

2021-09-18T21:30:59Z

Management

← Older revision		Revision as of 21:30, 18 September 2021
Line 52:		Line 52:

	==Management==		==Management==
	*Antibiotics (coverage of [[F. necrophorum]], [[strep]], [[bacteroides]]) - [[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks		*Antibiotics (specifically anaerobic coverage of [[F. necrophorum]] PLUS [[strep]], AND [[bacteroides]])
	**IV [[Antibiotics]]		*[[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks
	*Drainage of [[abscess]]		*Drainage of [[abscess]]
	*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>		*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>

Rossdonaldson1: /* Clinical Features */

2021-07-28T20:39:36Z

Clinical Features

← Older revision		Revision as of 20:39, 28 July 2021
Line 11:		Line 11:

	==Clinical Features==		==Clinical Features==
	[[File:PMC3663068 kjo-27-219-g002.png\|thumb\|Example of ~~neurologic~~ complication: paresis of the abducens nerve demonstrated in the right eye when looking to the right.]]		[[File:PMC3663068 kjo-27-219-g002.png\|thumb\|Example of an intracranial complication: paresis of the abducens nerve (demonstrated in the right eye when looking to the right).]]
	*Persistent [[sore throat]], [[fever]], and general [[weakness]]		*Persistent [[sore throat]], [[fever]], and general [[weakness]]
	*2 days - 2 weeks after initial symptoms:		*2 days - 2 weeks after initial symptoms:

Rossdonaldson1: /* Clinical Features */

2021-07-28T20:38:55Z

Clinical Features

← Older revision		Revision as of 20:38, 28 July 2021
Line 11:		Line 11:

	==Clinical Features==		==Clinical Features==
			[[File:PMC3663068 kjo-27-219-g002.png\|thumb\|Example of neurologic complication: paresis of the abducens nerve demonstrated in the right eye when looking to the right.]]
	*Persistent [[sore throat]], [[fever]], and general [[weakness]]		*Persistent [[sore throat]], [[fever]], and general [[weakness]]
	*2 days - 2 weeks after initial symptoms:		*2 days - 2 weeks after initial symptoms:

Rossdonaldson1: /* Evaluation */

2021-07-28T20:33:51Z

Evaluation

← Older revision		Revision as of 20:33, 28 July 2021
Line 36:		Line 36:

	==Evaluation==		==Evaluation==
			[[File:Lemierre Kilpatrick.gif\|thumbnail\|POCUS shows IJ thrombus<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]]
			[[File:PMC2813609 ASM-29-58-g001.png\|thumb\|CT of the neck showing partial thrombosis of the right internal jugular vein (black arrow) and complete thrombosis of the right external jugular vein (white arrow).]]
	===Workup===		===Workup===
	~~[[File:Lemierre Kilpatrick.gif\|thumbnail\|POCUS shows IJ thrombus<ref>http://www.thepocusatlas.com/soft-tissue-vascular/</ref>]]~~
	*CTA of neck		*CTA of neck
	*Point of care [[ultrasound]] may reveal IJ thrombus		*Point of care [[ultrasound]] may reveal IJ thrombus

ClaireLewis at 21:04, 30 September 2019

2019-09-30T21:04:55Z

← Older revision		Revision as of 21:04, 30 September 2019
Line 11:		Line 11:

	==Clinical Features==		==Clinical Features==
	*Persistent sore throat, [[fever]], and general weakness		*Persistent [[sore throat]], [[fever]], and general [[weakness]]
	*2 days - 2 weeks after initial symptoms:		*2 days - 2 weeks after initial symptoms:
	**Lethargy, [[fevers]], [[lymphadenopathy]], painful neck		**Lethargy, [[fevers]], [[lymphadenopathy]], [[neck pain\|painful neck]]
	**Often abdominal pain, [[diarrhea]], [[nausea and vomiting]]		**Often [[abdominal pain]], [[diarrhea]], [[nausea and vomiting]]
	**May lead to:		**May lead to:
	***[[Pneumonia]]		***[[Pneumonia]]
Line 31:		Line 31:
	*[[Mumps]]		*[[Mumps]]
	*[[Sjögren Syndrome]]		*[[Sjögren Syndrome]]
	*Heerfordt's syndrome (small percentage of sarcoidosis)		*Heerfordt's syndrome (small percentage of [[sarcoidosis]])

	{{Sore throat DDX}}		{{Sore throat DDX}}
Line 52:		Line 52:
	*Antibiotics (coverage of [[F. necrophorum]], [[strep]], [[bacteroides]]) - [[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks		*Antibiotics (coverage of [[F. necrophorum]], [[strep]], [[bacteroides]]) - [[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks
	**IV [[Antibiotics]]		**IV [[Antibiotics]]
	*Drainage of abscess		*Drainage of [[abscess]]
	*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>		*Consider ligation of the internal jugular vein where antibiotic can not penetrate.<ref>Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ (November 2002). "The evolution of Lemierre syndrome: report of 2 cases and review of the literature". Medicine (Baltimore) (Lippincott Williams & Wilkins) 81 (6): 458–465. doi:10.1097/00005792-200211000-00006. PMID 12441902.</ref>
	*No evidence for or against anticoagulation<ref>Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.</ref>		*No evidence for or against anticoagulation<ref>Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C (March 2008). "A Lemierre's syndrome variant caused by Staphylococcus aureus". American journal of emergency medicine test (Elsevier) 26 (3): 380–387. doi:10.1016/j.ajem.2007.05.020. PMID 18358967.</ref>

ClaireLewis: /* Management */

2019-01-26T22:53:04Z

Management

← Older revision		Revision as of 22:53, 26 January 2019
Line 50:		Line 50:

	==Management==		==Management==
	*Antibiotics (coverage of [[F. necrophorum]], [[strep]], [[bacteroides]]) - [[Unasyn]], [[Zosyn]], or [[~~carbapenam~~]] for at least 3-4 wks		*Antibiotics (coverage of [[F. necrophorum]], [[strep]], [[bacteroides]]) - [[Unasyn]], [[Zosyn]], or [[carbapenem]] for at least 3-4 wks
	**IV [[Antibiotics]]		**IV [[Antibiotics]]
	*Drainage of abscess		*Drainage of abscess