Lemierre Syndrome

 Q: Healthy people are at higher risk of developing Lemierre syndrome?

A) True

B) False

Answer: A

Septic thrombophlebitis of the internal jugular vein is called Lemierre syndrome. Although rare, it tends to occur more in healthy teens and young adults, with a high incidence in males. It is caused by normal oropharyngeal flora. The most common pathogen is the anaerobic nonmotile, filamentous, non-spore-forming gram-negative bacillus, called Fusobacterium necrophorum. 

Lemierre syndrome is usually preceded 2-3 weeks prior by tonsilitis or infection of peritonsillar tissue. It is also reported after dental infection, mastoiditis, otitis media, sinusitis, or parotitis. It mostly occurs via local invasion. Some authors also suspect hematogenous spread via tonsillar vein or via the lymphatics. 

Empiric antibiotics should be started as soon as possible. Monotherapy with piperacillin-tazobactam or a carbapenem is possible. Ceftriaxone can also be used but metronidazole should be added to it. Penicillin-based antibiotics are generally avoided as resistance is high globally.

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References:

1. Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre's syndrome due to Fusobacterium necrophorum. Lancet Infect Dis 2012; 12:808. 

2. Karkos PD, Asrani S, Karkos CD, Leong SC, Theochari EG, Alexopoulou TD, Assimakopoulos AD. Lemierre's syndrome: A systematic review. Laryngoscope. 2009 Aug;119(8):1552-9. doi: 10.1002/lary.20542. PMID: 19554637.

3. Gore MR. Lemierre Syndrome: A Meta-analysis. Int Arch Otorhinolaryngol. 2020 Jul;24(3):e379-e385. doi: 10.1055/s-0039-3402433. Epub 2020 Apr 24. PMID: 32754251; PMCID: PMC7394644.