Lemierre syndrome

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The Lemierre syndrome (Syn .: Post angina septicemia, post angina sepsis, sepsis postanginöse, necrobacillosis) is characterized by the combination of purulent thrombophlebitis a jugular vein ( vena jugularis ) and occurrence of septic emboli . The rare disease is usually caused by infections with anaerobic bacteria in the oropharynx (e.g. peritonsillar abscesses ). In most cases, Fusobacterium necrophorum can be detected in Lemierre's syndrome .

Disease picture and pathogenesis

Lemierre syndrome mostly affects young healthy adults. It usually begins with a sore throat and neck caused by abscess formation in the tonsil area. Anaerobic bacteria such as B. Fusobacteria do not need oxygen and can multiply in abscesses. Lethargy , fever attacks and swollen neck lymph nodes can be observed within a relatively short time . Liver and kidney dysfunction, diarrhea, vomiting, skin rashes ( exanthema ) and nausea can occur (usually two days to two weeks after the first symptoms). Since the clinical picture resembles a strong flu, the urgently needed treatment is often started too late. Certain infections in heart valves can also have a similar course, making it difficult to diagnose quickly and, in particular, to make the correct diagnosis.

In Lemierre's syndrome, the bacteria penetrate the abscess into the neighboring jugular veins ( internal jugular vein and / or external jugular vein ). Local inflammation and blood clots form , which can lead to a so-called jugular vein thrombosis . Lemierre syndrome is characterized by the spread of bacteria (bacteremia) and components of the local inflammatory reaction via the blood system. This leads to blockages of blood vessels in the periphery, a so-called septic embolism. Pulmonary embolism is the most common complication of Lemierre's syndrome, which, however, is not necessarily noticed due to the poor condition of the patient. The bacteremia leads to sepsis with systemic inflammatory reaction and fever.

diagnosis

A synopsis of clinical symptoms and a blood culture are decisive for the diagnosis . Laboratory tests can show signs of a bacterial infection (increased C-reactive protein , or neutrophilia ). Jugular vein thrombosis as part of Lemierre's syndrome can be detected using ultrasound, computed tomography (CT), or magnetic resonance imaging . MRSA may be related to Lemierre syndrome, according to the latest research.

treatment

Conservative treatment with high-dose broad-spectrum antibiotics can be attempted in the initial stage and if the disease is diagnosed in good time. Therefore, patients with a sore throat and signs of bacteremia and suspected Lemierre syndrome must be treated with a broad spectrum antibiotic. If treatment is too late or if it is detected later, intensive medical therapy is usually necessary. The mortality rate is high with late detection; with timely treatment it is 4.6%. In the absence of long-term studies, it cannot yet be clearly stated whether the thrombosed jugular vein should be surgically removed or whether long-term or lifelong anticoagulation makes sense.

history

In 1900 P. Courmant and A. Cade first recognized a connection between infections of the oropharynx and sepsis.

In 1922 Hugo Schottmüller published a paper on this subject.

The name and the first description of the syndrome characterizing the clinical picture go back to the publication of the French doctor André Alfred Lemierre in 1936. He examined 20 patients who showed signs of the syndrome. 18 patients died as a result of the disease.

literature

Review article

  • MI Syed et al .: Lemierre syndrome: two cases and a review. In: Laryngoscope. 2007 Sep; 117 (9), pp. 1605-1610. PMID 17762792 .
  • JA Chirinos et al: The evolution of Lemierre syndrome: report of 2 cases and review of the literature. In: Medicine (Baltimore). 2002 Nov; 81 (6), pp. 458-465. PMID 12441902

Case report

  • Kisser U et al. Lemierre syndrome: a case report. Am J Otolaryngol. 2012 Jan-Feb; 33 (1): 159-62.

Original publications of the first descriptions:

  • P. Courmont, A. Cade: Sur une septico-pyohemie de l'homme simulant la peste et causee par un streptobacille anaerobie. In: Arch Med Exp Anat Patnol. 1900; 12, pp. 393-418.
  • A. Lemierre: On certain septicaemias due to anaerobic organisms . In: The Lancet . 1936; 1, pp. 701-703.
Individual evidence
  1. ↑ a b c W. Siegenthaler: Siegenthaler's differential diagnosis: internal diseases - from symptom to diagnosis. Georg Thieme Verlag, 2005, ISBN 3-13-344819-6 , p. 133. Restricted preview in the Google book search
  2. ↑ B. Hochreutener, F. Lammer, T. Bregenzer: Not only cause of the Lemierre syndrome. In: Forum MedSuisse. 2008; 8 (39), p. 737.
  3. ↑ DN O'Dwyer, S. Ryan, T. O'Keefe, J. Lyons, L. Lavelle, E. McKone: Lemierre's syndrome. In: Irish journal of medical science. Volume 180, Number 2, June 2011, pp. 565-567, ISSN  1863-4362 . doi: 10.1007 / s11845-008-0255-7 . PMID 19002548 .
  4. ^ P. Bentley, DF Brennan: Lemierre's syndrome: methicillin-resistant Staphylococcus aureus (MRSA) finds a new home. In: The Journal of emergency medicine. Volume 37, Number 2, August 2009, pp. 131-134, ISSN  0736-4679 . doi: 10.1016 / j.jemermed.2007.07.066 . PMID 18280087 . (Review).
  5. ↑ RM Centor: Expand the pharyngitis paradigm for adolescents and young adults. In: Annals of Internal Medicine Volume 151, Number 11, December 2009, pp. 812-815, ISSN  1539-3704 . doi: 10.7326 / 0003-4819-151-11-200912010-00011 . PMID 19949147 .
  6. ↑ a b R. McMullan, C. McConville, JC Clarke, DA Adams, S. Hedderwick: Lemierre syndrome: remember the forgotten disease. In: The Ulster medical journal. Volume 73, Number 2, November 2004, pp. 123-125, ISSN  0041-6193 . PMID 15651772 . PMC 247546 (free full text).
  7. ↑ H. Schottmüller: About the alleged connection between infections of the teeth and general diseases. In: Dtsch med Wochenschr. Volume 48, 1922, pp. 181-182.
  8. ↑ MD Lu, Z. Vasavada, C. Tanner: Lemierre syndrome Following oropharyngeal infection: a case series. In: Journal of the American Board of Family Medicine: JABFM. Volume 22, Number 1, 2009 Jan-Feb, pp. 79-83, ISSN  1557-2625 . doi: 10.3122 / jabfm.2009.01.070247 . PMID 19124638 .