Skip to main content

Advertisement

SpringerLink
Log in

Lemierre’s syndrome

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Lemierre’s syndrome is characterized by an oropharyngeal infection followed by internal jugular vein septic thrombophlebitis and metastatic emboli, most often to the lungs and joints. The syndrome is most commonly associated with the anaerobic gram-negative rod Fusobacterium necrophorum. Diagnosis is established with evidence of metastatic infection and internal jugular vein thrombophlebitis. CT is considered the diagnostic procedure of choice. Treatment should include an extended course of a b-lactamase-resistant antibiotic and surgical drainage of any purulent fluid collection. Anticoagulation remains controversial, and ligation of the internal jugular vein is reserved for patients with persistent sepsis and recurrent emboli. With appropriate therapy, mortality is 4% to 12%; but mortality is increased when therapy is delayed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Courmont P, Cade A: Sur une septico-pyoheie de l’homme simulant la peste et causee par un streptobacille anaerobie. Arch Med Exp Anat Pathol 1900, 4.

  2. Mosher HP: Thrombosis of the internal jugular vein with pyemia as a complication of retropharyngeal abscess. Laryngoscope 1919, 29:638.

    Google Scholar 

  3. Beck AL: A study of twenty-four cases of neck infection. Ann Otol Rhinol Laryngol 1933, 42:741–777.

    Google Scholar 

  4. Lemierre A: On certain septicemias due to anaerobic organisms. Lancet 1936, 1:701–703.

    Article  Google Scholar 

  5. Sinave CP, Hardy GJ, Fardy PW: The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine 1989, 68:85–94.

    Article  PubMed  CAS  Google Scholar 

  6. Moore-Gillon J, Lee TH, Eykyn SJ, Phillips I: Necrobacillosis: a forgotten disease. BMJ 1984, 288:1526–1527.

    PubMed  CAS  Google Scholar 

  7. Weesner Cl, Cisek JE: Lemierre syndrome: the forgotten disease. Ann Emerg Med 1993, 22:256–258.

    Article  PubMed  CAS  Google Scholar 

  8. Carlson ER, Bergamo DF, Coccia CT: Lemierre’s syndrome: two cases of a forgotten disease. J Oral Maxillofac Surg 1994, 52:74–78.

    PubMed  CAS  Google Scholar 

  9. Leugers C, Clover R: Lemierre syndrome: postanginal sepsis. J Am Board Fam Pract 1995, 8:384–391.

    PubMed  CAS  Google Scholar 

  10. Moreno S, Altozano JG, Pinilla B, et al.: Lemierre’s disease: postanginal bacteremia and pulmonary involvement caused by Fusobacterium necrophorum. Rev Infect Dis 1989, 11:319–324.

    PubMed  CAS  Google Scholar 

  11. Hagelskjaer LH, Prag J, Malczynski J, Kristensen JH: Incidence and clinical epidemiology of necrobacillosis, including Lemierre’s syndrome, in Denmark 1990–1995. Eur J Clin Microbiol Infect Dis 1998, 17:561–565.

    Article  PubMed  CAS  Google Scholar 

  12. Goldhagen J, Alford BA, Prewitt LH, et al.: Suppurative thrombophlebitis of the internal jugular vein: report of three cases and review of the pediatric literature. Pediatr Infect Dis J 1988, 7:410–414.

    Article  PubMed  CAS  Google Scholar 

  13. Ieven M, Vael K, DeMayer M, et al.: Three cases of Fusobacterium necrophorum septicemia. Eur J Clin Microbiol Infect Dis 1993, 12:705–706.

    Article  PubMed  CAS  Google Scholar 

  14. Hughes CE, Spear RK, Shinabarger CE, Tuna IC: Septic pulmonary emboli complicating mastoiditis: Lemierre’s syndrome revisited. Clin Infect Dis 1994, 18:633–635.

    PubMed  CAS  Google Scholar 

  15. Shetty AK, Begue RE, Coffman K, et al.: Lemierre’s syndrome following mastoiditis. Infect Med 1998, 15:323–325.

    Google Scholar 

  16. Lustig LR, Cusick BC, Cheung SW, Lee KC: Lemierre’s syndrome: two cases of postanginal sepsis. Otolaryngol Head Neck Surg 1995, 112:767–772.

    Article  PubMed  CAS  Google Scholar 

  17. Beldman TFJ, Teunisse HA, Schhouten TJ: Septic arthritis of the hip by Fusobacterium necrophorum after tonsillectomy: a form of Lemierre syndrome? Eur J Pediatr 1997, 156:856–857.

    Article  PubMed  CAS  Google Scholar 

  18. Palmer AL, Strain JD, Henry DB, et al.: Postanginal sepsis after oropharyngeal trauma. Pediatr Infect Dis J 1995, 14:249–251.

    Article  PubMed  CAS  Google Scholar 

  19. Golpe R, Marin B, Alonso M: Lemierre’s syndrome (necrobacillosis). Postgrad Med J 1999, 75:141–44. An excellent review that incorporates data from several (non-English) European sources that are not typically referenced.

    PubMed  CAS  Google Scholar 

  20. Barker J, Winer-Muram T, Grey SW: Lemierre syndrome. South Med J 1996, 89:1021–1023.

    Article  PubMed  CAS  Google Scholar 

  21. Stahlman GC, DeBoer DK, Green NE: Fusobacterium osteomyelitisand pyarthrosis: a classic case of Lemierre’s syndrome. J Pediatr Orthop 1996, 16:529–532.

    PubMed  CAS  Google Scholar 

  22. Satchell SC, Riordan T, Beaman M: An unusual cause of an “acute abdomen.” Postgrad Med J 1998, 74:749–751. A “case conference” presentation that provides a good discussion of the differential diagnosis of a case of LS.

    Article  PubMed  CAS  Google Scholar 

  23. Goyal M, Sharma R, Jain Y, et al.: Unusual radiological manifestations of Lemierre’s syndrome: a case report. Pediatr Radiol 1995, 25:S105-S106.

    PubMed  Google Scholar 

  24. De Sena S, Rosenfeld DL, Santos S, Keller I: Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre’s syndrome). Pediatr Radiol 1996, 26:141–144.

    Article  PubMed  Google Scholar 

  25. McLean AS, Tyler K: Cardiac tamponade in a postpartum woman with Lemierre’s syndrome. Anaesth Intensive Care 1998, 26:582–583.

    PubMed  CAS  Google Scholar 

  26. Gupta M, Castello FV, Kesarwala HH: Respiratory failure caused by Lemierre’s syndrome. Clin Pediatr 1995, 34:275–277.

    CAS  Google Scholar 

  27. Koay CB, Heyworth T, Burden P: Lemierre syndrome: a forgotten complication of acute tonsillitis. J Laryngol Otol 1995, 109:657–661.

    PubMed  CAS  Google Scholar 

  28. Cosgrove EF, Colodny SM, Pesce RR: Adult respiratory distress syndrome as a complication of postanginal sepsis. Chest 1993, 103:1628–1629.

    PubMed  CAS  Google Scholar 

  29. Ely EW, Stump TE, Hudspeth AS, Haponik EF: Thoracic complications of dental surgical procedures: hazards of the dental drill. Am J Med 1993, 95:456–465.

    Article  PubMed  CAS  Google Scholar 

  30. Sunket A, Srinath L, Huang A, et al.: Lemierre’s syndrome: postanginal sepsis due to anaerobic oropharyngeal infection. Ann Otol Rhinol Laryngol 1994, 103:208–210.

    Google Scholar 

  31. Aoki M, Nobel RC, Scott EJ, Osetinsky GV: Lemierre’s syndrome caused by Fusobacterium necrophorum: a case report. J Ky Med Assoc 1993, 91:141–142.

    PubMed  CAS  Google Scholar 

  32. Karanas Y, Yim KK, Shuster BA, Lineaweaver WC: Lemierre’s syndrome: a case of postanginal septicemia and bilateral flank abscesses. Ann Plast Surg 1995, 35:525–528.

    Article  PubMed  CAS  Google Scholar 

  33. Stokroos RJ, Manni JJ, Kruijk JR, et al.: Lemierre syndrome and acute mastoiditis. Arch Otolaryngol Head Neck Surg 1999, 125:589–591.

    PubMed  CAS  Google Scholar 

  34. Goldstein EC, Summanen PH, Citron DM, et al.: Fatal sepsis due to a beta-lactamase-producing strain of Fusobacterium nucleatum subspecies polymorphum. Clin Infect Dis 1995, 20:797–800.

    PubMed  CAS  Google Scholar 

  35. Vandenberg SJ, Hartig GK: Lemierre’s syndrome. Otolaryngol Head Neck Surg 1998, 119:516–518.

    Article  PubMed  CAS  Google Scholar 

  36. Gudinchet F, Maeder P, Neveceral P, Schnyder P: Lemierre’s syndrome in children. Chest 1997, 112:271–213. A very good review with an excellent discussion of the relative merits of CT versus ultrasonography in the diagnosis of internal jugular vein thrombosis. The authors also provide a good discussion of the use of high-resolution CT for the diagnosis of pulmonary embolus.

    PubMed  CAS  Google Scholar 

  37. Stallworth JR, Carroll JM: Lemierre’s syndrome: new insights into an old disease. Clin Pediatr 1997, 36:715–718.

    CAS  Google Scholar 

  38. Moller, K, Dreijer B: Post-anginal sepsis (Lemierre’s disease): a persistent challenge. Presentation of 4 cases. Scand J Infect Dis 1997, 29:191–194.

    Article  PubMed  CAS  Google Scholar 

  39. Hara RPS, MacDonald A, Pullen D, et al.: Lemierre’s syndrome: are we underdiagnosing this life-threatening infection? ORL J Otorhinolaryngol Relat Spec 1996, 58:178–181.

    Google Scholar 

  40. Lee BK, Lopez F, Genovese M, Loutit J: Lemierre’s syndrome. South Med J 1997, 90:640–643.

    PubMed  CAS  Google Scholar 

  41. Venkataraman MT, Policar M: Fever, sore throat, and pulmonary infiltrates in a 20-year-old man. Chest 1997, 112:268–270.

    PubMed  CAS  Google Scholar 

  42. Vohra A, Saiz E, Ratzan KR: A young woman with a sore throat, septicaemia, and respiratory failure. Lancet 1997, 350:928.

    Article  PubMed  CAS  Google Scholar 

  43. Mane S, Toreres M, Buges J, et al.: Scintigraphic demonstration of jugular obstruction in a case of Lemierre syndrome. Clin Nucl Med 1992, 17:233–235.

    Article  PubMed  CAS  Google Scholar 

  44. Hanafee WJ, Polga JP, Morris AB: Gallium scinitgraphy in Lemierre syndrome. Clin Nucl Med 1995, 20:738.

    Article  PubMed  CAS  Google Scholar 

  45. Gong J, Garcia J: Lemierre’s syndrome. Eur Radiol 1999, 9:672–674. A good discussion of the advantages of CT in diagnosiing LS.

    Article  PubMed  CAS  Google Scholar 

  46. Wolf RFE, Konings JG, Prins TR, Weits J: Fusobacterium pyomyositis of the shoulder after tonsillitis. Acta Orthop Scand 1991, 62:595–596.

    Article  PubMed  CAS  Google Scholar 

  47. Alvarez A, Schreiber JR: Lemierre’s syndrome in adolescent children: anaerobic sepsis with internal jugular vein thrombophlebitis following pharyngitis. Pediatrics 96:354–359.

  48. Chalstrey SE, Williams HOL, Reilly G: Necrobacillosis: an unusual cause of cervical abscess. J Laryngol Otol 1992, 106:374–375.

    PubMed  CAS  Google Scholar 

  49. Gibb PA, Donell ST, Dowd GSE: Near-fatal necrobacillosis presenting as septic arthritis of the knee. J Bone Joint Surg Br 1990, 72A:1250–1253.

    Google Scholar 

  50. Page Y, Comtet C, Tardy B, et al.: Disseminated intravascular coagulation in Fusobacterium necrophorum septicemia. Scand J Infect Dis 1990, 22:743–747.

    PubMed  CAS  Google Scholar 

  51. Forrester LJ, Campbell BJ, Berg JN, Barrett JT: Aggregation of platelets by Fusobacterium necrophorum. J Clin Microbiol 1985, 22:245–249.

    PubMed  CAS  Google Scholar 

  52. Kanoe M, Yamanaka M, Inoue M: Effects of Fusobacterium necrophorum on the mesenteric microcirculation of guinea pigs. Med Microbiol Immunol 1989, 178:99–104.

    Article  PubMed  CAS  Google Scholar 

  53. Holzmann D, Huisman TAGM, Linder TE: Lateral dural sinus thrombosis in childhood. Laryngoscope 1999, 109:645–651.

    Article  PubMed  CAS  Google Scholar 

  54. Albertyn LE, Alcock MK: Diagnosis of internal jugular vein thrombosis. Radiology 1987, 162:505–508.

    PubMed  CAS  Google Scholar 

  55. Appelbaum PC, Spangler SK, Jacobs MR: b-Lactamase production and susceptibilities to amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis bacteroides isolates and 129 Fusobacteria from 28 US centers. Antimicrob Agents Chemother 1990, 34:1646–1650.

    Google Scholar 

  56. Brook I: Infections caused by beta-lactamase-producing Fusobacterium spp. in children. Pediatr Infect Dis J 1993, 12:532–533.

    Article  PubMed  CAS  Google Scholar 

  57. Josey WE, Staggers SR: Heparin therapy in septic pelvic thrombophlebitis: a study of 45 cases. Am J Obstet Gynecol 1974, 120:228–233.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, National Naval Medical Center, 8901 Wisconsin Avenue, 20889, Bethesda, MD, USA

    Adam W. Armstrong DO, Katherine Spooner MD & John W. Sanders MD

Authors
  1. Adam W. Armstrong DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Spooner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John W. Sanders MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Armstrong, A.W., Spooner, K. & Sanders, J.W. Lemierre’s syndrome. Curr Infect Dis Rep 2, 168–173 (2000). https://doi.org/10.1007/s11908-000-0030-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-000-0030-z

Keywords

Search

Navigation