Lemierre Syndrome: How to prevent & cure it

Symptom

Lemierre syndrome often starts from a throat infection, but can also originate from infections of the ears, sinuses, salivary glands, teeth or be related to infection with the Epstein-Barr virus.

Other typical symptoms include:

• Prolonged fever
• Chills
• Pain, swelling and tenderness in the throat and neck

Swelling and tenderness in the neck are important early signs that the infection has spread beyond the throat, into surrounding tissues.

Reason

Lemierre syndrome is mainly caused by the bacteria Fusobacterium necrophorum (F. necrophorum). This type of bacteria resides in the throat, digestive tract and female genital tract. When entering and growing abnormally, this bacteria can secrete toxins that damage nearby tissues, leading to Lemierre syndrome.

In some cases, initial infection by another agent such as the Epstein–Barr virus or streptococcus bacteria can weaken the body’s protective barrier, allowing F. necrophorum to grow and cause disease.

Risk

Lemierre syndrome is more common in young people, common in some cases of persistent neck pain, deep neck infections, and sepsis (serious blood infection).
Other risk factors include:

• Immunodeficiency
• Environmental conditions

Diagnose

Blood tests can detect signs of infection, blood clotting disorders, and abnormalities in liver and kidney function.

Commonly used diagnostic imaging tools include chest X-ray, ultrasound, MRI or CT of the neck. In particular, magnetic resonance venography (MRV) allows assessment and detection of thrombus in the jugular vein.

Disease stage

The treatment time for Lemierre syndrome depends on the time of diagnosis, the level of progression and the patient’s ability to respond. Normally, patients need to take antibiotics for a long time, up to about 6 weeks.

Severely ill patients can be treated in the intensive care unit. The average hospital stay for patients with Lemierre syndrome is about 3 weeks.

Treatment

Treatment of Lemierre syndrome focuses on two main measures: using antibiotics and draining the infection. In the early stages, antibiotics are usually administered intravenously, then can be switched to the oral route when the infection is controlled.

Doctors often prescribe a combination of antibiotics for a maximum period of about 6 weeks to increase the ability to penetrate infected clots.

When medical treatment and drainage are not effective, surgery may be considered to remove infected blood clots. Surgical intervention is also indicated in cases where blood clots cause difficulty breathing, spread to the brain, or when necrotic or severely damaged tissue needs to be removed.

Complications

When a blood clot caused by Lemierre syndrome travels through the blood, it can infect the lungs, skeletal system, and other organs such as the spleen, liver, kidneys, heart, or brain.

Complications may include:

• Pneumonia, lung damage, abscesses, and pleural effusion (fluid around the lungs)
• Pleural effusion
• Epidural abscess (abscess between the skull and brain)
• Brain abscess

Serious complications include:

• Respiratory distress syndrome due to pulmonary embolism (blood clot in the lungs)
• Damage to other affected organs
• Septic shock (in about 7% of cases)
• Bone infection
• Meningitis.