Lemierre Syndrome
What is Lemierre Syndrome ?
Lemierre syndrome is a rare and potentially life-threatening complication of bacterial infections that usually affects previously healthy adolescents and young adults.
Cause/Background Information
The bacteria, Fusobacterium necrophorum, is a big cause of Lemierre syndrome. This bacteria is found in the stomach, large intestine, small intestine, colon, and throat. About 90% of cases are because of this bacteria. Sometimes there is another bacteria or virus that happens before Lemierre Syndrome; this makes it easier to get this illness. The Fusobacterium necrophorum firstly spreads into the throat but can also spread inside the nose, ears, and other places in the head. After it spreads the bacteria will release toxins into the tissue around it causing an infection. After this, the bacteria will go into the inner jugular vein which is a big blood vessel that connects the brain to the heart and lungs. The infection goes next through the bloodstream and sends blood clots around that are infected.
The above Axial, sagittal, and coronal images from a contrast-enhanced CT scan of the neck show a rim-enhancing hypodense collection, representing an abscess, in the left peritonsillar region (black arrows). (Images courtesy St. Christopher’s Hospital for Children)
Primary Demographic
This is a very rare syndrome with only 1 out of every 1,000,000 have it.
- It affects young, previously healthy individuals, adolescents and adults.
- The median age of the patients is 19-22 years old.
- Approximately 90% of the patients who develop LS are between 10 and 35 years of age.
Complications
Severe complications of the Lemierre Syndrome might includes
- Osteomyelitis (bone infection)- Osteomyelitis is an infection to the bone; the infections can reach the bone by traveling through the bloodstream or spreading from nearby tissue. The infections could also begin in the bone itself if an injury exposes the bone to germs.
- Meningitis- Meningitis is the swelling of the membranes surrounding the brain and spinal cord called meninges.
- Acute Respiratory Distress Syndrome- Acute Respiratory Distress Syndrome is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood.
- Septic Shock- Septic shock is a serious condition that occurs when a body-wide infection leads to very low blood pressure.
According to the Journal of Microbiology, Immunology, and Infection, other complications may include:
- Pneumonia, lung lesions, abscesses, and pleural effusions (water around the lung)
- Empyema
- Epidural abscess (an abscess between your skull and your brain)
- Brain abscess
Per GARD, serious complications may include:
- Respiratory distress syndrome due to pulmonary emboli (blood clots in the lung)
- Damage to other affected organs
- Septic shock (in about 7 percent of cases)
- Bone infection
- Meningitis
According to the Journal of Microbiology, Immunology, and Infection, less common complications may include:
- Soft tissue abscesses
- Pyomyositis (bacterial infection of the skeletal muscle)
- Abscesses in the spleen and liver
- Endocarditis (inflammation of the heart’s inner lining)
- Pericarditis (inflammation of the membrane surrounding the heart)
- A renal abscess (kidney abscess)
- In rare cases, eye complications
Treatment
The main components of treatment include intravenous antibiotic therapy and drainage at the sites of infection. A combination of antibiotics (at least one beta-lactamase resistant antibiotic and one beta-lactam antibiotic) is recommended to cover all possible responsible bacteria, as there have been case reports of treatment failure with single antibiotics (monotherapy). A combination is used because some bacteria produce an enzyme called beta-lactamase, which makes them resistant to beta-lactam antibiotics. Ideally, the specific antibiotics used should depend on the culture results, when available. Antibiotic therapy typically is continued for up to 6 weeks in order to allow the medication to penetrate infected clots. Surgical incision and drainage of any abscesses may be needed to control the infection.