Lemierre syndrome – treat with antibiotics, anticoagulants o
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Lemierre syndrome is septic thrombophlebitis in the internal jugular vein due to oropharyngeal bacterial infection. The most frequent culprit is the gram negative anaerobe Fusobacterium necrophorum.

In this study, 712 cases were analyzed. The typical Lemierre syndrome with 1) oropharyngeal infection, 2) isolation of Fusobacterium spp., and 3) thrombosis in head or neck or alternatively septic embolism was seen in 47% of the cases and the remainder had the atypical form, in which other bacteria could be isolated.

The location of thrombosis was in the jugular vein in 74%, in cerebral vein(s) in 20%, and in any vein in the head or neck in 84%. Septic embolism was seen in 82%, mainly to the lungs. Whereas essentially all patients (99.7%) were treated with antibiotics, only 56% received anticoagulation during or after the hospitalization. This was mainly with LMWH or in fewer cases with unfractionated heparin in hospital. Subsequently, 131 patients (20%) were transitioned to a vitamin K antagonists and were anticoagulated for a median of 84 days.

In multivariable logistic regression analysis, use of anticoagulants was associated with lower risk for VTE or septic lesions during the hospitalization, whereas presence of intracranial involvement at the time of diagnosis was associated with worse prognosis. Turning to the potential risk of anticoagulant treatment for Lemierre syndrome, major bleeding was noted in 10 of 362 patient that received anticoagulation and in 9 of 290 that did not.

Conclusively, therapeutic anticoagulation is indicated for
Lemierre syndrome provided that there are no contraindications. The latter would mainly consist of activebleeding, which is not typical in these patients prior to therapy. Appropriate antibiotic and anticoagulant treatment together with high vigilance for septic, thrombotic and hemorrhagic complications are necessary to minimize the morbidity and mortality of Lemierre syndrome.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.13100
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