Lemierre ‘s syndrome is the late consequence of a bacterial infection with anaerobic bacteria in the throat area, for example with the causative agents of tonsillitis. The disease leads to phlebitis and regular septic embolism. In the case of early diagnosis, treatment with high-dose broad-spectrum antibiotics takes place, which in later stages is combined with the administration of anticoagulants.
What is Lemierre Syndrome?
In the early stages, patients with Lemierre syndrome suffer from tension in the neck area and sore throat. Within a short time, lethargy develops with severe bouts of fever and swollen lymph nodes in the neck. See AbbreviationFinder for abbreviations related to Lemierre Syndrome.
Bacterial infections of the mouth and throat can cause foci of inflammation in the acute phase. However, many bacterial infections can still cause symptoms long after these acute symptoms have healed, i.e. they can be associated with long-term effects. Lemierre syndrome is one such late consequence of bacterial infections in the mouth and throat area.
An infection that is simply delayed, i.e. that has not broken out, can also be related to the disease. The syndrome is also known as necrobacillosis, postanginal sepsis , postanginal septicemia, or postanginal sepsis. Sepsis is a systemic inflammatory response that affects the entire body.
In most cases, Lemierre’s syndrome manifests as purulent phlebitis, preferably in the jugular vein, and regularly culminates in septic embolism. In 1900, P. Courmant and A. Cade first described the basis of an infection of the oropharynx as a triggering factor for later sepsis. The name Lemierre syndrome goes back to the French doctor André Alfred Lemierre, who published a description and case study of 20 patients in 1936.
The cause of sepsis in terms of Lemierre syndrome is an infection with anaerobic bacteria. Peritonsillar abscess is most commonly associated with the syndrome. Mostly young, apparently healthy adults are affected by abscess formation in the area of the tonsils. Anaerobic bacteria such as fusobacteria need to multiply without oxygen in abscesses and in Lemierre syndrome penetrate the jugular veins via the abscess.
Local inflammation sets in and blood clots form, which can cause jugular vein thrombosis and help spread bacteria through the blood system. The blood vessels in the periphery close and thus cause a septic embolism. In principle, all anaerobic bacteria can cause the syndrome. It is not the direct result of an acute bacterial infection, but rather the result of a delayed infection with anaerobic bacteria.
Symptoms, Ailments & Signs
In the early stages, patients with Lemierre syndrome suffer from tension in the neck area and sore throat. Within a short time, lethargy develops with severe bouts of fever and swollen lymph nodes in the neck. Until then, the symptoms are similar to those of a severe flu.
A few days or a week after the onset of the first symptoms, liver and kidney dysfunctions set in due to the proliferation of anaerobic bacteria. These symptoms are often associated with diarrhea, vomiting and skin rashes. The progressing bacteremia leads to sepsis with systemic inflammatory reactions and flare-ups of fever.
The formation of blood clots in the vessels is a common phenomenon, since bacterial infection of the veins increases the risk of thrombus formation. Pulmonary embolism is the most common late-stage complication of Lemierre syndrome. Late-stage patients are often in such poor condition that the pulmonary embolism is hardly noticed. Of the 20 cases described by Lemierre, seven died as a result of the syndrome.
Diagnosis & course of disease
The clinical picture of Lemierre syndrome is similar to a strong flu and is therefore often treated too late with the necessary treatment. Since some infections of the heart valves are also associated with a similar course, the timely and correct diagnosis is a challenge. The decisive factor for the diagnosis of Lemierre’s syndrome is above all the combined consideration of all clinical symptoms with the initiation of a blood culture.
Laboratory tests may show early signs of bacterial infection, such as elevated C-reactive protein or neutrophilia. Jugular vein thrombosis of Lemierre syndrome is detected by ultrasound, CT, or MRI. The same also applies to syndrome-associated thrombosis. Appropriate treatment must be started immediately after diagnosis.
In most cases, Lemierre’s syndrome primarily causes the usual symptoms of the flu. Those affected suffer from fever and cough. There can also be tension in the neck or back. The lymph nodes also swell and the symptoms develop into a strong flu.
Without treatment, Lemierre syndrome can also lead to liver or kidney problems, so that in the worst case the affected person suffers from kidney failure. Rashes also appear on the skin and sufferers struggle with vomiting and diarrhea. It is not uncommon for a pulmonary embolism to occur, which if left untreated can also lead to death.
The patient’s quality of life is significantly restricted and reduced by Lemierre syndrome. In many cases, the symptoms of the syndrome are greatly underestimated, which is why treatment is often delayed. If the treatment is initiated early, the symptoms can be combated well. Consequential damage does not occur either, and Lemierre syndrome does not reduce the patient’s life expectancy.
When should you go to the doctor?
Symptoms such as tension, sore throat and signs of flu indicate Lemierre syndrome. Medical attention is needed if symptoms progress to flu. If there are other symptoms, medical advice is also required. If the symptoms have not subsided after three days, you must go to a doctor with the illness. If kidney or liver problems develop, medical advice should be sought on the same day. Otherwise, a painful rash may develop, accompanied by vomiting and diarrhea. In severe cases, a life-threatening pulmonary embolism can develop.
Patients diagnosed with a peritonsillar abscess are at particular risk of developing Lemierre syndrome. Local inflammation is also a risk factor. People who belong to the relevant risk groups should speak to the responsible doctor immediately. Pregnant women, children as well as sick and elderly people should in any case have alarming symptoms quickly clarified and, if necessary, treated. In addition to the general practitioner, people with Lemierre syndrome can go to a gastroenterologist and a dermatologist.
Treatment & Therapy
If the diagnosis of Lemierre syndrome is made in good time, the doctor can then initiate conservative treatment with high-dose broad -spectrum antibiotics. This treatment only works in the early stages of Lemierre syndrome and is therefore dependent on diagnosing the disease as early as possible.
Doctors often treat all patients with a sore throat and signs of bacteremia with high-dose, broad-spectrum antibiotics, even if the diagnosis of Lemierre syndrome has not yet been established. This procedure is necessary because delayed treatment of the syndrome has life-threatening consequences in most cases and therefore requires intensive medical therapy.
The later the syndrome is recognized, the higher the mortality. If appropriate treatment is given in good time, the mortality rate is less than five percent. So far, there have been hardly any long-term studies on the treatment of Lemierre syndrome. For this reason, it is currently unclear whether surgical removal of the thrombosed jugular vein is a sensible treatment option.
Likewise, it is not yet clear whether patients could benefit from lifelong administration of anticoagulant drugs. To date, anticoagulants have been administered at least in the late stages of the disease in order to prevent complications such as pulmonary embolism.
Outlook & Forecast
The prognosis for Lemierre syndrome is based on assessment of the progression of the disease. Although treatment measures have improved significantly due to medical developments, the disease can still be fatal. To date, the mortality rate is 10 percent.
If the diagnosis is made late, the bacterium has already spread widely in the organism and has caused irreparable damage in some cases. The body’s own immune system is weakened and can no longer successfully defend itself against the pathogens. If treatment is started in the early stages of the disease, the prognosis is usually good. Drug treatment can prevent the bacteria from spreading. In addition, bactericidal agents manage to cause the pathogen to die off. Within a few weeks, the patient is usually discharged from treatment as recovered.
There is an increased risk if pus builds up in the lungs or throat. Surgical interventions are performed to avoid sepsis . Otherwise, the person affected may die from blood poisoning. Every operation is associated with various risks and side effects. This fact must be taken into account when making the forecast. Normally, this is a routine intervention that proceeds without further complications and disturbances. Accordingly, after the wound has healed, the patient is discharged from treatment as cured.
Lemierre syndrome cannot be completely prevented. However, professional treatment of ear, nose and throat infections probably helps to prevent them. Above all, the pathogens of tonsillitis are causally associated with the syndrome. Therefore, the timely treatment and healing of such inflammations and infections can be described as a preventive measure in the broadest sense.
Aftercare measures for Lemierre syndrome are often very limited. First and foremost, a doctor should be consulted at an early stage so that no further complications can occur. This can also prevent a further worsening of the symptoms, so that the person concerned should consult a doctor as soon as the first symptoms or signs of Lemierre syndrome appear.
In most cases, the disease can be treated relatively well with the help of various medications. There are no further complications. When taking the medication, the person concerned should ensure that the dosage is correct and that it is taken regularly in order to permanently relieve the symptoms.
Regular check-ups by a doctor are very important in order to monitor the symptoms permanently. Reduced life expectancy is very rare. When taking antibiotics, it should be noted that they are not taken together with alcohol, otherwise their effect will be reduced. Those affected by Lemierre syndrome often need support and care from family and friends, which can have a positive effect on the further course of the disease.
You can do that yourself
Although Lemierre syndrome cannot be cured by everyday self-help, it is certainly possible to alleviate the accompanying symptoms.
Those affected tend to lethargy, which must be overcome. Regular exercise is particularly important, even if the symptoms make it difficult. However, regular mobilization prevents blood clots, so it should be routine. The usual home remedies, such as calf wraps, help against fever attacks or a cold rag on the forehead. A lot of rest and darkness can also be perceived as pleasant by those affected. Those affected also suffer from diarrhea and vomiting. Adequate fluid intake is therefore important, otherwise there is a risk of dehydration. With regard to diarrhea, a change in diet is suitable as an everyday aid. Before important appointments, you can refrain from eating. In general, patients should switch to a bland diet.
Neck pain often occurs at the beginning of the disease, and heat is often felt to be pleasant and soothing. The sore throat that occurs can be combated with honey. Gentle teas are also recommended, but care should be taken that they do not deprive the body of any liquid. In general, the symptoms resemble those of the flu. For this reason, everyday self-help strategies in the case of influenza are also suitable for reducing the side effects of Lemierre syndrome.