Lemierre's syndrome

The Lemierre syndrome (syn.: Post anginal septicemia, sepsis Post angina, postanginöse sepsis, necrobacillosis ) is characterized by the combination of suppurative thrombophlebitis of jugular vein ( jugular vein ) and occurrence of septic emboli. Cause of rare disease are usually infections with anaerobic bacteria in the mouth and throat (eg Peritonsillarabszesse ). In most cases, there is evidence in Lemierre syndrome Fusobacterium necrophorum.

Disease and pathogenesis

The Lemierre syndrome affects mainly young healthy adults. It usually begins with throat and neck pain caused by abscess formation in the tonsils. Anaerobic bacteria such as Fusobacterium do not require oxygen and can proliferate in abscesses. Within a relatively short time lethargy, fever and swollen neck lymph nodes are observed. Liver and kidney dysfunction, diarrhea, vomiting, skin rash ( exanthema), and nausea may occur (usually two days to two weeks after the first symptoms ). Since the clinical picture of a severe flu is similar, is often started too late with the much-needed treatment. Similarly, certain infections of heart valves have a similar course, so is the rapid and in particular the correct diagnosis is not easy.

When Lemierre 's syndrome, the bacteria penetrate through the abscess into the neighboring jugular vein ( internal jugular vein and / or external jugular vein ). Local is inflammation and the formation of blood clots that can lead to a so-called Jugularisvenenthrombose. Characteristic of the Lemierre syndrome is the dispersion of bacteria ( bacteremia ) and components of the local inflammatory response through the blood system. As a result, it comes at the periphery to closures of blood vessels, to a so-called septic embolism. Pulmonary embolism is the most common complication of Lemierre 's syndrome, which is not necessarily perceived due to the bad condition of the patient. Bacteremia leads to sepsis with systemic inflammatory response and fever.

Diagnosis

Critical to the diagnosis are the synopsis of clinical symptoms and a blood culture. Laboratory tests may be signs of a bacterial infection prove ( elevated C-reactive protein, or neutrophilia ). A Jugularisvenenthrombose within the Lemierre syndrome, by means of ultrasound, computed tomography ( CT) or magnetic resonance imaging detected. MRSA could be associated with Lemierre syndrome, according to the latest findings.

Treatment

A conservative treatment with high-dose broad-spectrum antibiotic may be tried in the early stages and in case of timely diagnosis of the disease. Therefore, patients should be treated with a sore throat and signs of bacteremia and suspected the Lemierre syndrome with a broad spectrum antibiotic. In late treatment or with late detection usually intensive medical therapy is required. Mortality is high in later recognition, with timely treatment it is 4.6 %. As can be long-term studies are lacking not yet be clearly stated whether the thrombosed jugular vein to be removed surgically or whether long -term or lifelong anticoagulation is useful.

History

In 1900, a link between infections of the oropharynx and sepsis was recognized by P. Courmant and A. Cade for the first time.

In 1922 and there were in this respect by Hugo Schottmüller publication.

The name and the first description of the syndrome that characterizes the disease back to the publication of the French physician Alfred André Lemierre in 1936. He examined 20 patients who had signs of the syndrome. 18 patients died as a result of the disease.