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Lemierre syndrome – a forgotten complication of acute tonsillitis

Published online by Cambridge University Press:  29 June 2007

C. B. Koay*
Affiliation:
Department of Otolaryngology, The Royal Berkshire Hospital, Reading.
T. Heyworth
Affiliation:
Department of Otolaryngology, The Royal Berkshire Hospital, Reading.
P. Burden
Affiliation:
Department of Microbiology, The Royal Berkshire Hospital, Reading.
*
Mr C. B. Koay, Department of Otolaryngology, Radcliffe Infirmary, Woodstock Road, Oxford OXZ 6HE.

Abstract

Lemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 1995

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References

Adams, J., Capistrant, T., Crossley, K., Johanssen, R., Liston, S. (1983) Fusobacterium necrophorum septicemia. Journal of the American Medical Association 250: 35.CrossRefGoogle ScholarPubMed
Anand, V. K., Morrison, M. V. (1987) Thrombophlebitis of the jugular vein. Ear, Nose and Throat Journal 66: 4146.Google ScholarPubMed
Albertyn, L. E., Alcock, M. K. (1987) Diagnosis of internal jugular vein thrombosis. Radiology 162: 505508.CrossRefGoogle ScholarPubMed
Alston, J. M. (1955) Necrobacillosis in Great Britain. British Medical Journal II: 15241528.CrossRefGoogle Scholar
Bartlett, J. G., Gorbach, S. L. (1976) Anaerobic infections of the head and neck: symposium on infectious disease of head and neck. Otolaryngologic Clinics of North America 9: 655678.CrossRefGoogle Scholar
Cosgrove, E. F., Colodny, S. M., Pesce, R. R. (1993) Adult respiratory distress syndrome as a complication of postanginal sepsis. Chest 103(5): 16281629.CrossRefGoogle ScholarPubMed
Dagan, R., Powell, K. R. (1987) Postanginal sepsis following infectious mononucleosis. Archives of Internal Medicine 147: 15811583.CrossRefGoogle ScholarPubMed
Duerden, B. I. (1990) The bacteroidacea: bacteroides, fusobacteria and leptotrichia. In Topley and Wilson's Principles of Bacteriology, Virology and Immunology. vol. 2, Ch. 2. (Parker, M. T., Duerden, B. I., eds.), Edward Arnold, London, p 28.Google Scholar
Hudson, S., Maddocks, A. C., Stacey, A. (1984) Necrobacillosis. British Medical Journal 288: 19151916.CrossRefGoogle ScholarPubMed
Lemierre, A. (1936) On certain septicaemias due to anaerobic organisms. Lancet 1: 701703.CrossRefGoogle Scholar
Mitre, R. J., Rotheram, E. B. (1974) Anaerobic septicemia from thrombophlebitis of the internal jugular vein. Journal of the American Medical Association 230(8): 11681169.CrossRefGoogle ScholarPubMed
Moore-Gillon, J., Lee, T. H., Eykyn, S. J., Phillips, I. (1984) Necrobacillosis: a forgotten disease. British Medical Journal 288: 15261527.CrossRefGoogle ScholarPubMed
Oleske, J. M., Starr, S. E., Nahmias, A. J. (1976) Complications of peritonsillar abscess due to Fusobacterium necrophorum. Pediatrics 57(4): 570571.CrossRefGoogle ScholarPubMed
Quinn, P., Guernsey, L. H. (1985) The presentation and complication of odontogenic septic shock. Oral Surgery, Oral Medicine and Oral Pathology 59: 336339.CrossRefGoogle ScholarPubMed
Seidenfeld, S. M., Sutker, W. L., Luby, J. P. (1982) Fusobacterium necrophorum septicemia following oropharyngeal infection. Journal of the American Medical Association 248(11): 13481350.CrossRefGoogle ScholarPubMed
Sinave, C. P., Hardy, G. J., Fardy, P. W. (1989) The Lemierre syndrome; suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine 68: 8594.CrossRefGoogle ScholarPubMed
Shek, M., Karamali, A., McGuire, N., Seifert, P., Alperin, N. (1988) Bacterial sepsis with Fusobacterium necrophorum. Archives of Internal Medicine 148: 2303.CrossRefGoogle Scholar
Vogel, L., Boyer, K. M. (1980) Metastatic complications of Fusobacterium necrophorum sepsis – two cases of Lemierre's postanginal septicemia. American Journal of Diseases of Childhood 134: 356358.CrossRefGoogle ScholarPubMed
Yau, P. G., Norante, J. D. (1980) Thrombophlebitis of the internal jugular vein secondary to pharyngitis. Archives of Otolaryngology 106: 507508.CrossRefGoogle ScholarPubMed
Yousem, D. M., Scatarige, J. C., Gayler, B. W., Siegelman, S. S. (1985) CT demonstration of postanginal sepsis. Journal of Otolaryngology 14(5): 333335.Google ScholarPubMed