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Presentation:
- Lemierre syndrome is a condition that primarily affects young, otherwise healthy patients with an underlying oropharyngeal infection.
- It presents with a worsening clinical course and subsequent sepsis with evidence for metastatic septic emboli.
- Patients may experience symptoms such as malaise, fever, sore throat, marked adenopathy, splenomegaly, and exudative pharyngitis.
- Neck pain or swelling and other extrapharyngeal symptoms may also be present.
Pathophysiology:
- Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein accompanied by metastatic infections.
- The most common causative organism is Fusobacterium necrophorum, although other bacterial species can also be involved.
- The infection can spread to various parts of the body, including the lungs, joints, bones, liver, meninges, and brain.
- The exact route of entry of the bacteria into the body is not well understood.
Diagnostics:
- The diagnosis of Lemierre syndrome is based on clinical presentation and evidence of sepsis with metastatic septic emboli.
- Imaging studies, such as CT scans or ultrasounds, may be used to confirm the presence of thrombophlebitis in the internal jugular vein.
- Blood cultures may be performed to identify the causative organism.
- Other laboratory tests, such as complete blood count and inflammatory markers, may show signs of infection and inflammation.
Treatment:
- The treatment of Lemierre syndrome involves antibiotics to target the causative bacteria.
- The role of anticoagulation in the treatment of Lemierre syndrome remains controversial.
- In severe cases, surgical intervention may be necessary to drain abscesses or remove infected tissues.
Prognosis:
- The prognosis for patients with Lemierre syndrome is guarded.
- Despite optimal treatment, case reports reveal a high mortality rate.
- The development of sepsis and metastatic infections can lead to severe complications and organ damage.
- Early recognition and prompt treatment are crucial for improving outcomes.