Lemierre's syndrome: A systematic review.

Area of Science:

• Infectious Diseases
• Vascular Surgery
• Otolaryngology

Background:

• Lemierre's syndrome, historically termed the "forgotten disease," is characterized by oropharyngeal infection, internal jugular vein thrombosis, and anaerobic pathogens, primarily Fusobacterium necrophorum.
• Recent observations suggest a potential increase in its incidence, challenging its historical rarity.

Purpose of the Study:

• To provide an updated review on the etiology, management, and prognosis of Lemierre's syndrome for healthcare professionals.
• To highlight the potential underestimation of Lemierre's syndrome prevalence.

Main Methods:

• A systematic review of English literature was conducted, including reviews, case reports, and case series.
• Search terms included "Lemierre's syndrome," "postanginal septicemia," "fusobacterium," and "internal jugular vein thrombosis."
• Studies focusing on atypical cases, negative Fusobacteria cultures, or lacking radiological evidence of thrombophlebitis were excluded.

Main Results:

• Eighty-four studies met the inclusion criteria, with a male to female ratio of 1:1.2 and ages ranging from 2 months to 78 years (median 22).
• Common infection sources included tonsils, pharynx, and chest, with sore throat, neck mass, and neck pain as frequent initial symptoms.
• Fusobacterium necrophorum was the most common pathogen; treatments involved antimicrobials, anticoagulants, and surgery, resulting in significant morbidity and a 5% overall mortality rate.

Conclusions:

• Lemierre's syndrome may be more prevalent than previously thought, possibly due to antibiotic resistance or changing prescription patterns.
• Effective management requires heightened physician awareness, a high index of suspicion, and a collaborative, multidisciplinary team approach.
• Prompt diagnosis and intervention are crucial for improving patient outcomes and reducing mortality.