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Lemierre's syndrome: One rare disease-Two case studies
Christine Le1, Dean Gennaro2, Derek Marshall1
1Touro College of Pharmacy, New York, New York.
What Is Known And Objective:
Lemierre's syndrome is often misdiagnosed as a common cold or viral infection. Fusobacterium necrophorum is the most common causative organism. The recommended treatment regimen is 6 weeks of a beta-lactam antibiotic along with metronidazole.
Case Description:
We present two cases of Lemierre's syndrome with internal jugular vein thrombophlebitis and positive blood cultures for F. necrophorum. The first case was successfully treated with 6 weeks of a beta-lactam antibiotic and 4 weeks of metronidazole, while the second case was successfully treated with 4 weeks of a beta-lactam antibiotic and 2 weeks of metronidazole.
What Is New And Conclusion:
Two cases of Lemierre's syndrome were treated successfully with only 2-4 weeks of metronidazole therapy. Shorter duration of metronidazole therapy should be explored in future studies.
Insights
Lemierre's syndrome, a serious infection often mistaken for a cold, can be effectively treated with shorter courses of metronidazole. This study suggests exploring briefer metronidazole durations for Fusobacterium necrophorum infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Internal Medicine
Background:
- Lemierre's syndrome is frequently misdiagnosed due to non-specific initial symptoms.
- Fusobacterium necrophorum is the primary pathogen implicated in Lemierre's syndrome.
- Current treatment guidelines recommend a prolonged 6-week course of beta-lactam antibiotics and metronidazole.
Observation:
- Two cases of Lemierre's syndrome involving internal jugular vein thrombophlebitis and F. necrophorum bacteremia are presented.
- Case 1 received 6 weeks of beta-lactam and 4 weeks of metronidazole.
- Case 2 received 4 weeks of beta-lactam and 2 weeks of metronidazole.
Findings:
- Both cases demonstrated successful treatment outcomes.
- Shorter durations of metronidazole (2-4 weeks) were effective in these patients.
- This challenges the necessity of the standard 6-week metronidazole regimen.
Implications:
- Shorter metronidazole courses may be sufficient for treating Lemierre's syndrome.
- Further clinical trials are warranted to validate reduced metronidazole therapy durations.
- Optimizing treatment length could reduce antibiotic exposure and potential side effects.