lemierre syndrome
DESCRIPTION
paediatric case review &literature.... etiology,pathologyTRANSCRIPT
![Page 1: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/1.jpg)
Lemierre syndrome: a pediatric case series and review of
literatureIntroduction by
Dr.Roohia Disscussion by
Dr. Ramanjaneyulu
![Page 2: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/2.jpg)
James M. Ridgway, MD(a) Dhavan A. Parikh, Ma(b) Ryan Wright, BS(b),Paul Holden, PhD© William Armstrong, MD(c)Felizardo Camilon, MD(d)Brian J.-F. Wong , MD, PhD(c)
a)Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA b)University of California, Irvine, School of Medicine, Irvine, CA, USA c)Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA d)Children's Hospital of Orange County, Orange, CA, USA
![Page 3: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/3.jpg)
introductionLemierre syndrome is a rare disease of the
head and neck often affecting adolescents and young adults.
infection begins in the oropharynx with thrombosis of the tonsillar veins followed by involvement of the parapharyngeal space and the internal jugular vein.
Septicemia and pulmonary lesions develop as infection spreads via septic emboli.
![Page 4: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/4.jpg)
a retrospective review of 3 cases and associated literature
![Page 5: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/5.jpg)
LEMIERRE’S SYNDROME
( A Forgotten Disease)
ANDRE LEMIERRE(1936)
![Page 6: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/6.jpg)
Epidemiology The incidence of Lemierre syndrome has
been reported between 0.6 and 2.3 per million.
Mortality rates between 4% and 18%. Young adults between the ages of 16 and 25
years.
![Page 7: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/7.jpg)
Lemierre syndromeFusobacterium species
F nucleatum and F necrophorum
normal inhabitants of the oral cavity, the female genital tract, and the gastrointestinal tract
strictly anaerobic, non-motile, Gram-negative bacillus .
Multiple virulence factors including cell wall lipopolysaccharideendotoxin, leucocidin, hemolysin, lipase,
hemagglutinin, and a cytoplasmic toxin
are produced by F necrophorum
![Page 8: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/8.jpg)
OTHERS: Streptococcus Bacteroides Lactobacillus Staphylococcus Eikinella
![Page 9: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/9.jpg)
Primary source of infectionPalatine tonsils
and peritonsillar tissuePharyngitisParotitisOtitis mediaSinusitisOdontogenic
infectionMastoiditis
![Page 10: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/10.jpg)
Pathophysiology
![Page 11: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/11.jpg)
![Page 12: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/12.jpg)
![Page 13: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/13.jpg)
StagesPatient generally exhibits three stages
1. Pharyngitis – sore throat (< 1 week) 2. Local invasion of lateral pharyngeal space and IJV septic thrombophlebitis swollen/tender neck = red flag3. Metastatic complications – fever, pulmonary infiltrates or possible joint involvement
![Page 14: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/14.jpg)
Disease PresentationSore throatTender/swollen lymph nodesProlonged feverMay experience abdominal pain, nausea or
vomittingBacteremiaIncreased WBC’s Hyperbilirubinemia and slight increase in liver
enzymes
![Page 15: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/15.jpg)
FEATURES OF METASTATIC COMPLICATIONS Pulmonary involvement
Pleuritic chest pain, dry cough, hemoptysis, ARDS
Bone and joint manifestationsSeptic arthritis, osteomyelitis
Soft tissue lesionsGluteal & abdominal wall abscesses
Intra-abdominal sepsisAbdominal pain, Jaundice, liver & splenic abscess,
Peritonitis
![Page 16: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/16.jpg)
FEATURES OF METASTATIC COMPLICATIONS CNS complications
Meningitis, cerebral abscess, cavernous sinus & sigmoid sinus thrombosis
Renal complicationsRenal abscess, glomerulonephritis, hemolytic-
uremic syndrome
Hematological complicationsDIC, peripheral ischemia & gangrene
![Page 17: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/17.jpg)
![Page 18: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/18.jpg)
![Page 19: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/19.jpg)
![Page 20: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/20.jpg)
![Page 21: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/21.jpg)
![Page 22: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/22.jpg)
DIFFERENTIAL DIAGNOSISViral PharyngitisInfectious MononucleosisPneumoniaTuberculosisEndocarditis
![Page 23: Lemierre syndrome](https://reader035.vdocuments.net/reader035/viewer/2022062513/556c6b6fd8b42ad85e8b4c00/html5/thumbnails/23.jpg)