Makindo Medical Notes

Thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection with subsequent systemic septic foci

About

• 1936 this disease was named after Dr. Andre Lemierre
• Disseminated abscesses after infection of the oropharynx.
• It is commonest in young healthy adults.
• Thrombophlebitis of the internal and possible external jugular vein

Aetiology

• Local invasion of the lateral pharyngeal space
• Septic thrombophlebitis of the Internal Jugular vein.
• Most due to Fusobacterium necrophorum
• Metastatic infections to Lung, liver, muscle, pericardium, brain and skin

Microbiology

• Fusobacterium necrophorum, hence also known as necrobacillosis
• Peptostreptococcus
• Group B and C Streptococcus
• Staphylococcus
• Enterococcus species
• Proteus has also been isolated

Clinical

• Often young healthy children and adults with prolonged symptoms of pharyngitis
• Fever, pharyngitis, dysphagia, odynophagia,
• Severe pain from oropharyngeal infection
• Focal neurology from Brain abscesses
• Localised lymphadenopathy and septicaemia
• Evidence of jugular vein thrombosis
• Horner's syndrome has been also seen as a complication.

Aetiology

• The predominant pathogen is a gram-negative anaerobic bacillus.
• Fusobacterium necrophorum is a common culprit organism
• It can be isolated from blood culture
• However some may be due to streptococcus.
• May just find a polymicrobial flora consisting of both aerobic and anaerobic bacteria

Investigations

• FBC, U&E, LFTs, CRP - signs of sepsis
• Blood culture: growth of anaerobic bacteria on blood culture.
• ECG: tachycardia
• CXR shows several foci of consolidation and cavitation and effusions.
• Doppler USS of both the external and the internal jugular veins if thrombosis suspected
• CT Neck with contrast may show extensive inflammation of the pharynx and jugular vein thrombosis

Management

• ABC, IV Access, Start Broad spectrum antibiotics
• Anticoagulate - Consider LMWH
• Consider Anaesthetic/ENT input if airway issues
• Prolonged Antibiotics: Metronidazole, clindamycin