1/ Hey #IDFellows, here is a new #IDTwitter Tweetorial: 24F w/1 wk hx pharyngitis + 1d cough & SOB. VS T 39.3C, RR 23, SpO2 92%, HR 112. Exam with tonsillar swelling & erythema; L neck pain and swelling on palpation. CXR w/peripheral nodular opacities. Best empiric abx?
3/ Most common organisms include Fusobacterium necrophorum >>> other fusobacterium > anaerobic streptococci. Fusobacterium necrophorum, an anaerobic gram-negative rod, seems to be distinctively adept at causing septic thrombophlebitis. 
4/ Affected patients are younger, teens to 30s, with preceding pharyngeal inflammation (such as mononucleosis or other viral illness). Some cases have followed documented influenza virus infection. See discussion by @WuidQ about pharyngitis:
5/ The suspected mechanism of pathogenesis is tonsillitis vs peritonsillar abscess with localized extension; can involve the carotid sheath. Anaerobic bacteria cause inflammation and thrombus (septic thrombophlebitis). This can lead to septic emboli (in lungs and joints).
6/ Severe complications involve erosion of carotid artery, cephalic extension of the clot, or cranial nerve involvement. Here is a great example of the #anatomy anatomy of Lemierre’s using #ultrasound ultrasound:
7/ For Leimerre’s syndrome, incl anaerobic coverage. F necrophorum typically susceptible to PCN - but they may contain beta-lactamases. Amox/Clav, Pip/Tazo, Flagyl and Clinda often active. In a critically ill patient with unclear syndrome, covering more broadly is recommended.
8/ Treatment is often prolonged, requiring weeks of antibiotics as the clot resolves. The role of anticoagulation is unclear and frequently clinician dependent.
9/ F. necrophorum has been implicated in septic thrombophlebitis in other regions of the body, including the pelvic vasculature in women and the portal venous system. Excellent Review: pubmed.ncbi.nlm.nih.gov/17934077/
10/ Summary:
Lemierre’s syndrome = Septic Thrombophlebitis.
➡️Syndrome of pharyngitis +/- neck pain + fever + septic emboli.
➡️Empiric tx should cover anaerobic gram negatives and streptococci.
➡️The syndrome is most frequently associated with Fusobacterium necrophorum.
Lemierre’s syndrome = Septic Thrombophlebitis.
➡️Syndrome of pharyngitis +/- neck pain + fever + septic emboli.
➡️Empiric tx should cover anaerobic gram negatives and streptococci.
➡️The syndrome is most frequently associated with Fusobacterium necrophorum.
11/ #IDFellows can check out other #IDTwitter resources here:
blogs.jwatch.org/hiv-id-observa…
And please feel free to share your own! Stay tuned for more #IDMedEd on Lemierre's later this week.
blogs.jwatch.org/hiv-id-observa…
And please feel free to share your own! Stay tuned for more #IDMedEd on Lemierre's later this week.
