A complication of an upper respiratory infection caused by the bacterium Fusobacterium necrophorum is called Lemierre’s syndrome. When it is left untreated, it may spread throughout the body and cause sepsis or blood clots in the jugular vein. Most of the time, Lemierre’s syndrome is treated with antibiotics, but in more severe cases, doctors may recommend surgery.
In other words, Lemierre’s syndrome is a potentially fatal complication that appears due to an infection in the upper respiratory tract (usually, the throat). If you leave this condition untreated, it may cause blood clots that can spread to the following parts of the body. Examples include:
Generally, this complication occurs rarely, and it affects about 4 out of 1 million people per year in the United States. Unfortunately, the number of cases has increased because the antibiotics that clear this infection no longer work (antibiotic resistance). Furthermore, the name of this condition comes from the French physician Andre Lemierre, who reported cases of this disorder in the 1930s.
What Are The Symptoms of Lemierre’s Syndrome?
While the primary symptom of this syndrome is a sore throat, it may also cause other symptoms. Check some examples below:
- Headaches
- Fever
- Light sensitivity
- Muscle stiffness or soreness
- Tonsil infection
- Difficulty breathing or swallowing
- Fatigue (extreme tiredness)
- Cough (sometimes, coughing up blood)
- Swollen lymph nodes in the neck
- Nausea
- Vomiting
If any of the previous symptoms occur without an obvious reason, immediately contact your healthcare professional. Otherwise, it may lead to life-threatening complications.
Causes
Approximately 80% of diagnosed cases occur due to a bacterium called Fusobacterium necrophorum (F. necrophorum). Moreover, this bacterium lives naturally in the body, and it can be found in the throat, gastrointestinal (GI) tract (including the mouth, esophagus, stomach, and small and large intestines), and male and female reproductive systems. In addition, there are other bacteria that may also cause Lemierre’s syndrome. Check some of them below:
- Fusobacterium nucleatum
- Klebsiella pneumoniae
- Porphyromonas asaccharolytica
- Staphylococcus and Streptococcus species
Risk Factors
Healthcare providers do not fully understand why adolescents and young adults are at increased risk of developing Lemierre’s syndrome. Generally, there are certain bacterial and viral infections that may also increase the risk of an F. necrophorum infection. Check some examples below:
- Mononucleosis
- Epstein-Barr virus
- Cytomegalovirus
- Mycoplasma pneumoniae
The previous infections increase the risk of F. necrophorum infection because they cause damage to the mucous membranes in the body, which allows this bacterium to grow faster.
Is Lemierre’s Syndrome Contagious?
While the syndrome itself is not contagious, the bacterium that causes it may spread from one person to another.
What Happens if Lemierre’s Syndrome is Left Untreated?
People who ignore the symptoms and leave this syndrome untreated may experience additional complications. Check some of them below:
- Pneumonia
- Lung abscess (a pocket of pus in the lungs)
- Arthritis (joint pain, stiffness, and inflammation)
- Empyema – This complication causes pus to form between the lungs and underneath the chest wall.
- Pleural effusion (fluid buildup around the lungs)
- Septic emboli – Usually, this complication occurs when an infected blood clot in the jugular vein spreads to other parts of the body and causes blockages.
- Sepsis – This is a life-threatening infection that requires immediate treatment. Otherwise, it can be fatal.
The previous list does not contain a full list of complications, but you can consult with your doctor about ways to reduce the risk or even prevent them.
Is There a Way To Prevent Lemierre’s Syndrome?
While it is not always possible to prevent this syndrome, doctors may recommend some tips to reduce the risk. Examples include:
- Avoid other people if they are sick
- Regularly brush and floss your teeth and rinse with antibacterial mouthwash
- Schedule regular checkups with a dentist
- Do not share your utensils and foods with other people (especially if they are sick)
Diagnosis
Mostly, it is difficult to diagnose this syndrome because it occurs very rarely and it shares symptoms with other infections. Doctors usually perform the following tests if your symptoms last for a long period. These include:
- A bacterial culture
- C-reactive protein (CRP) test
- Erythrocyte sedimentation rate test
If the previous tests show there is an infection in the body, physicians may also perform imaging tests of the neck and throat. These include CT (computerized tomography) scans, X-rays, ultrasounds, and MRI (magnetic resonance imaging) scans.
Treatment
Most of the time, physicians prescribe antibiotics to treat this infection. Check the most common options below:
- Clindamycin
- Amoxicillin/clavulanic acid
- Metronidazole
- Imipenem
In more severe cases, doctors may recommend surgery to:
- Remove the tonsils (tonsillectomy) or a blood clot from the jugular vein (thrombectomy)
- Drain fluid around the lungs or an abscess in the brain, head, lungs, or neck
- Tie off the jugular vein or stop bleeding from entering it
Recovery
The recovery time varies among people with Lemierre’s syndrome because it depends on several factors. These include the severity and cause of the disease, age, sex, your response to treatment, and overall health. While people start to feel better within a few days after starting the treatment, a complete recovery may take up to 6 weeks.
Frequently Asked Questions
Is Lemierre’s syndrome a sexually transmitted infection?
No, this health condition is not considered a sexually transmitted infection (STI). However, in rare cases, people may develop this syndrome due to P. asaccharolytica that does not exist in the mouth or throat. Usually, this bacterium is found in the gastrointestinal tract and genitals.
Who is most likely to develop Lemierre’s syndrome?
Lemierre’s syndrome most commonly affects teenagers and young adults, especially those between 15 and 30 years old. However, it can occur in children and older adults as well, especially after a bacterial throat infection.
How quickly can Lemierre’s syndrome become serious?
The condition can worsen rapidly over several days. A sore throat may initially seem to improve before symptoms such as high fever, neck swelling, chest pain, or difficulty breathing develop. Early diagnosis and treatment are essential to prevent life-threatening complications.
Why is the jugular vein commonly affected in Lemierre’s syndrome?
The infection usually begins in the throat and can spread into nearby tissues surrounding the internal jugular vein. This may lead to inflammation and the formation of an infected blood clot (septic thrombophlebitis), which is a hallmark of Lemierre’s syndrome.
Can Lemierre’s syndrome recur after treatment?
Recurrence is uncommon when the infection is diagnosed early and treated with the appropriate antibiotics for the recommended duration. However, it is important to complete the full course of antibiotics and attend follow-up appointments to ensure the infection has completely resolved.
Are blood thinners routinely used to treat Lemierre’s syndrome?
Not always. The use of anticoagulant (blood-thinning) medications remains controversial. Some healthcare providers may prescribe them in selected cases, such as when the blood clot continues to grow or extends into other veins, while others may treat the condition with antibiotics alone.
How long do antibiotics need to be taken for Lemierre’s syndrome?
Treatment typically lasts between 3 and 6 weeks, depending on the severity of the infection, the presence of complications, and how well the person responds to therapy. Some patients begin with intravenous (IV) antibiotics before switching to oral medications.
Can Lemierre’s syndrome be mistaken for other illnesses?
Yes. Early symptoms often resemble common conditions such as strep throat, infectious mononucleosis, influenza, or a viral upper respiratory infection. Because it is rare, diagnosis may be delayed unless healthcare providers suspect the condition based on persistent or worsening symptoms.
What warning signs should prompt immediate medical attention?
Seek emergency medical care if you develop a severe sore throat accompanied by a high fever, swelling or pain on one side of the neck, difficulty breathing or swallowing, coughing up blood, chest pain, confusion, or signs of sepsis, especially after a recent throat infection.
What is the outlook for people with Lemierre’s syndrome?
With prompt diagnosis and appropriate antibiotic treatment, most people recover completely. However, delayed treatment increases the risk of serious complications, including sepsis, lung infections, organ damage, and, in rare cases, death. Early recognition greatly improves the chances of a full recovery. If you have additional questions, ask your healthcare professional.
