Chirinos Julio A, Lichtstein Daniel M, Garcia Javier, Tamariz Leonardo J
Department of Medicine, University of Miami School of Medicine, FL, USA.
Medicine (Baltimore). 2002 Nov;81(6):458-65. doi: 10.1097/00005792-200211000-00006.
Lemierre syndrome (postanginal septicemia) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. A high degree of clinical suspicion is necessary for diagnosis. Fusobacterium necrophorum is the usual etiologic agent. The disease progresses in several steps. The first stage is the primary infection, which is usually a pharyngitis (87.1% of cases). This is followed by local invasion of the lateral pharyngeal space and IJV septic thrombophlebitis (documented in 71.5% of cases), and finally, the occurrence of metastatic complications (present in 90% of cases at the time of diagnosis). A sore throat is the most common symptom during the primary infection (82.5% of cases). During invasion of the lateral pharyngeal space and IJV septic thrombophlebitis, a swollen and/or tender neck is the most common finding (52.2% of patients) and should be considered a red flag in patients with current or recent pharyngitis. The most common site of metastatic infection is the lungs (79.8% of cases). In contrast to the preantibiotic era, cavitating pneumonia and septic arthritis are now uncommon. Most patients (82.5%) had fever at some stage during the course of the disease. Gastrointestinal complaints such as abdominal pain, nausea, and vomiting were common (49.5% of cases). An elevated white blood cell count occurred in 75.2% of cases. Hyperbilirubinemia with slight elevation of liver enzyme levels occurred in one-third of patients, but frank jaundice was uncommon, in contrast to its high frequency reported in the preantibiotic era. We conclude that, most likely as a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed since Lemierre's original description. The typical triad in our series was: pharyngitis, a tender/swollen neck, and noncavitating pulmonary infiltrates. The previous classical description of severe sepsis with cavitating pneumonia and septic arthritis was not commonly seen in our review. Mortality was low in our series (6.4%), but significant morbidity occurred, which was likely preventable by early diagnosis and treatment. The pathophysiology, natural history, diagnostic methods for internal jugular vein thrombosis, and management are discussed.
勒米尔综合征（咽后败血症）由急性口咽感染引起，继发颈内静脉化脓性血栓性静脉炎并常伴有转移性感染。诊断需要高度的临床怀疑。坏死梭杆菌是常见的病原体。该病按几个阶段发展。第一阶段是原发性感染，通常为咽炎（87.1%的病例）。随后是咽旁间隙的局部侵袭和颈内静脉化脓性血栓性静脉炎（71.5%的病例有记录），最后是转移性并发症的发生（诊断时90%的病例存在）。喉咙痛是原发性感染期间最常见的症状（82.5%的病例）。在咽旁间隙侵袭和颈内静脉化脓性血栓性静脉炎期间，颈部肿胀和/或压痛是最常见的发现（52.2%的患者），对于当前或近期患有咽炎的患者应视为警示信号。转移性感染最常见的部位是肺部（79.8%的病例）。与抗生素使用前的时代相比，空洞性肺炎和化脓性关节炎现在并不常见。大多数患者（82.5%）在疾病过程中的某个阶段出现发热。腹痛、恶心和呕吐等胃肠道症状很常见（49.5%的病例）。75.2%的病例白细胞计数升高。三分之一的患者出现高胆红素血症且肝酶水平略有升高，但与抗生素使用前时代报告的高频率相比，明显黄疸并不常见。我们得出结论，很可能由于咽部感染广泛使用抗生素，自勒米尔最初描述以来，该病的典型病程已经改变。我们系列中的典型三联征是：咽炎、颈部压痛/肿胀和非空洞性肺部浸润。我们的综述中未常见到先前关于严重脓毒症伴空洞性肺炎和化脓性关节炎的经典描述。我们系列中的死亡率较低（6.4%），但出现了显著的发病率，早期诊断和治疗可能可以预防。本文讨论了其病理生理学、自然病程、颈内静脉血栓形成的诊断方法及治疗。
