Lemierre syndrome: summary of the main clinical evidences

Abstract

Introduction: Lemierre syndrome (SL) originates as a complication of bacterial infections in the oropharynx. The disease is associated with anaerobic septicemia and death in young, healthy patients, and can quickly evolve to death if not diagnosed and treated quickly. Aim: To conduct a review of recent literature seeking to synthesize the main clinical evidence related to Lemierre's Syndrome. Method: The selection of papers was carried out on December 6, 2020. The database used in the search was PUBMED, using the following strategy: "lemierre's syndrome" [title]. Of the 17 articles initially selected, one was eliminated for discussing SL specifically related to trauma, and another that indicated a publication probably portrayed by the authors, which was not available for consultation. Conclusions: The diagnosis of SL is usually made with the aid of cervical or thoracic computed tomography to identify the emboli and thrombi, magnetic resonance imaging to identify the venous thrombi, and blood culture to identify the causative microorganisms. Regarding treatment, although there are no defined guidelines for SL, prolonged administration of intravenous antibiotics is essential, and surgical procedures are sometimes necessary. Anticoagulant therapy for the treatment of thrombi depends on the situation, since there are divergences regarding its usefulness. Regarding pharmacotherapeutic regimens, Fusobacteria necrophorum (FN) is generally susceptible to penicillin, clindamycin, metronidazole and chloramphenicol, and it is suggested that its use be carried out in conjunction with a beta-lactamase inhibitor. Gemella bergeri (GB) and Eikenella corrodens (EC) were reactive to meropenem, clindamycin and vancomycin, and methicillin-resistant Staphylococcus aureus (MRSA) was susceptible to cefazolin (which can also be applied to FN).