L Valerio1, F Zane2, C Sacco3, S Granziera4, T Nicoletti5, M Russo1, G Corsi6, K Holm7, M-A Hotz8, C Righini9, P D Karkos10, S H Mahmoudpour1,11, N Kucher12, P Verhamme13, M Di Nisio14, R M Centor15, S V Konstantinides1,16, A Pecci17, S Barco1,12. 1. From the, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. 2. Department of General Medicine, Hospital of Sondrio, Sondrio, Italy. 3. Thrombosis and Hemostasis Center, Humanitas Research Hospital and Humanitas University, Rozzano, Italy. 4. Department of Physical and Rehabilitation Medicine, "Villa Salus" Hospital, Mestre, Italy. 5. Institute of Neurology, Catholic University of the Sacred Heart and Institute of Neurology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy. 6. Department of Emergency Medicine, San Giovanni Calibita Fatebenefratelli Hospital, AFAR, Rome, Italy. 7. Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden. 8. Department of ENT, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland. 9. Department of ENT, Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France. 10. Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 11. Institute for Medical Biostatistics, Epidemiology, and Informatics (IMBEI), Department of Biometry and Bioinformatics, University Medical Center Mainz, Mainz, Germany. 12. Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland. 13. Department of Vascular Medicine and Hemostasis, University Hospitals Leuven, Leuven, Belgium. 14. Department of Medicine and Ageing Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy. 15. Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA. 16. Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. 17. Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy.
Abstract
BACKGROUND: Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. METHODS: In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. RESULTS: The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26 died (4.0%; 2.7-5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2-13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). CONCLUSIONS: Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.
BACKGROUND: Lemierre syndrome is characterized by head/neck vein thrombosis and septic embolism usually complicating an acute oropharyngeal bacterial infection in adolescents and young adults. We described the course of Lemierre syndrome in the contemporary era. METHODS: In our individual-level analysis of 712 patients (2000-2017), we included cases described as Lemierre syndrome if these criteria were met: (i) primary site of bacterial infection in the head/neck; (ii) objectively confirmed local thrombotic complications or septic embolism. The study outcomes were new or recurrent venous thromboembolism or peripheral septic lesions, major bleeding, all-cause death and clinical sequelae. RESULTS: The median age was 21 (Q1-Q3: 17-33) years, and 295 (41%) were female. At diagnosis, acute thrombosis of head/neck veins was detected in 597 (84%) patients, septic embolism in 582 (82%) and both in 468 (80%). After diagnosis and during in-hospital follow-up, new venous thromboembolism occurred in 34 (5.2%, 95% CI 3.8-7.2%) patients, new peripheral septic lesions became evident in 76 (11.7%; 9.4-14.3%). The rate of either was lower in patients who received anticoagulation (OR: 0.59; 0.36-0.94), higher in those with initial intracranial involvement (OR: 2.35; 1.45-3.80). Major bleeding occurred in 19 patients (2.9%; 1.9-4.5%), and 26 died (4.0%; 2.7-5.8%). Clinical sequelae were reported in 65 (10.4%, 8.2-13.0%) individuals, often consisting of cranial nerve palsy (n = 24) and orthopaedic limitations (n = 19). CONCLUSIONS:Patients with Lemierre syndrome were characterized by a substantial risk of new thromboembolic complications and death. This risk was higher in the presence of initial intracranial involvement. One-tenth of survivors suffered major clinical sequelae.
Authors: Diego Fernando Severiche-Bueno; Diego Alejandro Insignares-Niño; David Felipe Severiche-Bueno; María Teresa Vargas-Cuervo; Fabio Andrés Varón-Vega Journal: Germs Date: 2021-06-02