Lemierre Syndrome: Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis

Research output: Contribution to journalReview article

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Lemierre Syndrome : Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis. / Sacco, Clara; Zane, Federica; Granziera, Serena; Holm, Karin; Creemers-Schild, Dina; Hotz, Michel André; Turpini, Elena; Valentini, Adele; Righini, Christian; Karkos, Petros D.; Verhamme, Peter; Di Nisio, Marcello; Konstantinides, Stavros; Pecci, Alessandro; Barco, Stefano.

In: Hamostaseologie, Vol. 39, No. 1, 2019, p. 76-86.

Research output: Contribution to journalReview article

Harvard

Sacco, C, Zane, F, Granziera, S, Holm, K, Creemers-Schild, D, Hotz, MA, Turpini, E, Valentini, A, Righini, C, Karkos, PD, Verhamme, P, Di Nisio, M, Konstantinides, S, Pecci, A & Barco, S 2019, 'Lemierre Syndrome: Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis', Hamostaseologie, vol. 39, no. 1, pp. 76-86. https://doi.org/10.1055/s-0038-1654720

APA

CBE

Sacco C, Zane F, Granziera S, Holm K, Creemers-Schild D, Hotz MA, Turpini E, Valentini A, Righini C, Karkos PD, Verhamme P, Di Nisio M, Konstantinides S, Pecci A, Barco S. 2019. Lemierre Syndrome: Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis. Hamostaseologie. 39(1):76-86. https://doi.org/10.1055/s-0038-1654720

MLA

Vancouver

Author

Sacco, Clara ; Zane, Federica ; Granziera, Serena ; Holm, Karin ; Creemers-Schild, Dina ; Hotz, Michel André ; Turpini, Elena ; Valentini, Adele ; Righini, Christian ; Karkos, Petros D. ; Verhamme, Peter ; Di Nisio, Marcello ; Konstantinides, Stavros ; Pecci, Alessandro ; Barco, Stefano. / Lemierre Syndrome : Clinical Update and Protocol for a Systematic Review and Individual Patient Data Meta-analysis. In: Hamostaseologie. 2019 ; Vol. 39, No. 1. pp. 76-86.

RIS

TY - JOUR

T1 - Lemierre Syndrome

T2 - Hamostaseologie

AU - Sacco, Clara

AU - Zane, Federica

AU - Granziera, Serena

AU - Holm, Karin

AU - Creemers-Schild, Dina

AU - Hotz, Michel André

AU - Turpini, Elena

AU - Valentini, Adele

AU - Righini, Christian

AU - Karkos, Petros D.

AU - Verhamme, Peter

AU - Di Nisio, Marcello

AU - Konstantinides, Stavros

AU - Pecci, Alessandro

AU - Barco, Stefano

PY - 2019

Y1 - 2019

N2 - Lemierre syndrome usually affects otherwise healthy adolescents or young adults and occurs at an overall rate of 1 to 10 cases per million person-years with an estimated fatality rate of 4 to 9%. Diagnostic criteria remain debated and include acute neck/head bacterial infection (often tonsillitis caused by anaerobes at high potential for sepsis and vascular invasion, notably Fusobacterium necrophorum) complicated by local vein thrombosis, usually involving the internal jugular vein, and systemic septic embolism. Medical treatment is based on antibiotic therapy with anaerobic coverage, anticoagulant drugs and supportive care in case of sepsis. Surgical procedures can be required, including drainage of the abscesses, tissue debridement and jugular vein ligation. Evidence for clinical management is extremely poor in the absence of any adequately sized study with clinical outcomes. In this article, we illustrate two cases of Lemierre syndrome not caused by Fusobacterium necrophorum and provide a clinically oriented discussion on the main issues on epidemiology, pathophysiology and management strategies of this disorder. Finally, we summarize the study protocol of a proposed systematic review and individual patient data meta-analysis of the literature. Our ongoing work aims to investigate the risk of new thromboembolic events, major bleeding or death in patients diagnosed with Lemierre syndrome, and to better elucidate the role of anticoagulant therapy in this setting. This effort represents the starting point for an evidence-based treatment of Lemierre syndrome built on multinational interdisciplinary collaborative studies.

AB - Lemierre syndrome usually affects otherwise healthy adolescents or young adults and occurs at an overall rate of 1 to 10 cases per million person-years with an estimated fatality rate of 4 to 9%. Diagnostic criteria remain debated and include acute neck/head bacterial infection (often tonsillitis caused by anaerobes at high potential for sepsis and vascular invasion, notably Fusobacterium necrophorum) complicated by local vein thrombosis, usually involving the internal jugular vein, and systemic septic embolism. Medical treatment is based on antibiotic therapy with anaerobic coverage, anticoagulant drugs and supportive care in case of sepsis. Surgical procedures can be required, including drainage of the abscesses, tissue debridement and jugular vein ligation. Evidence for clinical management is extremely poor in the absence of any adequately sized study with clinical outcomes. In this article, we illustrate two cases of Lemierre syndrome not caused by Fusobacterium necrophorum and provide a clinically oriented discussion on the main issues on epidemiology, pathophysiology and management strategies of this disorder. Finally, we summarize the study protocol of a proposed systematic review and individual patient data meta-analysis of the literature. Our ongoing work aims to investigate the risk of new thromboembolic events, major bleeding or death in patients diagnosed with Lemierre syndrome, and to better elucidate the role of anticoagulant therapy in this setting. This effort represents the starting point for an evidence-based treatment of Lemierre syndrome built on multinational interdisciplinary collaborative studies.

KW - anticoagulant treatment

KW - bacterial infection

KW - Fusobacterium necrophorum

KW - Lemierre syndrome

KW - venous thromboembolism

U2 - 10.1055/s-0038-1654720

DO - 10.1055/s-0038-1654720

M3 - Review article

VL - 39

SP - 76

EP - 86

JO - Hamostaseologie

JF - Hamostaseologie

SN - 0720-9355

IS - 1

ER -