Program Schedule

122
Clinical and Microbiologic Characteristics of Pediatric Patients with Lemierre Syndrome

Session: Oral Abstract Session: Characterizing Genetic and Clinical Factors in Pediatric Infectious Diseases
Thursday, October 9, 2014: 11:45 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: Lemierre’s and Lemierre’s like syndromes (LALLS) are rare, life-threatening infections characterized by oropharyngeal disease with thrombophlebitis of the internal jugular vein and septic emboli. While Fusobacterium necrophorum is the classic pathogen, other pathogens are emerging.  We evaluated the presenting symptoms, clinical features, pathogens, and outcomes of patients with LALLS in order to identify opportunities to improve the early diagnosis and empiric treatment of LALLS.  

Methods: The Intermountain Enterprise Data Warehouse was queried for patients < 21 years old with LALLS from January 1, 2002 to December 31, 2013.  Patients were identified by ICD-9 codes for septic thrombophlebitis and/or positive cultures for Fusobacterium infections. All cases were validated by manual chart review. 

Results:   We identified 35 patients with LALLS.  66% were female with a median age of 16 years (IQR: 15-18).  There was an average of 2.5 LALLS cases annually from 2002-2007; this increased to 3.3 cases annually from 2008-2013 (p=0.01).  Fever (100%), sore throat (82%), and lower respiratory symptoms (60%) were the most common presenting symptoms.  The median duration of symptoms before admission was 7 days (IQR: 6-8).  91% of patients were evaluated at least once before admission.  71% of patients had rapid strep testing performed and 49% had monospot testing, which were negative in 96% and 94% of cases, respectively.  Before recognition of LALLS, 26% of patients received narcotics and 14% received steroids for severe pharyngitis as outpatients.  60% of patients required intensive care.  74% of patients had a jugular vein thrombosis or septic embolization.  F.necrophorum (57%), F.gonidiaformans (17%), Fusobacterium species (9%), and Group C Streptococcus (9%) were the most common bacteria isolated; there was one case of MRSA.  17% had two bacterial pathogens identified with Group C Streptococcus found in 50% of co-infections.  There were no deaths. 

Conclusion: With the apparent increase in case numbers, clinicians should have a high index of suspicion for LALLS in adolescent patients with severe pharyngitis who test negative for S. pyogenes and EBV or present more than once for pharyngitis.  Empiric therapy for suspected LALLS should consider possible causative pathogens beyond Fusobacterium.

Andrew Nuibe, MD1, Elizabeth Doby, MD1, Adam L. Hersh, MD, PhD2, Chris Stockmann, MSc1, E. Kent Korgenski, MS3, Andrew Pavia, MD, FIDSA, FSHEA1, Jeffrey M. Bender, MD4 and Kwabena Ampofo, MD5, (1)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (2)University of Utah School of Medicine, Salt Lake City, UT, (3)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (4)Pediatrics, Kaiser Permanente, Los Angeles, CA, (5)Pediatric Infectious Disease, University of Utah SOM, Salt Lake City, UT

Disclosures:

A. Nuibe, None

E. Doby, None

A. L. Hersh, None

C. Stockmann, None

E. K. Korgenski, None

A. Pavia, None

J. M. Bender, None

K. Ampofo, None

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