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

Autor: Sacco C; Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy., Zane F; Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy., Granziera S; Department of Medicine (DIMED), Geriatric Clinic, University of Padua, Padua, Italy.; Department of Physical and Rehabilitation Medicine, 'Villa Salus' Hospital, Mestre, Italy., Holm K; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden., Creemers-Schild D; Department of Internal Medicine, Langeland Hospital, Zoetermeer, The Netherlands., Hotz MA; Department of ENT, Head and Neck Surgery, Inselspital (University Hospital of Bern), University of Bern, Bern, Switzerland., Turpini E; Department of Radiology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy., Valentini A; Department of Radiology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy., Righini C; Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France., Karkos PD; Department of Otolaryngology-Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece., Verhamme P; Department of Vascular Medicine and Haemostasis, University Hospitals Leuven, Leuven, Belgium., Di Nisio M; Department of Medicine and Ageing Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy., Konstantinides S; Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece., Pecci A; Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy., Barco S; Center for Thrombosis and Haemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Jazyk: angličtina
Zdroj: Hamostaseologie [Hamostaseologie] 2019 Feb; Vol. 39 (1), pp. 76-86. Date of Electronic Publication: 2018 Aug 02.
DOI: 10.1055/s-0038-1654720
Abstrakt: 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.
Competing Interests: Marcello Di Nisio reports personal fees from Daiichi and Bayer HealthCare. Stavros Konstantinides has received consultancy, advisory board and lecture fees from Bayer HealthCare, Boehringer Ingelheim, Merck Sharp & Dohme, Daiichi-Sankyo, Pfizer–Bristol-Myers Squibb and BTG Biocompatibles Group UK; and institutional grants from Boehringer Ingelheim, Bayer HealthCare, Daiichi-Sankyo, Merck Sharp & Dohme-Pfizer and Actelion. All the other authors do not report any potential conflict of interest for the present publication.The work of Stavros Konstantinides and Stefano Barco is supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and 01EO1503).
(Georg Thieme Verlag KG Stuttgart · New York.)
Databáze: MEDLINE