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It is an extremely rare medical condition characterized by an anaerobic sepsis following a recent oropharyngeal infection and associated with septic thrombophlebitis of the internal jugular vein and metastatic abscesses. It may also be associated with septic pulmonary emboli that can result in fatal systemic sepsis. This is a life-threatening disease as it is associated with a mortality rate of over 90%.
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Postanginal Septicemia; Necrobacillosis; Post-Anginous Septic Syndrome.
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Bacterial infection by gram-negative bacillus Fusobacterium necrophorum (Bacteroides melaninogenicus, Eikenella corrodens, and nongroup A streptococcus have also been isolated from patients with this syndrome) reported in 1936 by Andre Lemierre when he reviewed 20 cases. He called this medical condition “postanginal septicemia.”
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Rare but probably frequently overlooked. Occurs more frequently in teenagers and young adults but has also been described in children.
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Untreated F. necrophorum tonsillitis or peritonsillar abscess may cause septic thrombophlebitis of the ipsilateral internal jugular vein that rapidly progresses to septicemia because of septic emboli in the lungs or other organs. The proliferation of these bacteria is favored by disruption of normal host mucosal defenses through trauma or hypoxia. It is due to the release of proteolytic enzymes lipopolysaccharide endotoxin, leukocidin, and hemagglutinin that accounts for the pathogenicity of F. necrophorum, an infectious agent that usually invades the regional veins, particularly the internal jugular vein. The hemagglutinin moiety can aggregate bovine platelets, and this phenomenon may play a role in the development of internal jugular vein thrombosis, which is favorable to develop a thrombophlebitis.
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Cervical Doppler ultrasound shows thrombophlebitis of the internal jugular vein, and high-resolution CT scanning shows nodules abutting the pleura with or without cavitation. Positive blood cultures for F. necrophorum confirm the diagnosis.
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Fever and neck pain; moderate dyspnea; pharyngo-tonsillar inflammation (pharyngotonsillitis) and ipsilateral tender swelling of the cervical region; often complicated by distant metastatic infections; chest radiograph usually shows ill-defined infiltrates or round opacities but also signs of septic lung emboli (wedge-shaped peripheral densities nodular or cavitary lesions). The overall mortality rate is approximately 15% (but >90% if left untreated promptly).
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Precautions before anesthesia
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It is important to obtain the patient’s oxygen saturation at room air and a chest radiograph. Elective surgical procedure must be delayed until the infection is completely treated with appropriate antibiotic. In the presence of an emergency, antibiotics must be begun or commenced immediately. If central venous catheterization is foreseen, ultrasound examination of the jugular and subclavian vessels must be obtained to ensure the potency of these vessels.