Introduction
Intravenous lines are used frequently for administering medicines or treatment. There is a risk of developing blood clots around this intravenous placement. The intravenous placement is also vulnerable to infection and inflammation, leading to septic thrombophlebitis.
What Is Septic Thrombophlebitis?
Suppurative or septic thrombophlebitis is the formation of an infectious thrombus post-catheter placement in the vein. The thrombus results in inflammation and pus formation within the venous wall and surrounding vessels. Commonly affected veins are pelvic, peripheral, superior vena cava, dural sinuses, internal jugular, and portal veins.
Neonates and older age groups are the most vulnerable to developing septic thrombophlebitis. It could be because of underdeveloped host defenses in neonates and reduced immunologic function and comorbidities in older age.
What Are the Types of Septic Thrombophlebitis?
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Septic Pelvic Thrombophlebitis: It is a rare postpartum complication in women who undergo cesarean section—the blood clots formed due to infection or subsequent inflammation block one or more pelvic veins. Other conditions causing septic thrombophlebitis are endometriosis, pelvic inflammatory disease, abdominal surgery, intra-abdominal infection, or septic abortion. The vein wall becomes infected by bacteria (primarily Staphylococcus aureus) or viruses and causes intimal damage, leading to thrombogenesis of the ovarian vein. The symptoms include persistent postpartum fever, which does not respond to broad-spectrum antibiotics.
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Lemierre Syndrome: Septic thrombophlebitis of the internal jugular vein caused by bacterial invasion from nearby structures is called Lemierre syndrome. The condition develops from pharyngitis (pharynx inflammation) associated with peritonsillar abscess, which ruptures and spreads to other structures. But can also develop secondary to dental infections. The condition develops primarily in healthy young adults.
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Dural Sinus Septic Thrombophlebitis: The condition primarily develops from ear, nose, or throat infections such as otitis media or mastoiditis. Infections in periorbital areas and soft palate increase the risk of developing septic thrombophlebitis. Some of this infectious drains into the cavernous sinus, causing the infection to spread. Dental infections, meningitis, and sinusitis also cause septic thrombophlebitis in the dural sinus through direct spread.
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Deep (Non-catheter-Associated): It is a less common type of septic thrombophlebitis.
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Pylephlebitis: A rare septic thrombophlebitis developing in the portal vein is called pylephlebitis. The reported mortality rate is 25 percent despite using antibiotics. It is associated with diverticulitis, pancreatitis, inflammatory bowel disease, appendicitis, hemorrhoidal disease, and intraabdominal infections, which drain into the portal vein.
What Causes Septic Thrombophlebitis?
The predominant cause is mechanical or chemical irritation caused by intravenous line placement within blood vessels. The catheters are placed as a part of treatment but may induce complications. These catheters are susceptible to infection from bacteria or fungi. Bacteria can enter the body through an intravenous catheter or post-placement. The immune system reacts with inflammation and blood clot formation when infection or injury develops.
Other conditions like Lemierre syndrome, dural sinus septic thrombophlebitis, pylephlebitis, and pelvic vein thrombophlebitis result from infection spreading from nearby non-vascular structures. Patients with malignancy increasingly develop deep vein thrombosis due to their compromised immune system and disrupted fibrinolytic system, leading to septic thrombophlebitis. Burn patients, individuals on long-term steroids, and intravenous drug users can also develop septic thrombophlebitis.
What Is the Mechanism of Developing Septic Thrombophlebitis?
The exact mechanism for developing septic thrombophlebitis is unknown. However, septic thrombophlebitis begins due to disruption in the venous wall leading to thrombus formation. Vein wall disruption develops from mechanical or chemical irritation. However, individuals with a pre-existing hypercoagulable state, such as cancer, can also develop septic thrombophlebitis. The infection may enter through broken skin or adjacent structures when the thrombus forms. As the infection enters the vein, it multiplies and causes thrombus formation and inflammation.
What Are the Symptoms of Septic Thrombophlebitis?
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Presenting clinical symptoms can vary from mild swelling and pain in the superficial vein to severe systemic infection or septic shock. The typical symptoms of septic thrombophlebitis are blood clots and infection.
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Peripheral vein involvement causes high fever (greater than 100.4 Fahrenheit), erythema and tenderness along the course of the vein, and purulent discharge from the catheter insertion site. Some patients also experience hypoxemia, chest pain, and respiratory distress due to emboli in the lungs. However, septic embolism in the lungs is a rare phenomenon.
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Septic thrombophlebitis in the jugular vein causes fever, throat or neck pain, trismus, dysphagia, neck swelling, induration over the jugular vein, sternocleidomastoid muscle, or jaw. Additional presenting symptoms are pseudomembrane formation, ulceration, or erythema.
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Individuals with Lemierre’s syndrome exhibit symptoms such as sinusitis, oral pain or infection, and post-septal cellulitis.
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Individuals with pylephlebitis present with fever, abdominal pain, nausea, and vomiting. Jaundice may occur rarely.
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Other symptoms include hypotension, tachycardia, and severe sepsis. The thrombi can break off and form septic emboli, which travel to bone or joint and cause septic arthritis or osteomyelitis. Such patients complain of joint pain and body aches.
How Is Septic Thrombophlebitis Treated?
Antibiotics and antifungal medication help treat specific infectious causes of the disease. Remove any central line or intravenous catheter in septic thrombophlebitis patients. Additionally, the doctors might give medications to thin the blood and dissolve clots.
Treatment for septic thrombophlebitis could last for a few days to several weeks. Some patients might have to continue anticoagulant and antibiotic therapy even after infection resolution. Extensive infection or clotting rarely requires surgical intervention. The clots are cleared to prevent any complications.
If septic thrombophlebitis remains untreated, there is a risk for significant morbidity and mortality to occur. However, the extent of adverse effects depends on the location of the thrombus.
What Are the Complications of Septic Thrombophlebitis?
When bacteria or infected blood thrombus in patients affected by septic thrombophlebitis enters the bloodstream, it produces complications such as septic arthritis, endocarditis, and septic uveitis. The development of septic thrombophlebitis in the cavernous sinus or superior sagittal sinus results in a high mortality rate. It is more common in children than adults.
Before the advent of antibiotics, septic thrombophlebitis predominantly caused cerebral sinus thrombosis, leading to mortality. Presently, the development of cerebral sinus thrombosis is rare.
Conclusion
Septic thrombophlebitis is a medical condition that could develop in any vessel. The condition often develops during peripheral vein cannula insertion. Immediate diagnosis and treatment can prevent the infected thrombus from entering the bloodstream and causing further complications.
