Fusobacterium necrophorum Septicemia Following Oropharyngeal Infection

Lemierre's syndrome (necrobacillosis)

“…Therefore, it is easy to misdiagnose the syndrome as infectious endocarditis in a patient who presents with evidence of septic emboli 1616. Postanginal septicaemia with renal complications has also been misdiagnosed as post-streptococcal glomerulonephritis 17…”

“…15 The thrombosed jugular vein is rarely palpable 15. It must be remembered that local findings can be subtle or absent,16 especially if the infection affects selectively the posterior compartment of the lateral pharyngeal space 3…”

“…Associated pleural effusion is common,14-16 and may precede the appearance of pulmonary infiltrates 11. Empyema and lung abscess are relatively frequent,16 18 19 and both pneumatoceles and pneumothorax have been described 20…”

“…When arthritis is present, fluid from the involved joints must be cultured 16. Cultures of skin pustules and pus from liver abscesses can also yield positive results,7 11 as can culture of pus obtained from empyemas 5…”

“…F necrophorum has been traditionally susceptible to penicillin, clindamycin, metronidazole and chloramphenicol, but activity of the cephalosporins, erythromycin and tetracyclines have been variable 46 It must be noted that some treatment failures with penicillin have been reported 1629 β-Lactamase production by some F necrophorum might account for this observation,6 30 so that β-lactamase-resistant antibiotics with anaerobic activity (ticarcillin–clavulanate, ampicillin–sulbactam, etc,) are recommended today 6…”