Human Necrobacillosis, with Emphasis on Lemierre's Syndrome

Abstract

Lemierre's syndrome is the classical presentation of human necrobacillosis. It is characterized by a primary infection in the head in a young, previously healthy person who subsequently develops persistent high fever and disseminated metastatic abscesses, frequently including a septic thrombophlebitis of the internal jugular vein. The main pathogen is Fusobacterium necrophorum, an obligate anaerobic, pleomorphic, gram-negative rod. Clinical microbiologists have a key role in alerting clinicians and advising proper antibiotic treatment when the characteristic microscopic morphology of the pleomorphic F. necrophorum is seen in Gram stains from positive anaerobic cultures of blood and pus. Early diagnosis and prolonged appropriate antibiotic treatment with good anaerobic coverage are crucial to reduce morbidity and mortality. F. necrophorum also causes human necrobacillosis with foci caudal to the head, mainly in elderly patients with high mortality related to age and predisposing diseases, such as cancers of the primary focus.

Descending Mediastinitis in Epstein-Barr Virus Infection

“…F. necrophorum was isolated in a blood culture, but the CT scan of the head, neck, and thorax did not show a septic thrombophlebitis or abscess (4).The cases described above show that EBV infection can be complicated by superinfections. Hagelskjaer Kristensen and Prag speculated that a transient decrease in the T cell-mediated immunity caused by EBV infection may predispose to a bacterial superinfection (5). Oral commensals would be the logical microorganisms to cause cases like these (6).…”

Síndrome de Lemierre: Una entidad clínica casi en el olvido. Reporte de tres casos y revisión de la literatura

“…Ignacio Maldonado Sch (1) , José M Gutiérrez C (1) , Anita Wilkens R (2) , Carolina Weitz R (3) , Alberto Rojas A (2) , Cristian Varela U (1) .…”

“…Los pacientes generalmente fallecían dentro de 7 a 15 días de iniciado el cuadro. Lemierre postuló que este síndrome era tan característico, que permitía realizar el diagnóstico incluso antes de los exámenes bacteriológicos (1,2) .…”

Lemierre’s Syndrome: The Forgotten Disease?

“…Necrophrum is a strictly non-motile, non spore forming, anaerobic, gram-negative bacilli that is part of the a normal flora of the orophayngeal cavity, gastrointestinal tract and female genital tract [7,8].…”