Lemierre’s Syndrome: Are We Underdiagnosing This Life-Threatening Infection?

Abstract

Over a period of 12 months 3 patients presented with severe tonsillitis and subsequently grew Fusobacterium necrophorum (literally-spindle-shaped rod which brings death!) from blood cultures. Two patients responded well to antibiotics and were discharged within 4 days of admission. The third case had a longer history of symptoms and following investigations of a minor but unusual neck swelling was found to have thrombosis of the external and internal jugular vein. This is the first stage in the potentially fatal dissemination of this virulent organism which manifests clinically as Lemierre's syndrome. We describe the clinical histories and discuss whether cases are unrecognised because of the prompt clinical response to penicillin and metronidazole. We stress the importance of taking blood cultures and careful examination of the neck in all patients presenting with a severe tonsillitis.

Lemierre's syndrome: A systematic review

“…One hundred two studies were published from 1950 to 2007. Eighty‐four fulfilled our inclusion criteria, totaling 114 patients for review 3–86. Selection and information bias, lack of uniform reporting, and inclusion of low methodological quality studies prevented a formal meta‐analysis.…”

Human Infection withFusobacterium necrophorum(Necrobacillosis), with a Focus on Lemierre's Syndrome

“…Oteo et al (297) used the term "bacteremic tonsillitis" to describe the relatively benign condition that they had observed, without local or systemic complications or metastases. Six of the 21 patients would fit this description (15,43,162,185,297). F. necrophorum cases with systemic metastatic lesions with no clear source.…”

Lemierre’s Syndrome: The Forgotten Disease?

“…The percentage of cases and the reason why F. Necrophorum goes on to invade the lateral pharyngeal space and cause IJV thrombophlebitis is unknown [15,34]. Some researchers propose that the most likely mechanism involves spread of infection from the palatine or peritonilar tissues either haematogenously via the tonsilar vein causing IJV thrombosis or alternatively lymphatically to the adjacent lateral pharyngeal space causing luminal lymphatic thrombosis [27].…”