Necrobacillosis in humans

Abstract

Necrobacillosis, often used synonymously with Lemierre's syndrome, is a form of abscess infection in the peritonsillar area associated with a thrombophlebitis and caused by the strict anaerobic species Fusobacterium necrophorum. The thrombosis formed affects the internal jugular vein, from which the bacteria are seeded out in the bloodstream and cause bacteremia. Septicemia is a common complication with an often fatal outcome. Necrobacillosis is very rare and is referred to as the 'forgotten disease'. It is probably frequently overlooked in clinical practice in its early and milder forms such as tonsillitis (sore throat) and peritonsillar abscess. F. necrophorum frequently participates in these infections and is thus suspected to have an etiological role in Lemierre's syndrome. Similarly, F. necrophorum seems to play an important role in noma (cancrum oris) and this disease is also included in the necrobacillosis complex. Diagnosis of infections of the necrobacillosis complex seeks to disclose F. necrophorum in swab samples or blood culture. The most commonly used therapy is metronidazole in combination with penicillin or amoxicillin. Clindamycin is also an option, especially in cases of penicillin allergy.

Lemierre syndrome: Current evidence and rationale of the Bacteria-Associated Thrombosis, Thrombophlebitis and LEmierre syndrome (BATTLE) registry

“…Fusobacterium necrophorum funduliforme can adhere to epithelial cells [9] and penetrate tissues by converting plasminogen into the fibrinolytic enzyme plasmin [10]. It may be able to evade the innate immune system by binding factor H [11] and by secreting a protein that inhibits leukocyte migration toward the site of infection [12]. Its ability to promote thrombus formation has been attributed to its hemagglutinin [12], which promotes platelet aggregation, or to direct activation of the contact system [13], and may also have evolved as a mean to stave off immune cells while promoting a locally anaerobic environment [12].…”

“…It may be able to evade the innate immune system by binding factor H [11] and by secreting a protein that inhibits leukocyte migration toward the site of infection [12]. Its ability to promote thrombus formation has been attributed to its hemagglutinin [12], which promotes platelet aggregation, or to direct activation of the contact system [13], and may also have evolved as a mean to stave off immune cells while promoting a locally anaerobic environment [12]. Heparinase may then precipitate septic embolization [14,15].…”

Lemierre’s Syndrome: The Forgotten Disease?

“…Necrobacillosis often used synonymously with Lemierre's Syndrome is the presence of F. Necrophorum causing human peritonsilar abscesses leading to thrombophlebitis and septicaemia. Thus the term necrobacillosis requires positive microbiology for F. Necrophorum [3,6]. Post anginal septicaemia is a clinical term denoting the complications seen after purulent pharyngitis or peritonsilar abscess [3].…”

“…Some authors have recommended anticoagulation in patients where antibiotics alone have failed or where there is clinical or radiological evidence of cavernous sinus thrombosis [2,6].…”

Esthetic dentistry and eating disorders

“…13 Oral lesions are particularly evident on the tongue, buccal mucosa, and the floor of the mouth. 13 Oral lesions are particularly evident on the tongue, buccal mucosa, and the floor of the mouth.…”