Lemierre's syndrome

Fusobacterium necrophorum

• is part of anaerobic normal throat flora
• has a predisposition to abscess formation (termed 'necrobacillus' - this is very rare - affecting one per million of population)
  • platelet aggregation and virulent toxin production results in internal jugular venous thrombosis (Lemierre's syndrome)
  • cavitating pulmonary lesions and haemoptysis occur as a result of septic embolisation
  • other possible features include empyema, septic arthritis, and abscesses in the liver, spleen and muscles
• if fusibacteria isolated on a throat swab
  • consult local microbiologist for guidance re: treatment
  • some strains are beta-lactimase producers so there may be advantages of prescribing a beta-lactimase inhibitor such as co-amoxiclav (1)

Lemierre syndrome is a rare and potentially life-threatening infection

• is infectious thrombophlebitis of the internal jugular vein
  • a severe illness generally caused by the anaerobic bacterium, Fusobacterium necrophorum which typically occurs in healthy teenagers and young adults
  • infection originates in the throat and spreads via a septic thrombophlebitis of the tonsillar vein and internal jugular vein
    
    
• bacteria typically responsible is Fusobacterium necrophorum, although a variety of bacteria types may cause the condition
  • F necrophorum is found in the normal flora of the oropharynx and so there must be factors that precipitate invasive infection
    • mucosal damage by bacterial or viral pharyngitis may be a precipitating factor
    • several reports have described infected patients to have serological evidence of recent Epstein-Barr virus infection
  • initial infection is in the throat and then spreads through the lymphatic vessels
  • symptoms include sore throat and fever, followed by swelling of the internal jugular vein
    • subsequently, pus-containing tissue moves from the original location to various organs, most commonly the lungs
    • other affected sites may include the joints, muscles, skin and soft tissue, liver, and/or spleen
  • treatment involves the use of intravenous antibiotics

Reference:

1. Pulse (2003), 63(4), 72.
2. Srivali N, Ungprasert P, Kittanamongkolchai W, Ammannagari N. Lemierre's syndrome: An often missed life-threatening infection. Indian J Crit Care Med. 2014 Mar; 18(3):170-2.
3. Gupta N, Kralovic SM, McGraw D. Lemierre syndrome: not so forgotten!. Am J Crit Care. 2014 Mar; 23(2):176-9.