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Fusobacterium infection: is Lemiérre’s disease the tip of an iceberg?

Is Fusobacterium necrophorum an underrated anaerobic pathogen, and could Lemiérre’s disease be prevented by earlier treatment of sore throat? Here, Mike Wren looks at the available evidence and illustrates some of the issues in two short case studies

On 3 March 1936 Andre-Alfred (Anton) Lemiérre, Professor of Bacteriology at the Faculty of Medicine in Paris, and physician to the Claude Bernard Hospital, delivered an address at the Middlesex Hospital Medical School entitled ‘On certain septicaemias due to anaerobic organisms’. In this lecture, he described 18 deaths caused by Fusobacterium funduliforme (at that time the name given to F. necrophorum) in “a clinical syndrome that was so characteristic that mistake is almost impossible; clinically it is easy to make the diagnosis even before bacteriological examinations have provided conclusive proof”.

The name Lemiérre’s disease (LD), or necrobacillosis, was given to this syndrome in recognition of Professor Lemiérre’s work and his description of this potentially fatal disease. It begins with pharyngitis symptoms, sore throat and then progresses to bacteraemia (indicated by rigors, and shows the importance of maintaining anaerobic blood cultures), septic thrombophlebitis of the jugular vein and metastatic abscesses in the lungs, brain, and in other organs including the eye and large joints.

Lemiérre reported a fatality rate of 90% in the pre-antibiotic area. Fatality rates in the modern day can still reach 4–10%, even with appropriate antibiotic therapy. F. necrophorum may also be cultured from abscesses in other organs, in particular the liver and lung where the origin of the source is unclear.

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Upcoming Events

Pathology Horizons 2024

MacDonald Bath Spa Hotel, Bath
18-20 April, 2024

Diagnostics North East Conference 2024

The Catalyst, Newcastle upon Tyne
19 April, 2024

ECCMID 2024 - European Congress of Clinical Microbiology and Infectious Diseases

Fira Gran Via, 08038 Barcelona, Spain
27-30 April 2024

British Society for Microbial Technology Annual Microbiology Conference

UK Health Security Agency, Colindale, London
2 May 2024

EQA Reports: Interpreting Key Information & Troubleshooting Tips

ONLINE - Zoom
Thursday 16th May 2024

Participants’ Meeting: UK NEQAS Immunology, Immunochemistry & Allergy

Sheffield Hallam University, City Campus, Howard Street, Sheffield
24th May 2024

Access the latest issue of Pathology In Practice on your mobile device together with an archive of back issues.

Download the FREE Pathology In Practice app from your device's App store

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