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

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.