Fusobacterium and Lemierre's Syndrome

We live in wondrous times.  An astute physician and antibiotics gave my son what could have eluded him in earlier years – a tomorrow.

On a recent morning before heading to campus, Nick mentioned that his throat hurt.  “I hope it’s not strep,” was my reply on the way out.  After a couple days of using ibuprofen and gargling with warm salt water, relentless pain forced him to make a trip to the doctor.  He didn’t test positive for strep but his symptoms appeared bacterial, so antibiotics were prescribed.  I anticipated Nick would feel much better in a day or two.  He slept all weekend, gargled frequently, and took his medicine; despite his best efforts he felt worse come Monday – Nick was chilling and refusing to eat or drink because his throat was so sore.

He returned to the doctor that morning, and found he had lost six pounds.  Another strep test came back negative.  Since enough time had passed for a positive result, strep was ruled out, as was mononucleosis.  It looked as though Nick was suffering from something viral; prednisone was prescribed.

After two days my son was still in pain, had a tender, puffy neck and his gums were so inflamed they were swelling over his molars.  He went back to the doctor, his third visit in five days.  Dr. Scott spent considerable time with Nick, and after a bit of research concluded that Nick needed antibiotics for Fusobacterium.

When Nick got home from the pharmacy, I looked at the scrap of paper with the doctor’s diagnosis written on it and decided to Google it.  The outcome of that search left me shaken and thankful.  With Nick’s permission, I am sharing his experience with you in the hopes that someone will profit from the disclosure.

Diagnosis of Lemierre’s Syndrome (LS) is chiefly based on the presence of Fusobacterium in blood cultures. Since Fusobacterium can take several weeks to grow, early detection and treatment depends on keen medical suspicion.  Treatment cannot wait several weeks, it must commence before a conclusive diagnosis can be made.  Fusobacterium is present in our bodies but is thought to proliferate as a result of mouth trauma (which Nick did not have).

LS usually affects healthy people between the ages of 16 and 25 (Nick is 19), and mostly males. Typically, a person visits his family doctor with a fever and sore throat (the patient may also have lethargy and neck or ear pain), and is often diagnosed with either strep or flu.  Several weeks after the onset of initial symptoms, the patient develops fever, stiffness, and septicemia (blood infection).  The lungs, spleen, joints, bones, and liver can be adversely affected.  Untreated, LS has a poor prognosis (90-100% mortality in the pre-antibiotic era).  LS is highly curable if appropriate antibiotic therapy is administered promptly.  Notwithstanding timely response, LS carries a mortality rate of about 15% despite antibiotic therapy.

In conclusion, early recognition of LS is critical.  Family physicians must consider the possibility of LS for any young adult who presents with persistent fever after a sore throat, so that appropriate antibiotic therapy can be started.

An interesting case study memorialized by Winson Y Cheung, MD and Jonathon Bellas, MD, can be found at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234623/   

This story was originally published April 15, 2011 at 11:05 PM with the headline "Fusobacterium and Lemierre's Syndrome."