Routine Diagnostic Test for Lemierre Syndrome Is Required

Physicians when diagnosing sore throat, or pharyngitis, in adolescents and young adults must consider the newly identified, potentially dangerous Fusobacterium necrophorum as the source of infection. The bacterium can cause Lemierre syndrome, a potentially dangerous condition.

Symptoms of Lemierre syndrome include unilateral neck swelling, rigors, night sweats, or high fevers. Currently there is no routine test for F. necrophorum pharyngitis, and a CT scan is required to detect Lemierre syndrome. In the event that the disease is diagnosed, aggressive treatment with antibiotics such as a combination of penicillin and metronidazole or with clindamycin alone is appropriate.

Lemierre syndrome mostly affects adolescents and young adults and rarely is seen in preadolescents. It begins with a sore throat, followed by an infected jugular vein after four to five days. Abscesses in other parts of the body may occur. Approximately 5 percent of people who get Lemierre syndrome die.

Physicians are trained to suspect group A streptococcal bacteria as the primary cause of pharyngitis. But according to findings by investigators at the University of Alabama at Birmingham (UAB; USA), and published on December 1, 2009 in the Annals of Internal Medicine, sore throat in young adults and adolescents that worsens or is strep-negative, could be due to F. necrophorum. Although group A strep. is associated with rheumatic fever, the incidence and rate of Lemierre syndrome following exposure to F. necrophorum is much higher and associated with greater morbidity and mortality.

Robert Centor, M.D., professor of internal medicine, associate dean of medicine at UAB and the paper's lead author, said, "F. necrophorum, which only has been recognized as a potential cause of pharyngitis in adolescents and young adults in the past five years, may cause up to 10 percent of sore throat in those 15-24 years of age. More important, F. necrophorum is associated with a rare but life-threatening complication called Lemierre syndrome."

Prof. Centor added that he hopes this analysis will lead to better diagnostic tests for the presence of F. necrophorum.

Related Links:
University of Alabama at Birmingham