Information on Lemierre's Syndrome

Lemierre's Syndrome also known as necrobacillosis or post-anginal sepsis. It is caused by the bacterium Fusobacterium necrophorum, and occasionally by other members of the genus fusobacterium. Fusobacterium necrophorum is the most common pathogen isolated from the patients. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. Deep in the abscess, anaerobic bacteria like Fusobacterium necrophorum can flourish. Fusobacterium necrophorum organism is found in the intestines of many species as part of the normal flora. It survives well in wet soil that has high manure content.

Other bacteria are frequently linked with the disease, swollen cervical lymph nodes and septicemia (infection of the blood), arcanobacterium pyogenes being the most common. Lemierre's syndrome generally occurs in healthy adolescents and young adults. The infection usually begins with a sore throat, followed by fever, septicemia, thrombosis, and metastatic abscesses. Other symptoms of Lemierre's syndrome neck tenderness or swelling develops.

Contrast computed tomography of the neck provides the definitive diagnosis, showing distended veins with enhancing walls, intraluminal filling defects, and swelling of contiguous soft tissues. A treatment involves intravenous antibiotic therapy and drainage of septic foci.  Fusobacterium necrophorum is generally highly susceptible to Beta-lactam antibiotics, metronidazole, clindamycin and third generation cephalosporins while the other fusobacteria have varying degrees of resistance to beta-lactams and clindamycin. The role of anticoagulation is controversial. Ligation or excision of the internal jugular vein may be needed in some cases.

Surgical drainage of purulent collections may, however, be required. Amputation of a toe may be required in severe cases of foot rot where there is bone and joint involvement. Prolonged therapy is recommended because of the endovascular nature of the infection. Ligation or excision of the internal jugular vein is frequently required. As with most diseases, prevention is much more rewarding than treatment. Good general hygiene should be practiced with attention paid to control of excessive fecal contamination of paddocks, holding and handling facilities, and feeding equipment.