Still worrying about Lemierre syndrome #continuedfrustration


Category : Medical Rants

Periodically something happens that reminds me that I must continue working to increase our knowledge of Lemierre syndrome. Today I received a comment on a post from 2008 – Championing an orphan disease – Lemierre syndrome. The latest comment makes 15 comments over the years. If you doubt the personal impact this disease has on adolescents and their families, please read the comments.

Here is the problem. Lemierre syndrome is infrequent but very dangerous. It can kill and can disable. It occurs more frequently in the US than does rheumatic fever. The most common organism causing Lemierre syndrome is Fusobacterium necrophorum – an anaerobic gram negative bacteria. Routine throat cultures will not grow this organism.

In 2009 I published an article in the Annals of Internal Medicine – Expanding the pharyngitis paradigm – the rest of the story – in which I argued that we should worry more about this organism in adolescent (approximately ages 15-30) pharyngitis than we should worry about group A strep. Yet the “experts” continue to minimize the importance of this infection.

What should we think about an infection whose initial presentation is seemingly benign? Physicians see many sore throats that have no complications. But we have not taught the “red flags” that this sore throat is different.

This is actually the major challenge for diagnostic accuracy. When should we worry about seemingly routine presentations? When I teach about sore throats I include this, but I doubt that many others mention the red flags.

So I will continue to study this problem and hopefully convince the experts that trying to prevent this complication is worth some empiric antibiotics in adolescents. I will continue to try to educate as many physicians as possible. To do less is to ignore a rare totally treatable disease that still has significant morbidity and mortality.

Comments (4)

This may not have occurred to yet, Dr. C, or maybe it has.
One reason your message has such a hard time finding traction i stye way doctor are taught these days. Rules, heuristics, evidence-based medicine, they are not taught about the complexity of diagnosis and outliers, that while infrequent are important to know and identify.
Th concept of situational medicine- this is true, except in this situation – is not a priority for today’s student or teachers.
Lemierre’s, which I have seen several times and once diagnosed to save a patient’s life, falls into that category.
I hope I never missed it.


You are spot on.

Medicine today is obsessed with standardizing treatment to meet the needs of those in the middle of the normal distribution (Bell curve). Lemierre’s is dismissed as an outlier.

Thank you for bringing awareness of Lemierre’s to so many of us. I’ve shared your blog posts with other docs in our small town, and in consequence, one of our ER docs correctly diagnosed it in a 19 year old a couple years ago, enabling effective treatment.

That story makes me very happy!

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