(Including Lemierre Disease)

Fusobacterium species may colonize humans and animals. Fusobacterium necrophorum and Fusobacterium nucleatum can be isolated from oropharyngeal specimens in healthy people, are frequent components of human dental plaque, and may lead to periodontal disease. Invasive disease attributable to Fusobacterium species has been reported following otitis media, tonsillitis, gingivitis, and oropharyngeal trauma. Ten percent of published cases of invasive Fusobacterium infections are associated with Epstein-Barr virus infection.

Invasive infection with Fusobacterium species can lead to life-threatening disease. Otogenic infection is the most frequent primary source in children younger than 5 years of age and can be complicated by meningitis and thrombosis of the dural venous sinuses. Invasive infection following tonsillitis was described in the early 20th century and classically was referred to as postanginal sepsis or Lemierre disease. Lemierre disease occurs most commonly in adolescents and young adults and includes internal jugular vein thrombophlebitis or thrombosis (JVT), evidence of septic embolic lesions in lungs or other sterile sites, and usually isolation of Fusobacterium species from blood or other normally sterile sites. Fever and sore throat are followed by severe neck pain (anginal pain) that can be accompanied by unilateral neck swelling, trismus, and dysphagia. People with classic Lemierre disease have a sepsis syndrome with multiple organ dysfunction, disseminated intravascular coagulation, empyema, pyogenic arthritis, or osteomyelitis. Persistent headache or other neurologic signs may indicate the presence of cerebral venous sinus thrombosis (eg, cavernous sinus thrombosis) or meningitis or brain abscess.

JVT can be completely vaso-occlusive. Some children with JVT associated with Lemierre disease have evidence of thrombophilia at diagnosis, which can include presence of antiphospholipid antibodies, abnormal levels of factor VIII, and factor V Leiden. These findings often resolve over several months and may indicate response to the inflammatory, prothrombotic process associated with infection rather than an underlying hypercoagulable state.