Infectious Disease Compendium

Lemierre's Disease

Diagnosis

Septic thrombophlebitis of the internal jugular vein. Patient presents with a sore throat, fevers, and septic emboli on CXR. CT the neck to find the clot and lung to see the emboli along with positive blood cultures makes the diagnosis.

Epidemiologic Risks

Usually a result of poor dentition. Often occurs after a sore throat, hence the name post-anginal sepsis.In the old days angina meant sore throat; the word "angina" comes from the Latin verb "angere" meaning "to choke or throttle."  It is moving South and, with a form of medical techtonics will mean foot pain in 10,000 years. There are a few cases where it has been a complication of mononucleosis.

Microbiology

Usually Fusobacterium necrophorum but occasionally other anaerobes. I have seen two cases due to Staphylococcus aureus, and cases with MRSA are reported (PubMed).

Empiric Therapy

Penicillin, metronidazole, clindamycin, carbapenems.

Pearls

Rants

It seems to be a disease on the rise. I postulate that the decreased use of antibiotics in the outpatient setting is resulting in more odd head and neck infections of all kinds. As I am sure you know, no good deed goes unpunished.