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PEDIATRICS Vol. 112 No. 5 November 2003, pp. e380-e380

ELECTRONIC ARTICLE

Increased Diagnosis of Lemierre Syndrome and Other Fusobacterium necrophorum Infections at a Children’s Hospital

Susan Ramirez, MD^*,, Tannaz G. Hild, MA, Colin N. Rudolph, MD, PhD, John R. Sty, MD, Susan C. Kehl, PhD^||, Peter Havens, MD, Kelly Henrickson, MD, Michael J. Chusid, MD

^* Departments of Internal Medicine
Pediatrics
Radiology
^|| Pathology, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee, Wisconsin

Objective. To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children’s hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites.

Methods. Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children’s Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002.

Results. During the 7-year period of the study, there was an increase in the isolation of F necrophorum from patients who were seen at Children’s Hospital of Wisconsin, as well as the number of cases of LS. There was 1 isolation of F necrophorum from clinical specimens per year from 1996 to 1999, which increased to 10 isolates of the organism from January 2000 to January 2002. During the most recent period, January 2001–January 2002, 5 cases of LS were diagnosed, a distinctive entity not recognized previously at the institution.

Conclusions. The cause for the recent increase in the number of serious infections caused by F necrophorum infection diagnosed at our institution is unclear but does not seem to be related to changes in microbiologic techniques or patient demography. We speculate that it could be attributable, in part, to alterations in antibiotic usage patterns in our region. Clinicians need to be aware of the increasing clinical importance of F necrophorum infections and the life-threatening nature of LS.

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Key Words: Fusobacterium necrophorum • Lemierre syndrome • peritonsillar abscess • thrombophlebitis • pulmonary emboli

Abbreviations: ABBREVIATIONS. LS, Lemierre syndrome • CHW, Children’s Hospital of Wisconsin • CT, computed tomography • WBC, white blood cell • CMV, cytomegalovirus • IgM, immunoglobulin M • EBV, Epstein-Barr virus • WARN, Wisconsin Antibiotic Resistance Network

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Received for publication May 1, 2003; Accepted Jul 10, 2003.

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