Lemierre's syndrome: A forgotten and re-emerging infection

Wen Sen Lee, Shio Shin Jean, Fu Lun Chen, Szu Min Hsieh, Po Ren Hsueh

Research output: Contribution to journalReview articlepeer-review

43 Citations (Scopus)


Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. Modern physicians have “forgotten” this disease. The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. The causative focus mostly originated from pharyngitis or tonsillitis, accounting for over 85% of the cases of Lemierre's syndrome. Pneumonia or pleural empyema is the most common metastatic infection in Lemierre's syndrome. Antimicrobial therapy should be prescribed for 3–6 weeks. The treatment regimens include metronidazole and β-lactam antibiotics. In recent years, the antibiotic stewardship program has resulted in decreased antibiotic prescription for upper respiratory tract infections. The incidence of Lemierre's syndrome has increased over the past decade. F. necrophorum is an underestimated cause of acute pharyngitis or tonsillitis. A high index of suspicion is required for the differential diagnosis of acute tonsillopharyngitis with persistent neck pain and septic syndrome.

Original languageEnglish
Pages (from-to)513-517
Number of pages5
JournalJournal of Microbiology, Immunology and Infection
Issue number4
Publication statusPublished - Aug 2020


  • Bacteremia
  • Lemierre's syndrome
  • Septic emboli
  • Thrombophlebitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • General Immunology and Microbiology
  • Microbiology (medical)
  • Infectious Diseases


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