Lemierre's syndrome: are we underdiagnosing this life-threatening infection?

Over a period of 12 months 3 patients presented with severe tonsillitis and subsequently grew Fusobacterium necrophorum (literally-spindle-shaped rod which brings death!) from blood cultures. Two patients responded well to antibiotics and were discharged within 4 days of admission. The third case had a longer history of symptoms and following investigations of a minor but unusual neck swelling was found to have thrombosis of the external and internal jugular vein. This is the first stage in the potentially fatal dissemination of this virulent organism which manifests clinically as Lemierre's syndrome. We describe the clinical histories and discuss whether cases are unrecognised because of the prompt clinical response to penicillin and metronidazole. We stress the importance of taking blood cultures and careful examination of the neck in all patients presenting with a severe tonsillitis.