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October 2008
Vol. 18 No. 10
Patient Care and Science
EIN: Rates of a Rare Disease Rising?
Steve Baragona

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN's sponsor), or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.

Cases of Lemierre’s disease may be increasing in some areas, according to anecdotal reports from members of the Emerging Infections Network (EIN), and some cases have been caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA).

A rare but life-threatening illness, Lemierre’s is characterized by septic internal jugular vein thrombophlebitis. Typical cases of Lemierre’s occur following a sore throat, when invasive Fusobacterium species take up residence in an abscess in the mouth, pharynx, neck, or head created by the sore-throat pathogen and then travel to the jugular vein. Septic emboli may move to the lungs, causing shortness of breath, chest pain, and pneumonia. A handful of cases are reported each year nationwide, usually among young, previously healthy patients.

Although several members—from New York to Minnesota to California—reported no change in the number of Lemierre’s cases, others from around the country said they have experienced increases. Several reported having seen their first cases in years, sometimes decades. For example, a member in Ohio described having seen two adolescent cases in the last four years and none in the previous 20 years.

One member referenced an abstract presented at the Pediatric Academic Societies’ Annual Meeting showing that of the 13 cases identified in a Utah health care system from 2002 to 2007, eight were in the last two years.  They concluded that Lemierre’s and Lemierre’s-like syndrome  is identified with increasing frequency and the “range of pathogens is expanding, and includes multidrug-resistant Fusobacterium sp. and MRSA.”

In addition, several others reported cases of Lemierre’s-like disease caused by MRSA. A member in Georgia said, “We have seen a presumptive septic jugular thrombophlebitis with septic pulmonary emboli related to MRSA. The increased incidence of the community-acquired MRSA strain across the country may contribute to the increased cases, but obviously these are not related to Fusobacterium.”

Clinicians are advised to have a high index of suspicion for Lemierre’s. Another abstract showing increasing rates of Lemierre’s disease is scheduled to be presented at the 48th ICAAC/IDSA 46th Annual Meeting this month in Washington, DC.

E-mail the Emerging Infections Network. 

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) and supported by funding from the Centers for Disease Control and Prevention, EIN tracks emerging infectious diseases and keeps the public-health community up to date with issues that are currently affecting or may soon affect members’ clinical practices.The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. The EIN listserve allows members to discuss new disease trends and difficult cases. Click here for more information or to join EIN.

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