Could you give me information on a condition called Lemierre's syndrome? My husband was diagnosed with it. I was told it was an infection that started in his mouth and traveled aggressively throughout his body. He was on a ventilator for two weeks. One lung was infected, and the infection spread through his bloodstream. This disease was supposedly common before penicillin was invented. I cannot find any information about this syndrome.

M.

Lemierre's disease is rare in the antibiotic era. It starts after a throat infection, usually strep throat (caused by certain bacteria in the Streptococcus family). In some cases of strep throat, there is damage to the areas around the tonsils, and an abscess, a collection of pus and bacteria, develops nearby. The bacteria in the abscess are anaerobes (microbes that don't require oxygen) and other bacteria that normally inhabit the mouth, rather than the strep bacterium that started it all.

If the infection progresses, it can cause an infected clot to form in the jugular vein in the neck, which becomes filled with pus and clot. The bacteria can then easily spread throughout the body, causing sepsis (severe widespread infection) and even death. Also, pieces of the infected clot can break off and travel to the lung, causing emboli (obstructions) of the pulmonary artery and its branches, the blood vessels that carry blood from the heart to the lungs. In addition to causing some of the problems seen when noninfectious emboli block these vessels -- shortness of breath, chest pain and sometimes sudden death -- these fragments of infected clot can set up multiple lung infections. The X ray will show several rounded spots in the lung, which enlarge if no treatment is given.

Once the infection is at this stage, it can cause complications anywhere in the body. In my first week of a fellowship, I saw a similar infection in a young patient who developed a pleural empyema, a serious infection of the lining of the lung, requiring a chest tube to drain the pus and bacteria. Since the bacteria are within a vein that drains directly into the heart, the infection can literally go anywhere. In this case, it spread to the bones of the pelvis.

The bacterium cultured from the blood of such patients is usually Fusobacterium necrophorum, an anaerobic organism that commonly inhabits the mouth. It is usually susceptible to penicillin, but to cure this serious infection, treatment must be started as early as possible. Any abscesses in the throat or in other areas should be drained. Care must be taken not to miss any areas of infection that may not be apparent initially. With aggressive treatment, successful recovery is likely, depending on the areas of the body involved.