Authors from the University of Michigan Department of Otolaryngology have recently published a fascinating article titled Implication of Fusobacterium necrophorum in recurrence of peritonsillar abscess. This article adds to the emerging story of the dangers of incompletely treated Fusobacterium necrophorum pharyngitis.
This article has a wonderful discussion section (of course they cite our work favorably). The gist of the article is included in the abstract :
One hundred fifty-six of the 990 patients in our study developed recurrence of their abscess (16%). The age ranges most susceptible to recurrence included adolescent (22.9%) and young adult groups (17.1%) … The presence of FN was significantly more prevalent in the recurrent group (P?<?0.0001).
This article adds to our understanding of who develops peritonsillar abscess (PTA). 26% were in the 13-18 age group and 44% in the 19-30 age group. The 13-18 age group disproportionately developed recurrent PTA.
The article supports the Danish data that shows Fusobacterium necrophorum as the most common cultured bacteria in PTA (31%). The striking finding of 65% of recurrent PTA had FN in their original culture.
This study adds to our clinical understanding of the devastating potential of this gram negative anaerobic bacteria. We have previously found that FN pharyngitis has the same clinical presentation as strep pharyngitis. Our microbiome study showed that patients with more severe clinical pharyngitis (defined as Centor scores of 3 or 4) differed between group A strep and Fusobacterium necrophorum. The tonsils with FN infection had a less bacterial diversity – this means that FN overwhelms the microbiome in many such patients.
These findings suggest that FN more likely causes suppurative complications. We know from the Cochrane analysis that antibiotics decrease the risk of PTA independent of group A strep testing. This article adds to our growing concern about how to diagnosis and treat Fusobacterium necrophorum pharyngitis.
This article does not address the Lemierre Syndrome. We do know that this syndrome most often follows FN pharyngitis. We cannot prove that appropriate antibiotics would prevent the syndrome, but neither can you provide any evidence that antibiotics would not decrease the syndrome.
As the article documents, the epidemiology of FN pharyngitis, PTA and Lemierre Syndrome overlap almost perfectly. These infections occur primarily in adolescents and young adults. While different articles have differing specific age ranges, one can easily generalize to around 15-30 year old patients. This large age group deserves a different approach to sore throats. One can only hope that the IDSA and CDC will study the growing evidence and develop new guidelines for diagnosing and treating sore throats in these patients.
