IS F. NECROPHORUM A SINE QUA NON FOR LEMIERRES SYNDROME?
Brocard and Guibé (54) described the complex microbial interactions that occur in the course of F. necrophorum septicemia. Thus, often the original tonsillar portal has a mixed infection. They stated that “it is easy to conceive since the septicemia originates from a polymicrobial source, that the selection is not always absolute and that other bacteria can sometimes temporally be associated with F. necrophorum.” Teissier et al. (378) commented that due to the episodic nature of the bacteremia with F. necrophorum, culture of material from metastatic abscesses was often more productive in revealing the causative organism. Indeed, they noted that blood cultures could be actively misleading by yielding a “saprophytic organism captured by leukocytes and accidentally introduced into the circulation.” This is certainly supported by data from the current series. Thus, for cases fulfilling the criteria for Lemierre’s syndrome and from which a Fusobacterium sp. was isolated, 22/168 blood cultur
