1. Introduction
Fusobacterium nucleatum was first reported as an anaerobic oral commensal and a periodontal pathogen associated with multiple human diseases, described for the first time in early 1900’s17. The pathogen has five proposed subspecies (ss):animalis, ss fusiforme, ss nucleatum, ss polymorphum, and ss vincentii 15 and often present in small numbers as part of the normal human throat flora15,10.
LS is a rare disease that presents in healthy young adults without any underlying medical conditions8. LS is highly curable if appropriate antibiotic therapy is administered on a timely basis. In the pre-antibiotic era, LS was a common complication of pharyngitis with poor prognosis, resulting in 90%-100% mortality.28Although the prompt use of β-lactam antibiotics have reduced the incidence to 0.8 to 1.5 cases per million persons per year, LS still remains a potentially life-threatening disease that results in a 15% mortality rate.8, 16, 29 A study in Denmark revealed the annual incidence of 14.4 cases per million people among young adults aged 14-24 years old11. Lastly, surgical drainage of abscesses is indicated for patients who fail to respond successfully to antibiotics alone27. Although using anticoagulation in LS is common, it remains controversial.
Moreover, it is important for physicians to include LS in their differentials for patients presenting with toxic appearance, fever, sore throat, respiratory distress and cough to ensure timely diagnosis of this potentially life-threatening disease and start appropriate microbiological therapy2.