Fusobacterium necrophorum is believed to be part of the normal flora in the oropharynx although accurate data on prevalence is lacking.
Reasons for an increase in infections:
(1) fewer tonsillectomies
(2) reduced antibiotic therapy for pharyngitis
When to suspect:
(1) acute pharyngitis and/or tonsillitis with fever AND negative tests for Streptococcus pyogenes
(2) presence of tonsils
(3) elevated C-reactive protein (CRP) or other measure of systemic inflammation
(4) adolescent or young adult
(5) infection with infectious mononucleosis
(6) failure to respond to macrolide antibiotic therapy
(7) worsening symptoms
(8) neck swelling
Because Fusobacteria may be resistant to macrolides, therapy with erythromycin or other macrolites is not a good choice for a patient with pharyngitis who may have a Fusobacterium necrophorum infection.
Complications:
(1) peritonsillar abscess
(2) Lemierre's syndrome (septic thrombophlebitis of the internal jugular vein)
(3) sepsis
(4) endocarditis or pericarditis
