Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre’s syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and m stoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, butthere is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicatedotitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.

Lemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

Necrobacillosis is a rare infection which may be fatal if inadequately treated. We present a case demonstrating the classical clinical picture upon which correct diagnosis depends. The need for a high index of suspicion is highlighted and appropriate management is discussed.

A case of meningitis secondary to acute suppurative otitis media in a previously healthy child is reported. The only organism isolated from blood after aerobic and prolonged anaerobic culture was identified as Fusobacterium necrophorum. Complete recovery followed treatment with surgery and prolonged antibiotic therapy. The role of anaerobes in the development of meningitis, the isolation and identification of Fusobacterium necrophorum, the clinical presentations of F. necrophorum infection and the choice of antibiotics in the treatment of these infections are discussed.