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Salman Muddassir - One of the best experts on this subject based on the ideXlab platform.
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actinomyces turicensis an unusual cause of cervicofacial actinomycosis presenting as Ludwig Angina in an immunocompromised host case report and literature review
IDCases, 2019Co-Authors: Nirali Vassa, Ateeq Mubarik, Dharti Patel, Salman MuddassirAbstract:Actinomyces is an anaerobic, gram-positive bacillus that is known to cause chronic granulomatous infections. Common risk factors predisposing patients to this life-threatening infection are recent dental procedures, immunosuppression from malignancy, or history of smoking and alcohol use. Actinomyces, commonly found in the normal flora of the oral cavity, is one of the pathogens that can cause Ludwig's Angina. Ludwig's Angina is diffuse cellulitis and edema of the soft tissues of the neck and floor of the mouth. Cervicofacial actinomyces is an invasive infection that can form life-threatening abscesses through its rapid spread. Actinomyces turicensis is an isolate that has emerged recently to cause infections in humans. There are few reported cases of this species causing abdominal and genital infections; however, there is no report of it invading the cervicofacial space. A feared complication of Ludwig's Angina and cervicofacial actinomyces is airway compromise. Therefore, prompt initiation of intravenous antibiotics is required for the treatment and prevention of deadly complications. We present a patient with left-sided neck swelling after a recent oral surgical procedure and was found to grow Actinomyces turicensis on wound culture. The patient was treated with intravenous ampicillin-sulbactam, which not only decreased the swelling but improved the necrotic appearance of his abscess wound.
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Actinomyces turicensis: An unusual cause of cervicofacial actinomycosis presenting as Ludwig Angina in an immunocompromised host - Case report and literature review
'Elsevier BV', 2019Co-Authors: Nirali Vassa, Ateeq Mubarik, Dharti Patel, Salman MuddassirAbstract:Actinomyces is an anaerobic, gram-positive bacillus that is known to cause chronic granulomatous infections. Common risk factors predisposing patients to this life-threatening infection are recent dental procedures, immunosuppression from malignancy, or history of smoking and alcohol use. Actinomyces, commonly found in the normal flora of the oral cavity, is one of the pathogens that can cause Ludwig’s Angina. Ludwig's Angina is diffuse cellulitis and edema of the soft tissues of the neck and floor of the mouth. Cervicofacial actinomyces is an invasive infection that can form life-threatening abscesses through its rapid spread. Actinomyces turicensis is an isolate that has emerged recently to cause infections in humans. There are few reported cases of this species causing abdominal and genital infections; however, there is no report of it invading the cervicofacial space. A feared complication of Ludwig’s Angina and cervicofacial actinomyces is airway compromise. Therefore, prompt initiation of intravenous antibiotics is required for the treatment and prevention of deadly complications. We present a patient with left-sided neck swelling after a recent oral surgical procedure and was found to grow Actinomyces turicensis on wound culture. The patient was treated with intravenous ampicillin-sulbactam, which not only decreased the swelling but improved the necrotic appearance of his abscess wound. Keywords: Actinomyces, Actinomyces turicensis, Cervicofacial actinomycosis, Ludwig’s angin
Steven N Parks - One of the best experts on this subject based on the ideXlab platform.
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is surgical airway necessary for airway management in deep neck infections and Ludwig Angina
Journal of Critical Care, 2011Co-Authors: Mary M Wolfe, James W Davis, Steven N ParksAbstract:Abstract Background Deep neck infections are potentially life-threatening conditions because of airway compromise. Management requires early recognition, antibiotics, surgical drainage, and effective airway control. The Surgical Education and Self-Assessment Program 12 states that awake tracheostomy is the treatment of choice for these patients. Hypothesis With advanced airway control techniques such as retrograde intubation, GlideScope, and fiberoptic intubation, surgical airway is not required. Design A retrospective analysis of all deep neck abscesses treated from December1999 to July 2006 was performed. Methods All patients who underwent urgent or emergent surgery for Ludwig Angina and submental, submandibular, sublingual, and parapharyngeal abscesses (Current Procedural Terminology codes 41015, 41016, 41017, 42320, and 42725) were included in our review. Charts were studied for age, presence of true Ludwig Angina, presence of airway compromise, airway management, morbidity/mortality, and the requirement for surgical airway. Results Of 29 patients, 6 (20%) had symptoms consistent with true Ludwig Angina. Nineteen (65.5%) had evidence of airway compromise. Eight (42%) of these 19 patients required advanced airway control techniques. No patient required a surgical airway, and no mortality resulted from airway compromise. Advance airway control techniques were required more often in patients with airway compromise ( P Conclusion Treatment of Ludwig Angina and deep neck abscesses requires good clinical judgment. Patients with deep neck infections and symptoms of airway compromise may be safely managed with advanced airway control techniques.
William W. Shockley - One of the best experts on this subject based on the ideXlab platform.
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Ludwig Angina: A Review of Current Airway Management
Archives of otolaryngology--head & neck surgery, 1999Co-Authors: William W. ShockleyAbstract:Ludwig Angina is a dreaded infection involving the sublingual, submandibular, and submental spaces. Its pathogenesis is most often related to an odontogenic infection gaining access to these spaces and thereby creating a clinical scenario manifested by painful swelling in the floor of the mouth, tense edema and induration of the submental soft tissues, and progressive elevation and posterior displacement of the tongue. The pain and trismus, along with the swelling of the oral and cervical tissues and tongue displacement, create a severely compromised airway. Marple has addressed the issues surrounding the management of this tenuous airway in a timely and balanced fashion. As he points out, Ludwig Angina is seen with decreasing frequency; therefore, physician experience with this potentially life-threatening infection is much less than it was a generation ago. With advances in medical care, we now have better antibiotics, more readily available critical care facilities, and a broader range of airway control options. As pointed out in this review, Ludwig Angina, like all diseases, presents a spectrum of severity. Patients with early infections have few airway symptoms and can be effectively treated with intravenous antibiotics and careful observation. More advanced infections require drainage procedures, a controlled airway (ie, intubation or tracheotomy), and intensive care unit treatment. Unfortunately, there is no one set of rules that applies to all patients. Clinical judgment and experience cannot be substituted with clinical pathways. Each surgeon and each hospital have a level of capability that must be coupled to management decisions. Sometimes the most appropriate decision is to transfer the patient to a secondary or tertiary care facility where more expertise and more resources are available. The airway management options include the following: • Observation: This option is perfectly appropriate in selected circumstances (ie, cases of lesser severity). • Blind nasotracheal intubation: Uh, no. • Routine orotracheal intubation: This option is rarely applicable since most patients who are candidates for this approach can be observed. • Fiberoptic nasotracheal intubation: This is a good option in the appropriate setting if undertaken by those with skill and experience in this technique. • Tracheotomy with the patient under local anesthesia: This is a reasonable choice, preferably in the operating room with monitored anesthesia. Of course, each of these options must take into account whether incision and drainage procedures are indicated. Obviously, if a surgical procedure is necessary, then airway control becomes mandatory. In this author’s experience, fiberoptic intubation should be performed with the patient in the sitting or semiFowler position, not in the supine position. In the head-up position, secretions are better managed and both the tongue and larynx are in a more optimal position for proper visualization. If a prolonged course is anticipated, a tracheotomy could also be performed following intubation. In those patients with a stable airway, intravenous antibiotics and observation are appropriate starting points. Patients with a more tenuous airway require an intensive care unit setting as the minimum level of care. In hospitals with little backup for airway emergencies, a controlled airway should be obtained before the surgeon leaves the hospital. When in doubt, taking control of the airway is the most conservative method of treatment. Tracheotomy is still a tried and true method for obtaining and maintaining a safe airway. For those patients requiring a trip to the operating room, the options of fiberoptic intubation vs tracheotomy must be decided before anesthesia induction. Generally, we would perform a fiberoptic intubation, drain the affected spaces, keep the tube in place overnight, and monitor the patient in the intensive care unit. The decision on the timing of extubation rests with the clinician, based on the patient’s clinical course and the physical findings at that time. These patients may progress quickly and airway compromise can occur with little warning. As these critical decisions are made, keep in mind that the discomfort of an intubation or the deformity of a tracheotomy scar will be forgiven much more readily than an anoxic event that occurs during the chaos of an emergency airway crisis.
Christopher J. O'donnell - One of the best experts on this subject based on the ideXlab platform.
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Post-mortem CT findings in a case of necrotizing cellulitis of the floor of the mouth (Ludwig Angina).
Forensic Science Medicine and Pathology, 2013Co-Authors: Richard Bassed, Christopher J. O'donnellAbstract:Ludwig Angina is a rare but potentially lethal infection of the submandibular space that can cause significant upper airway obstruction. We report a case of undiagnosed Ludwig Angina that progressed rapidly to death. Ludwig Angina was suspected after post-mortem computed tomography (PMCT) found swollen mylohyoid muscle with stranding in subcutaneous fat, thickening of deep fascia, and local lymphadenopathy. Subsequently, an autopsy revealed woody induration of the submental region and liquefactive necrosis of the mylohyoid muscle, confirming the diagnosis. It is likely that the dental abscess identified on PMCT was the source of infection. Multiple invasive medical procedures were performed on the subject by the ambulance crew prior to his death. PMCT assisted further in determining procedural success.
Nirali Vassa - One of the best experts on this subject based on the ideXlab platform.
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actinomyces turicensis an unusual cause of cervicofacial actinomycosis presenting as Ludwig Angina in an immunocompromised host case report and literature review
IDCases, 2019Co-Authors: Nirali Vassa, Ateeq Mubarik, Dharti Patel, Salman MuddassirAbstract:Actinomyces is an anaerobic, gram-positive bacillus that is known to cause chronic granulomatous infections. Common risk factors predisposing patients to this life-threatening infection are recent dental procedures, immunosuppression from malignancy, or history of smoking and alcohol use. Actinomyces, commonly found in the normal flora of the oral cavity, is one of the pathogens that can cause Ludwig's Angina. Ludwig's Angina is diffuse cellulitis and edema of the soft tissues of the neck and floor of the mouth. Cervicofacial actinomyces is an invasive infection that can form life-threatening abscesses through its rapid spread. Actinomyces turicensis is an isolate that has emerged recently to cause infections in humans. There are few reported cases of this species causing abdominal and genital infections; however, there is no report of it invading the cervicofacial space. A feared complication of Ludwig's Angina and cervicofacial actinomyces is airway compromise. Therefore, prompt initiation of intravenous antibiotics is required for the treatment and prevention of deadly complications. We present a patient with left-sided neck swelling after a recent oral surgical procedure and was found to grow Actinomyces turicensis on wound culture. The patient was treated with intravenous ampicillin-sulbactam, which not only decreased the swelling but improved the necrotic appearance of his abscess wound.
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Actinomyces turicensis: An unusual cause of cervicofacial actinomycosis presenting as Ludwig Angina in an immunocompromised host - Case report and literature review
'Elsevier BV', 2019Co-Authors: Nirali Vassa, Ateeq Mubarik, Dharti Patel, Salman MuddassirAbstract:Actinomyces is an anaerobic, gram-positive bacillus that is known to cause chronic granulomatous infections. Common risk factors predisposing patients to this life-threatening infection are recent dental procedures, immunosuppression from malignancy, or history of smoking and alcohol use. Actinomyces, commonly found in the normal flora of the oral cavity, is one of the pathogens that can cause Ludwig’s Angina. Ludwig's Angina is diffuse cellulitis and edema of the soft tissues of the neck and floor of the mouth. Cervicofacial actinomyces is an invasive infection that can form life-threatening abscesses through its rapid spread. Actinomyces turicensis is an isolate that has emerged recently to cause infections in humans. There are few reported cases of this species causing abdominal and genital infections; however, there is no report of it invading the cervicofacial space. A feared complication of Ludwig’s Angina and cervicofacial actinomyces is airway compromise. Therefore, prompt initiation of intravenous antibiotics is required for the treatment and prevention of deadly complications. We present a patient with left-sided neck swelling after a recent oral surgical procedure and was found to grow Actinomyces turicensis on wound culture. The patient was treated with intravenous ampicillin-sulbactam, which not only decreased the swelling but improved the necrotic appearance of his abscess wound. Keywords: Actinomyces, Actinomyces turicensis, Cervicofacial actinomycosis, Ludwig’s angin
