Infectious Disease Compendium

Ludwig's Angina

Diagnosis

Infections in the sublingual, submaxillary, or submandibular spaces. It tends to spread rapidly.

It pushes the tongue up and back, leading to obstruction. Have a low threshold for intubation.

Epidemiologic Risks

Poor dentition. Sometimes after trauma

Microbiology

Viridans and other streptococci, Peptostreptococcus spp., Bacteroides spp., and oral anaerobes.

Empiric Therapy

Penicillin G OR ampicillin PLUS metronidazole OR penicillin/beta-lactamase inhibitors OR clindamycin OR cefoxitin OR cefotetan.

I&D as needed.

Pearls

Like all collections of pus, drain it. These are quasi-emergencies and the big risk is airway obstruction. Put a trach kit in the room as a magical talisman; once in the room they are never needed.

Angina is derived from the Latin word “angere” which means “choke”; and the Greek word “ankhone”, which means “strangle”.

Rants

Given the increased resistance of streptococci and anaerobes to clindamycin (around 30%), I no longer use it.

Last Update: 11/03/18.