Management of Upper Airway Obstruction caused by Fungal Ludwing’s Angina in Lokoja, Nigeria

Abstract

-Ludwig’s angina is a life threatening infection involving the floor of the mouth and submandibular region which has the potential to cause upper airway obstruction if not adequately managed. The cellullitis progressed very fast to involve the major deep neck spaces and is associated with fever, malaise, tender swelling of the floor of the mouth and occasionally can cause upper airway obstruction. The majority of cases respond well to conventional antibiotic usage, hence, most cases do well on medical management. We report this case of fungal Ludwing angina in a 32years old man, who was referred to our hospital due to none response to treatment with antimicrobial agents, with signs and symptoms of progressive upper airway obstruction. Patient had tooth extraction two weeks prior to his presentation and was also on antibiotics for two weeks. His past medical history did not show that he was on steroid therapy at any time or had any co-morbid condition that could have depressed his immunity and his HIV status was negative. On physical examination, we found a young man with bull neck and in obvious respiratory distress. Had multiple submental punctured wounds with plastic drains oozing blood projecting from the wounds. He was febrile to touch, anicteric and not pale. Throat examination revealed severe trismus, swollen base of the tongue and poor visualization of the oropharynx. A soft tissue neck plain radiograph showed a narrowed upper airway air column due to soft tissue swelling in the pharynx. He was then resuscitated and given emergency tracheostomy to secure the airway and specimen taken for microscopy, culture, sensitivity and fungal studies which showed later that the angina was caused by fungal infection. Patient did well on six weeks course of amphotericinB and was decanulated with no sequalae. Keywords--Fungal, Ludwig angina, Management, Obstruction, Upper Airway _________________________________________________________________________________________________