Ludwig’s angina: Analysing clinical profile and microbiology with antibiotic sensitivities at a tertiary care hospital

Abstract

Introduction: Ludwig’s angina is a form of severe diffuse cellulitis secondary to an odontogenic infection that presents as acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving. Aim: To assess the age sex distribution, comorbidity factors, association with odontogenic infection, management protocol, organisms isolated and their antibiotic resistance. Patients and Methods: Retrospective record based study, over 2 years period at JSS hospital, Mysuru. Results: This study showed ludwig’s angina to have male preponderance with M:F =1.6:1, most commonly occurring above 40 years of age (61.8%). Commonest etiology was Odontogenic infections 26 cases (76.5%). Diabetes Mellitus (DM) was the commonest comorbidity (32.4%). The cornerstone of treatment was incision and drainage with intravenous empirical antibiotics in 94.1% cases, followed by tooth extraction in all patients with dental caries. A total of 25 bacterial strains were isolated from 32 patients. The bacteria were found to be 88% gram-positive and 12% gram-negative. Alpha hemolytic Streptococcus was the most common organism. Gram positive bacteria showed resistance to penicillin, cotrimoxazole and erythromycin being sensitive to ceftriaxone. Conclusion: A male: Female ratio of 1.6:1 and odontogenic infection accounting for 76.5% cases mirrors previous statistics. DM patients had increased risks of complications with longer hospital stays. Incision and drainage must be done immediately to reduce airway compromise and mortality. Empirical antibiotics therapy with ceftriaxone and metronidazole would be ideal till we wait for pus culture and sensitivity reports.