Moreland L W, Corey J, McKenzie R
Department of Medicine, West Virginia University Medical Center, Morgantown.
Arch Intern Med. 1988 Feb;148(2):461-6. doi: 10.1001/archinte.148.2.461.
In the preantibiotic era, Ludwig's angina frequently caused asphyxiation and death. Recognized less often today, this rapidly progressive submaxillary cellulitis may still be fatal. A case associated with Haemophilus influenzae bacteremia in an adult is presented. Twelve additional cases of cellulitis of the neck in adults with H influenzae bacteremia are summarized. One hundred forty-one cases of Ludwig's angina reported since 1945 are reviewed and compared with 315 earlier cases. In the cases reported in the antibiotic era, the mean age of the patients was 29 years. Most patients were previously healthy but had evidence of dental disease. Submandibular swelling, elevation of the tongue, fever, dysphagia, and trismus were each present in more than one half of patients. Streptococci and anaerobes were most frequently isolated from soft-tissue cultures. Untreated, this illness is fatal in one half of patients. Early recognition is therefore essential. Appropriate therapy includes maintenance of the airway, antibiotics, and surgical drainage when indicated.
在抗生素出现之前的时代，路德维希咽峡炎常常导致窒息和死亡。如今这种情况较少见，但这种迅速进展的颌下蜂窝织炎仍可能致命。本文介绍了一例与成人流感嗜血杆菌菌血症相关的病例。还总结了另外12例成人流感嗜血杆菌菌血症合并颈部蜂窝织炎的病例。回顾了自1945年以来报告的141例路德维希咽峡炎病例，并与315例早期病例进行了比较。在抗生素时代报告的病例中，患者的平均年龄为29岁。大多数患者此前身体健康，但有牙科疾病的证据。超过一半的患者出现颌下肿胀、舌抬高、发热、吞咽困难和牙关紧闭。链球菌和厌氧菌最常从软组织培养物中分离出来。若不治疗，半数患者会死亡。因此，早期识别至关重要。适当的治疗包括保持气道通畅、使用抗生素以及在必要时进行手术引流。
