A rare cause of Ludwig's angina by Morganella morganii

Ludwig's angina is a rapidly spreading and potentially lethal infection involving the floor of the mouth and neck. We present a rare case of Ludwig's angina caused by an unusual microorganism, Morganella morganii, and the group D alpha-hemolytic streptococcus. To our knowledge, this is the first case of Ludwig's angina and deep neck infection caused by Morganella morganii. Adequate airway maintenance, appropriate use of antibiotics and surgical drainage resulted in survival of the patient without complications.     

Ludwig's angina and mediastinitis due to Streptococcus milleri: usefulness of computed tomography

Despite intensive use of antibiotics, Ludwig's angina remains a potentially lethal infection because of the risk of upper airway obstruction and spread into the mediastinum. We present two patients who survived mediastinitis complicating Ludwig's angina due to Streptococcus milleri. Computed tomography performed early in the course of the disease detected pus collections and directed appropriate drainage procedures.     

Recurrent aortic valve endocarditis caused by Gemella morbillorum--report of a case and review of the literature.

Gemella morbillorum (G. morbillorum) is part of the commensal flora of the oropharynx and intestinal tract, and on rare occasions causes infective endocarditis. A 55-year-old man with massive aortic regurgitation caused by recurrent infective endocarditis with G. morbillorum had a history of prior endocarditis caused by alpha-hemolytic streptococcus and multiple antibiotic allergies 5 years prior, and was successfully treated by aortic valve replacement. Almost all the reported cases of endocarditis caused by G. morbillorum have been bacteriologically cured with antibiotics and this is the first reported case of recurrent endocarditis caused by G. morbillorum in which the initial infection was bacteriologically cured by antibiotics and the secondary infection treated with valve replacement. This organism can be one of the causes of infective endocarditis and prompt surgical repair is mandatory if the infection is refractory or there is progression of congestive heart failure under antibiotic cover.     

Ludwig's angina. Report of a case and review of the literature

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.     

Liver abscess caused by Gemella morbillorum]

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.     

Gemella morbillorum liver abscess

We report a case of liver abscess caused by Gemella morbillorum. G. morbillorum was isolated and confirmed from both pus and blood. The patient recovered uneventfully after catheter drainage and treatment with cefmetazole. This is the first case report of liver abscess caused by G. mobillorum in the English literature.     

Endocardite por Gemella: uma entidade agressiva

The authors present a rare case of subacute endocarditis caused by Gemella morbillorum. A 72-year-old man, with a history of hypertension, aortic valve disease and upper and lower endoscopy six months previously, was admitted due to fever and abdominal pain. He also complained of long-standing dyspnea on exertion and petechiae on his lower limbs. Imaging scans showed a consolidation in the lower left lung field, a splenic infarct and a left subphrenic abscess. Transthoracic echocardiogram findings were highly suggestive of endocarditis affecting three valves, with destruction of the mitral valve anterior leaflet. G. morbillorum was identified in three blood cultures and was considered the etiologic pathogen. Due to the patient's worsening condition, he underwent cardiac surgery, aiming to control the infection and to resolve the associated mechanical complications. This case highlights the need for a complete and thorough history to arrive at likely diagnostic hypotheses that, together with complementary exams, will lead to correct diagnosis and the prompt institution of appropriate therapy.     

Ludwig's angina: an analysis of 14 cases

Ludwig's angina remains a potentially lethal disease entity as it causes rapidly progressive airway obstruction, although the current mortality rate is low. Early surgical intervention should be carried out in severe cases which show signs of fluctuation, abscess formation or other serious complications. We report our experience with 14 cases of Ludwig's angina, 12 of which (86%) were of dental origin. Only one case was complicated with Klebsiella pneumoniae septicemia which resolved upon treatment. There were no deaths. Surgical procedures including incision and drainage and tooth extraction were performed in 11 cases (78%). Antibiotics were administered to all patients. Most of them were treated with crystalline penicillin with or without an aminoglycoside. Only one patient received a tracheostomy in this series. The number of tracheostomies or intubations carried out was much lower than in previous reports. We suggest that an aggressive antimicrobial therapy, early surgical intervention and careful monitoring of the respiratory symptoms would reduce both the need for tracheostomy and the mortality rate.     

麻疹孪生球菌致感染性心内膜炎一例并国内外文献复习

麻疹孪生球菌是人体口咽及肠道中共生菌丛中的条件致病菌,很少引起感染性心内膜炎。1例26岁女性无心脏基础疾病,患麻疹孪生球菌感染所致二尖瓣受累感染性心内膜炎,经抗生素和二尖瓣置换术后治愈。本例患者出现了颈内动脉栓塞,国内外报道较少见。     

A case of septic arthritis due to infection with Gemella morbillorum

Gemella morbillorum is a facultatively anaerobic Gram-positive coccus which forms part of the normal flora of the oro-pharynx and the upper respiratory tract. It rarely causes human infection but has been described previously in cases of empyema and lung abscess, septic shock, endocarditis, meningitis, and osteomyelitis. We describe a case of septic arthritis due to G. morbillorum occurring in an otherwise healthy 42-year old man and review previous reports of infection in the literature.     

Endocarditis caused by Gemella morbillorum resistant to beta-lactams and aminoglycosides

Two rare cases of Gemella morbillorum endocarditis, caused by a strain resistant to penicillin and gentamicin are reported. G. morbillorum is usually sensitive to beta-lactams and aminoglycosides. The present 2 cases raise concern that appropriate prophylaxis and empirical treatment may be more complicated than believed in the past.     

Gemella endocarditis: consider the colon

Gemella species, including Gemella morbillorum, are part of the normal flora of the human oropharynx, upper respiratory tract and gastrointestinal tract. Differentiation of Gemella from viridans streptococci in the laboratory may be difficult. Although uncommonly pathogenic, they have been implicated in a variety of human infections, most notably infective endocarditis. Dental instrumentation appears to be the usual source of infection. The case is reported of Gemella morbillorum native valve endocarditis, which was associated with an underlying colonic carcinoma. An association with colonic neoplasm has been described in three previous cases of endocarditis attributed to Gemella. It is well documented that Streptococcus bovis endocarditis may occur in the setting of colonic neoplasia. It is suggested that colonic investigation should be considered in patients with Gemella endocarditis, in whom no other source is apparent.     

Pulmonary nodules associated with Gemella bacteremia: CT findings in two children with osteosarcoma

Gemella morbillorum and Gemella haemolysans are normal oral flora that can also be pathogenic. We report 2 cases of adolescents with osteosarcoma who developed multiple pulmonary nodules associated with Gemella bacteremia. These nodules mimicked metastatic disease. To our knowledge, this manifestation of Gemella infection has not been previously reported. In the setting of malignancy, infectious pulmonary nodules must be distinguished from metastatic nodules in order to treat appropriately.     

Endocarditis due to Streptococcus morbillorum

Two cases of endocarditis due to Streptococcus morbillorum are described. Neither patient had any known history of valvular disease. These are believed to be the first such reported cases in the U.K. In the first case, previous anal surgery and, in the second, drainage of a dental abscess and extraction of a tooth are the likely procedures which initiated endocarditis. The first case is of further interest in that the incriminated strain showed marked tolerance to beta-lactam antibiotics. A combination of penicillin with gentamicin was shown to be required in order to give satisfactory bactericidal activity in vitro.     

Multidetector Computed Tomographic Imaging of Erdheim-Chester Disease

Erdheim-Chester disease is a rarely reported disease that can affect nearly every organ and chiefly infiltrates the connective, perivascular, and adipose tissue. The disease is a form of non-Langerhans-cell histiocytosis characterized by the proliferation of foamy histiocytes; its cardiovascular complications carry a severe prognosis. We present the case of a 29-year-old woman who was admitted for analysis of her angina. Our evaluation with use of cardiac multidetector computed tomographic angiography revealed large mediastinal soft tissue that compressed the patient''s left anterior descending coronary artery. To our knowledge, this is the first report of the use of low-dose, dual-source, 256-slice multidetector computed tomography to characterize Erdheim-Chester disease that exclusively caused angina and stenosis of a coronary artery in a young adult.     

Transient left anterior hemiblock during angina pectoris: coronarographic aspects and clinical significance.

The data of 6 patients in whom a left anterior hemiblock appeared in the course of angina pectoris attacks were reviewed. All 6 patients were found to fulfill the criteria for unstable angina. 1 patient who presented the features of Prinzmetal variant angina was included in this group. Coronary arteriography showed significant coronary artery disease in all 6 patients involving 3 vessels in 2 patients, 2 vessels in 1 and 1 vessel in 3. A severe lesion (70--100%) of the left anterior descending artery in the vicinity of the first perforator was demonstrated in every case. The 2 patients with 3-vessel disease were not operable and died 4 and 5 days after the hemodynamic study. These deaths were caused by myocardial infarction with cardiogenic shock in one case and intractable ventricular arrhythmias in the other case. 4 patients were operable and underwent aortocoronary saphenous bypass surgery. There were 2 operative deaths. The 2 survivors are asymptomatic 7 and 16 mth after surgery. This study suggest that transient left anterior hemiblock during an attack of angina pectoris may be a feature of impending myocardial infarction and may be indicative of a severe obstruction of the left anterior descending coronary artery.     

Ludwig's angina.

Ludwig's angina is a cellulitis frequently occurring as a result of infections of the second and third lower molar. Despite a decrease in mortality from 50% to less than 10% since the introduction of antibiotics, it remains a rare but life-threatening illness. The potential for rapid respiratory obstruction is the greatest concern. Familiarity with the anatomy of the neck and recognition of symptoms are essential for effective treatment. Treatment focuses on maintenance of an airway, antibiotic therapy, and surgery. Asphyxia, aspiration, mediastinitis, pneumonia, empyema, and septicemia are possible complications.     

Management of purulent mediastinitis with sternal dehiscence - a case report

The authors report the case of 70-year-old female who underwent urgent CABG for unstable angina. The post-operative course was complicated by Staphylococcal mediastinitis, which was treated with chest irrigation system and antibiotics. Because of extensive tissue destruction caused by the infection, the steel sternal wires were not placed. Interestingly, one year after surgery the sternal wound was completely healed and there were no paradoxical respiratory movements.     

Pleural empyema associated with Gemella morbillorum: report of a case and review of the literature

Gemella morbillorum, a microaerophilic Gram-positive coccus, is a natural inhabitant of the human oropharyngeal, gastrointestinal and urogenital flora. However, it is an infrequently isolated organism and a rare cause of pulmonary or pleural infections. We report on a 26-y-old male subject with a past medical history of epilepsy and intravenous drug abuse, who presented with imminent sepsis and respiratory failure. Computed tomography of the thorax revealed a pleuropulmonary consolidation of the left lower lobe, and ultrasound guided thoracentesis resulted in aspiration of pus. Microbiological analysis revealed Gemella morbillorum in the pleural fluid. Thoracic drainage and antibiotic therapy resulted in full recovery. We discuss previous cases of pleuropulmonary infections due to Gemella morbillorum and review the available literature of this rare occurrence.     

Prinzmetal's angina in a patient with angiosarcoma of the right cardiac chambers

Variant (Prinzmetal's) angina pectoris is a clinical syndrome characterized by the presence of angina at rest, coinciding with a transient ST-segment elevation. This syndrome is often caused by vasospasm, either on a normal coronary artery or at the site of a coronary atherosclerotic stenosis. We describe a classic case of variant angina associated with an angiosarcoma of the right heart chambers.