Infectious Disease Compendium

Head and Neck Infections

Diagnosis

There are a variety of spaces in the neck that can become infected: peritonsillar, retropharyngeal, submandibular. They can all dissect down the neck and into the chest as well as lead to airway obstruction.

Epidemiologic Risks

Poor dentition, trauma.

Microbiology

Abscesses: Streptococci (esp milleri) + anaerobes + HACEK ( Haemophilus species, Aggregatibacter species, Cardiobacterium species, Eikenella species, and Kingella species). Gram negative aerobic rods should not occur unless the dentition is really rasty: rotting black nubs of teeth. And they always have a significant other, who, I presume, kisses them.

Lemierres Disease: septic thrombophlebitis of the internal jugular. Patient presents with a sore throat, fevers, and septic emboli on CXR; due to Fusobacterium necrophorum but occasionally other anaerobes or other organisms. I have seen a smattering of S. aurues causing Lemierres.

Lumpy Jaw: Actinomycosis.

Empiric Therapy

Abscesses: Call ENT. They need to be drained. I tend to suggest a third generation cephalosporins like ceftriaxone PLUS metronidazole.

Alternatives include a carbapenem OR penicillin/beta-lactamase inhibitors OR a quinolone PLUS metronidazole. In place of metronidazole, clindamycin can be used.

For Lumpy Jaw and Lemierres, see each illness.

Steroids, combined with drainage, is perhaps the best therapy (PubMed).

Pearls

They say never put a mirror in the back of the throat to look at the vocal cords as you can precipitate obstruction. I have seen it twice in my career, with disasterous results.

Rants

One of my few areas of magical thinking: if you put a tracheostomy kit in the room, the patient will never need it.