A rare fungi, Candida Krusei implicated in Ludwig's angina and deep neck necrotising infection- a case report and review of literature

ABSTRACT

Introduction/Aim: Ludwig's angina is potentially life-threatening, polymicrobial infection of bilateral submandibular and sublingual spaces. Most common organisms isolated from deep neck infections are viridans streptococci, streptococcus anginosus group of oral flora. We describe a previously un-reported case of Ludwig's angina associated with an unusual fungus, Candida Krusei. Case Description 35-year-old, fit and healthy, non-smoking male patient presented with ludwig's angina and sepsis, previously diagnosed with parotitis following telephone consultation with his GP due to the COVID-19 pandemic. CT scan showed periapical pathology of both carious lower third molars with involvement of deep neck tissue spaces including the prevertebral space. The patient underwent multiple theatre visits for neck exploration and had prolonged hospital stay and subsequently recovered and discharged. Tissue samples grew Candida Krusei on multiple occasions. Discussion(s) This is a rare and previously unreported case of Ludwig's angina related to Candida Krusei. Literature search was carried out using MeSH terms Candida krusei, dental infection, neck infection, cervicofacial infection and Ludwig's angina using EMBASE, Medline, PubMed and Google Scholar. Candida Krusei has low disease-causing potential when compared to commonly found candida, with poor adhesive properties to oral cavity. It is not well-studied with regards to its virulence but has high resistance to azoles and other antifungal medications. Conclusion/Clinical Relevance This report emphasises keeping an open mind when considering potential pathogens in cervico-dentofacial infections, to test tissue for fungi as well as bacteria, and to seek timely advice from microbiologists. The authors also counsel caution when carrying out telephone consultations during the ongoing COVID-19 pandemic. Copyright © 2022