Head and Neck Manifestations of Uncommon Infectious Diseases

Abstract

Certain uncommon systemic infections may be present with head and neck manifestations either initially or during the course of the disease. A high index of suspicion is required on the part of the otolaryngologist with the subsequent procedures leading to the appropriate diagnosis. The manifestations of infectious diseases such as erysipelas, histoplasmosis, rabies, tetanus, botulism, and cysticercosis must be understood by the head and neck specialist. For successful management, many of the infections require prompt identification and initiation of therapy. Airway maintenance, ventilatory support, and medical chemotherapy may be required.

Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases

“…[2][3][4][5][6][7][8] Necrotising fasciitis in its early stages can be misdiagnosed as a soft tissue infection such as cellulitis or erysipelas. 9 A diagnosis of necrotising fasciitis should be suspected if the following features are present: rapid spread of infection, cellulitis with disproportionate pain, the presence of subcutaneous crepitation, skin which is hyperaesthetic or anaesthetic to pinprick and toxic manifestations such as tachycardia, hypotension, marked apathy and confusion. The presence of gas in the tissues, although not pathognomonic, is an important sign which may be demonstrated by soft tissue plain radiograph or CT scan.…”

“…3,13 In the diagnosis and surgical management of ascending necrotising fasciitis, a thorough knowledge of the anatomy of the fascial spaces of the head and neck is critical to understanding the route of infection. 9 Generally, multiple debridement procedures are necessary to drain loculations of pus and excise gangrenous tissue. Patients are usually systemically toxic and require admission to an ICU for supportive management.…”

“…Six days postoperatively, the patient's condition deteriorated, with continued discharge from the drains and a temperature of 39°C, wcc 8.9ϫ10 9 /l and ESR 119. Under general anaesthesia, via a right hemicoronal incision, the temporalis muscle was found to be necrotic.…”

“…Plain radiography revealed retained roots of 17 and carious 47 and 48 teeth. Laboratory investigations showed Hb 13.1g/dl, wcc 8.7ϫ10 9 /l, platelets 282ϫ10 9 /l, glucose 11.9mmol/l and electrolytes within normal range. The patient was commenced on 1.2g IV benzylpenicillin six-hourly and 500mg IV metronidazole eight-hourly.…”

Early diagnosis of craniofacial necrotising fasciitis: Analysis of clinical risk factors

“… 6 NF involving the craniofacial area is associated with a high rate of progression and a mortality rate of 15% to 40% because of its abundant vascular distribution. 9 Unlike the upper and lower extremities, the clinical course of severe infections and simple abscess in the craniofacial region is similar in the early stages of clinical treatment, 10 and a differential diagnosis based on physical examination is difficult, suggesting the need to develop a predictor of CNF. Currently, a haematological predictor such as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system (Table 1 ) is utilised for NF involving the upper and the lower limbs.…”