Head And Neck Infections
Corynebacterium Diphtheriae
Gram-positive bacillus which is unencapsulated, is non-spore forming, and nonmotile.
Produce exotoxin when the patient has low iron (turning on the TOX gene).
Clinical features
Usually incubates for 2-5 days. Complications include respiratory and cardiovascular distress.
- Pharyngitis: Sore throat, fever, inflammation
- White pseudomembrane formation on proximal pharynx, which should not be removed for risk of hemorrhage
Treatment
Diphtheria antitoxin plus antibiotics (especially erythromycin and penicillin). A Diphtheria vaccine also exists for the exotoxin.
Streptococcus Pyrogenes
See here for more detail: [[Gram Positive Cocci#Group A Streptococcus pyogenes]]
Clinical presentation
Usually incubates for 2-5 days. Complications include [[Gram Positive Cocci#Scarlet fever from Streptococcus pharyngitis|scarlet fever]] and associated [[Gram Positive Cocci#Scarlet fever from Streptococcus pharyngitis|acute rheumatic fever]].
- Sore throat, malaise, fever and headaches
- Physical exam will include redness, edema, and lymphoid hyperplasia of the posterior pharynx
Treatment
Combo of Amoxicillin and Penicillin. Clindamycin if the patient is allergic to penicillin.
Haemophilus Influenza
Gram-negative coccobacillus. It is finicky and requires a 35-37 degree C chocolate agar. Other strains of Haemophilus can cause Otitis media (inflammation of the mucosal lining of the inner ear) and Community Acquired Pneumonia.
Main virulence factor is polyribitol ribose phosphate (PRP).
Clinical features
- Epiglottitis: Diagnosed via a “cherry-red” epiglottis
- Meningitis
- Children will present with hyperextension of the neck, protrusion of the chin, and tripoding
Treatments
Usual suspects are Ceftriaxone and Cefotaxime. If meningitis is included, steroids may help with hearing loss. For resistant strains, Amoxicillin-clavulanate and Fluoroquinolones are available.
Conjugate vaccine is available against the PRP capsule.
Lemierre's Syndrome
This case specifically describes fusobacerium necrophorum, but the syndrome can appear with infectious mononucleosis, bacterial pharyngitis, or a dental abscess. Other implicated organisms include S. pyrogenes, S. milleri, S. intermedius, and S. oralis.
Complications include thrombophlebitis in the jugular vein and pulmonary infiltrates.
Clinical features
- Lingual vein filling defect seen on an X-ray or MRI, which will present with limited rightward rotation.
- Painful cervical lymphadenopathy
- Moist mucous membranes
Treatment
Three options: Ampicillin + Sulbactam, Piperacillin + Tazobactam, or Carbapenems.