Home / Deep Research / Ludwig's Angina

Ludwig's Angina

Ludwig’s Angina (Infectious) — Disease Characteristics Research Report

2026-05-09
Falcon MONDO:0006576 Model: Edison Scientific Literature 23 citations

Ludwig’s Angina (Infectious) — Disease Characteristics Research Report

1. Disease information

1.1 Concise overview (current understanding)

Ludwig’s angina is a rapidly progressive, potentially life‑threatening cellulitis/infection involving the floor of mouth and upper neck that classically affects the submandibular, sublingual, and submental spaces, often bilaterally, and can cause tongue elevation/displacement and acute airway compromise. (ahmed2025ludwig’sanginain pages 8-11, sahoo2024incidenceofmortality pages 1-2, boynton201612–odontogenic pages 13-14)

Older surgical-pathology descriptions emphasize a “firm, acute, toxic cellulitis” in these spaces and highlight that tongue displacement can produce a “sensation of choking and suffocation.” (boynton201612–odontogenic pages 13-14)

1.2 Key identifiers (ontology/terminology)

The currently retrieved full texts do not provide standardized identifiers (MONDO, MeSH, ICD-10/ICD-11, OMIM, Orphanet) directly; this portion should be curated from external ontology portals (e.g., MONDO browser, MeSH, ICD). This report therefore focuses on evidence-backed clinical characteristics from peer‑reviewed/primary literature. (sahoo2024incidenceofmortality pages 1-2, boynton201612–odontogenic pages 13-14, mahbub2024bacteriologicalstudyand pages 1-2)

1.3 Synonyms and alternative names

Commonly used clinical terminology in the literature includes: - “Ludwig’s angina” (standard eponym) (sahoo2024incidenceofmortality pages 1-2) - “Diffuse cellulitis of the submandibular space extending to the sublingual space” (definition used in pediatric report/review) (benhoummad2023ludwig’sanginain pages 1-3)

1.4 Evidence source type

Evidence synthesized here is largely aggregated disease-level clinical literature (retrospective/prospective hospital cohorts and narrative reviews) plus selected case reports for special populations (pediatrics). (mahbub2024bacteriologicalstudyand pages 1-2, benhoummad2023ludwig’sanginain pages 1-3, kumari2024diabetesmellitusand pages 2-4)

2. Etiology

2.1 Disease causal factors

Primary cause: Ludwig’s angina is usually odontogenic (originating from infected mandibular molars or dental infections), with polymicrobial oral flora. (sahoo2024incidenceofmortality pages 1-2, boynton201612–odontogenic pages 13-14, sahoo2024incidenceofmortality pages 5-6)

Causal chain (high-level): odontogenic infection → spread along fascial planes into submandibular/sublingual/submental spaces → edema/cellulitis ± abscess/necrotizing infection → tongue elevation/posterior displacement → airway compromise and systemic spread (sepsis/mediastinitis). (sahoo2024incidenceofmortality pages 1-2, boynton201612–odontogenic pages 13-14, sahoo2024incidenceofmortality pages 6-7)

2.2 Risk factors

Diabetes mellitus (DM): Multiple cohorts show high DM comorbidity among Ludwig’s angina/deep neck infection patients and association with worse clinical course. - Prospective Ludwig’s angina cohort (India, 2022–2023): 50% had diabetes mellitus. (kumari2024diabetesmellitusand pages 2-4) - Prospective Ludwig’s angina cohort (Bangladesh): 25% had diabetes mellitus. (mahbub2024bacteriologicalstudyand pages 2-4) - Retrospective Ludwig’s angina cohort (n=17): 50% had DM; 70.5% had comorbidities. (sahoo2024incidenceofmortality pages 5-6) - Population-based cohort (Taiwan; deep neck infection broadly, including Ludwig angina ICD coding in methods): Type 1 DM associated with adjusted hazard ratio 10.71 for deep neck infection and longer hospitalizations (9.0 ± 6.2 vs 4.1 ± 2.0 days). (sahoo2024incidenceofmortality pages 5-6)

Other host risk factors discussed in clinical series/reviews include immunocompromise (e.g., HIV/AIDS), malnutrition, chronic kidney disease, cirrhosis, COPD, CAD, pregnancy, and older age. (sahoo2024incidenceofmortality pages 1-2, sahoo2024incidenceofmortality pages 5-6)

Socioeconomic/oral hygiene factors: In the Bangladesh cohort, many patients were from poor socioeconomic background (70%), rural areas (70%), and had dental infection (70%). (mahbub2024bacteriologicalstudyand pages 2-4)

2.3 Protective factors

Direct protective factors are not explicitly quantified in the retrieved evidence; however, prevention-focused statements emphasize oral hygiene and early dental care to prevent odontogenic infections that precipitate Ludwig’s angina. (mahbub2024bacteriologicalstudyand pages 1-2, ahmed2025ludwig’sanginain pages 8-11)

2.4 Gene–environment interactions

No gene–environment interaction evidence specific to Ludwig’s angina was found in the retrieved full texts; the condition is typically not described as genetically determined but rather driven by infection + host comorbidity. (sahoo2024incidenceofmortality pages 1-2, mahbub2024bacteriologicalstudyand pages 1-2)

3. Phenotypes (clinical presentation)

3.1 Core signs and symptoms (with cohort statistics)

Common phenotypes include neck/floor-of-mouth swelling, pain, fever, dysphagia, trismus, tongue elevation, drooling, muffled voice, and respiratory distress.

Recent cohort examples: - India prospective cohort (n=40): pain 80%, neck swelling 75%, dysphagia 65%, trismus 55%, fever 25%, respiratory distress 22.5%. (kumari2024diabetesmellitusand pages 2-4) - Bangladesh prospective cohort (n=100): floor-of-mouth/neck swelling 100%, pain/tenderness 100%, fever 100%, dysphagia 80%, trismus 15%, muffled voice 10%, respiratory distress 3%. (mahbub2024bacteriologicalstudyand pages 4-5) - Somalia retrospective cohort (n=90): submandibular swelling + trismus + tongue elevation + difficulty breathing 52.2%; fever/toothache/submental swelling 35.6%. (ahmed2025ludwig’sanginain pages 8-11)

3.2 Suggested HPO terms (non-exhaustive)

The following HPO mappings are appropriate for knowledge base structuring (ontology suggestions; not claims of frequency unless paired with above statistics): - Neck swelling (HP:0000474) - Facial swelling (HP:0000289) - Fever (HP:0001945) - Dysphagia (HP:0002015) - Trismus (HP:0000210) - Drooling (HP:0002307) - Dyspnea/Respiratory distress (HP:0002094) - Stridor (HP:0001618) - Muffled voice/Hoarseness (HP:0001609)

3.3 Quality of life impact

Although validated QoL instrument scores (EQ‑5D/SF‑36) were not reported in the retrieved texts, the symptom complex (pain, dysphagia, trismus, airway threat) implies acute, severe functional impairment requiring urgent care and often hospitalization/ICU-level monitoring. (sahoo2024incidenceofmortality pages 1-2, sahoo2024incidenceofmortality pages 6-7)

4. Genetic / molecular information

4.1 Causal genes and pathogenic variants

Ludwig’s angina is not primarily characterized as a monogenic disorder in the retrieved evidence and no causal genes/variants are reported. It is best represented as an acute polymicrobial infection syndrome influenced by host comorbidity rather than inherited variants. (sahoo2024incidenceofmortality pages 1-2, mahbub2024bacteriologicalstudyand pages 1-2)

4.2 Molecular profiling / omics

No transcriptomic/proteomic/metabolomic profiling studies specific to Ludwig’s angina were identified in the retrieved evidence set. (mahbub2024bacteriologicalstudyand pages 1-2)

5. Environmental information

5.1 Lifestyle and contextual factors

Poor oral hygiene and delayed dental care are repeatedly implicated as upstream factors increasing odontogenic infection burden, which then precipitates Ludwig’s angina/deep neck infection. (mahbub2024bacteriologicalstudyand pages 2-4, ahmed2025ludwig’sanginain pages 8-11)

5.2 Infectious agents

Ludwig’s angina is commonly polymicrobial and derived from oral flora; cohorts report frequent isolation of viridans streptococci, Staphylococcus aureus, and Gram-negative organisms in some settings. - Bangladesh cohort: Streptococcus viridans 40%, S. aureus 23%, coagulase‑negative staphylococci 20%, Klebsiella 16%, E. coli 13%, Pseudomonas 12%, Proteus 11%, and mixed organisms 30% (note: multiple isolates possible). (mahbub2024bacteriologicalstudyand pages 4-5) - India cohort: S. viridans 22.5%, S. aureus 12.5%, E. coli 7.5%, Klebsiella 5%; “no growth” 52.5% (likely reflecting pre-treatment/collection limits). (kumari2024diabetesmellitusand pages 2-4)

6. Mechanism / pathophysiology

6.1 Anatomic–pathophysiologic mechanism (causal chain)

A consistent mechanistic explanation is: 1) odontogenic infection (often mandibular molar) spreads through lingual cortical bone and fascial planes (relationship to mylohyoid region) (sahoo2024incidenceofmortality pages 5-6) 2) cellulitis/edema involves submandibular space and spreads to sublingual/submental spaces, frequently bilaterally (sahoo2024incidenceofmortality pages 1-2, boynton201612–odontogenic pages 13-14) 3) floor-of-mouth induration and edema displace tongue upward/backward → airway compromise (boynton201612–odontogenic pages 13-14, sahoo2024incidenceofmortality pages 5-6) 4) systemic extension may cause sepsis, necrotizing fasciitis, and descending mediastinitis. (sahoo2024incidenceofmortality pages 5-6, mahbub2024bacteriologicalstudyand pages 4-5)

6.2 Immune involvement and host factors

Diabetes is repeatedly discussed as contributing to susceptibility and more severe course. The comorbidity burden is emphasized in a 2024 retrospective series where all deaths occurred in patients with comorbidity. (sahoo2024incidenceofmortality pages 1-2)

6.3 Suggested GO biological process terms (mechanism structuring)

Ontology suggestions for mechanistic annotation: - GO:0006954 inflammatory response - GO:0002682 regulation of immune system process - GO:0009617 response to bacterium - GO:0009405 pathogenesis - GO:0009408 response to heat (fever physiology)

6.4 Suggested cell types (CL) implicated

Ontology suggestions: - Neutrophil (CL:0000775) (consistent with inflammatory marker emphasis and neutrophil predictors in deep neck abscess airway risk modeling) (sahoo2024incidenceofmortality pages 5-6) - Macrophage (CL:0000235) - Oral epithelial cell (CL:0000066)

7. Anatomical structures affected

7.1 Primary sites

Core spaces: submandibular, sublingual, submental spaces (floor of mouth). (ahmed2025ludwig’sanginain pages 8-11, boynton201612–odontogenic pages 13-14)

Suggested UBERON terms (ontology suggestions): - Floor of mouth (UBERON:0003679) - Submandibular region (UBERON concept mapping may be required) - Tongue (UBERON:0001723)

7.2 Secondary involvement (complications)

Reported complications include necrotizing fasciitis, septicemia/sepsis, mediastinitis, and airway obstruction. (ahmed2025ludwig’sanginain pages 8-11, mahbub2024bacteriologicalstudyand pages 4-5)

8. Temporal development

8.1 Onset and course

Ludwig’s angina is typically acute and rapidly progressive; delays in presentation are common in some settings (e.g., 77.8% waiting 5–7 days in a Somali ED cohort), which can increase complication risk. (ahmed2025ludwig’sanginain pages 8-11)

8.2 Disease stages (practical clinical staging)

Evidence supports a practical progression: odontogenic infection → cellulitis/edema → airway-threatening floor-of-mouth swelling ± abscess/necrotizing infection → systemic complications. (boynton201612–odontogenic pages 13-14, sahoo2024incidenceofmortality pages 6-7)

9. Inheritance and population

9.1 Epidemiology

High-quality population incidence/prevalence estimates for Ludwig’s angina specifically were not captured in the retrieved texts. Available evidence is predominantly hospital-based series.

Examples of reported demographics: - Somalia ED cohort: 77.8% male; mean age 39.1 years. (ahmed2025ludwig’sanginaina pages 5-7) - Bangladesh cohort: 60% male; most common age group 31–45 years (42%). (mahbub2024bacteriologicalstudyand pages 2-4)

10. Diagnostics

10.1 Clinical diagnosis and labs

Diagnosis is largely clinical, supported by inflammatory markers (WBC, CRP) and cultures where feasible. Pediatric case review notes hyperleukocytosis and very high CRP (CRP=300 in the index case). (benhoummad2023ludwig’sanginain pages 1-3)

10.2 Imaging

A 2024 retrospective Ludwig’s angina series reports routine use of contrast-enhanced CT (CECT) to define spread. (sahoo2024incidenceofmortality pages 6-7) Radiographic work-up may begin with dental imaging (OPG) to identify source and chest X‑ray to evaluate thoracic spread. (sahoo2024incidenceofmortality pages 5-6)

10.3 Differential diagnosis

Conditions that may mimic floor-of-mouth swelling include angioneurotic (angioedema) edema and sublingual hematoma, which are explicitly listed as differential diagnoses in a 2024 retrospective report. (sahoo2024incidenceofmortality pages 5-6)

11. Outcomes / prognosis

11.1 Mortality and severe complications

Mortality varies substantially by setting and comorbidity burden. - India prospective cohort (n=40): death 7.5% (3 deaths, attributed to septicemia). (kumari2024diabetesmellitusand pages 2-4) - Bangladesh cohort (n=100): deaths reported (2 patients died due to mediastinitis in the discussion of complications). (mahbub2024bacteriologicalstudyand pages 4-5) - Retrospective series (n=17): mortality 23.5%; all deaths occurred with comorbidity. (sahoo2024incidenceofmortality pages 1-2) - Somalia ED cohort (n=90): no mortality reported, despite 48.9% complication rate. (ahmed2025ludwig’sanginain pages 8-11)

Complication rates can be high: - Somalia cohort: any complication 48.9%; septicemia 36.7%; necrotizing fasciitis 5.5%; DIC 3.3%; laryngeal spasm 3.3%. (ahmed2025ludwig’sanginain pages 8-11) - Bangladesh cohort: necrotizing fasciitis 8%; mediastinitis and septicemia are reported complications (percentages reported in text). (mahbub2024bacteriologicalstudyand pages 4-5)

11.2 Prognostic factors (expert synthesis grounded in evidence)

Across series, comorbidities (especially diabetes) and delayed presentation are repeatedly linked to longer hospitalization and worse outcomes, and multispace disease/airway compromise increases intervention needs. (sahoo2024incidenceofmortality pages 5-6, ahmed2025ludwig’sanginaina pages 5-7, sahoo2024incidenceofmortality pages 1-2)

12. Treatment

12.1 Current applications and real-world implementation (core algorithm)

Evidence from recent cohorts emphasizes a consistent emergency-management triad: 1) Airway management (monitoring, oxygen, escalation to intubation or tracheostomy) (sahoo2024incidenceofmortality pages 6-7) 2) Broad-spectrum IV antibiotics with aerobic + anaerobic coverage, tailored to cultures when possible (sahoo2024incidenceofmortality pages 6-7, mahbub2024bacteriologicalstudyand pages 1-2) 3) Early surgical decompression/drainage and source control (e.g., extraction/drainage) when indicated. (sahoo2024incidenceofmortality pages 6-7, kumari2024diabetesmellitusand pages 4-5)

A 2024 retrospective series provides quantitative airway management data: oro-tracheal intubation 88.2% and tracheostomy 11.2%. (sahoo2024incidenceofmortality pages 6-7) A 2024 prospective series reported emergency tracheostomy 12.5% in patients presenting with respiratory distress/stridor. (kumari2024diabetesmellitusand pages 4-5)

12.2 Antibiotics and susceptibility (recent microbiology/statistics)

The Bangladesh cohort provides organism-specific susceptibility counts and overall statements including that the “most effective antibiotic was Ceftriaxone (65%)” and ceftazidime 58% (as reported in the results and Table VI). (mahbub2024bacteriologicalstudyand pages 4-5, mahbub2024bacteriologicalstudyand media 459caceb)

12.3 MAXO (Medical Action Ontology) suggestions

Ontology suggestions for intervention annotation: - Airway management / tracheal intubation / tracheostomy (MAXO term mapping required) - Surgical drainage of abscess / surgical decompression (MAXO mapping required) - Antibacterial therapy (MAXO mapping required) - Tooth extraction / dental source control (MAXO mapping required)

13. Prevention

Primary prevention centers on preventing odontogenic infection progression via oral hygiene, regular dental evaluation, and early treatment of dental infections, which is explicitly recommended in cohort conclusions. (ahmed2025ludwig’sanginain pages 8-11, mahbub2024bacteriologicalstudyand pages 1-2)

Secondary/tertiary prevention in clinical practice includes early recognition, early imaging when needed, and early airway protection to prevent catastrophic airway obstruction and systemic spread. (sahoo2024incidenceofmortality pages 6-7)

14. Other species / natural disease

No evidence in the retrieved texts describes Ludwig’s angina as a naturally occurring disease entity in non-human species, or zoonotic transmission; this section is currently not evidenced in the available corpus. (sahoo2024incidenceofmortality pages 1-2)

15. Model organisms

No animal model or experimental model organism evidence specific to Ludwig’s angina was identified in the retrieved texts; most mechanistic and therapeutic understanding is derived from human clinical series of odontogenic and deep neck space infections. (mahbub2024bacteriologicalstudyand pages 1-2)

Recent developments (prioritizing 2023–2024) — synthesis

The strongest “recent” (2023–2024) evidence retrieved here consists of prospective/retrospective cohorts in diverse health systems that quantify: - High burden of DM and other comorbidities among cases and association with longer stays/outcomes. (kumari2024diabetesmellitusand pages 2-4, sahoo2024incidenceofmortality pages 5-6) - Persistent polymicrobial patterns with site-specific Gram-negative representation and substantial “no growth” proportions, emphasizing sampling/treatment effects and the need for empiric broad coverage. (mahbub2024bacteriologicalstudyand pages 4-5, kumari2024diabetesmellitusand pages 2-4) - Real-world airway intervention rates (intubation vs tracheostomy) and continued emphasis on early decompression plus antibiotics. (sahoo2024incidenceofmortality pages 6-7, kumari2024diabetesmellitusand pages 4-5)

Key quantitative evidence table

The following table consolidates the most actionable statistics and management details from the retrieved studies.

Table (click to expand)
Study (first author, year) Design/Setting N Key etiologies/risk factors (with %) Key clinical features (with % if available) Microbiology findings Interventions (airway/surgery/antibiotics) Outcomes/complications (with %) URL/DOI Publication date
Kumari, 2024 Prospective study; ENT department, Government Medical College, Amritsar, India 40 Dental infection 85%; tooth extraction 10%; diabetes mellitus 50%; HIV/HCV 15% (kumari2024diabetesmellitusand pages 2-4, kumari2024diabetesmellitusand pages 4-5) Pain 80%; neck swelling 75%; dysphagia 65%; trismus 55%; fever 25%; respiratory distress 22.5% (kumari2024diabetesmellitusand pages 2-4) Streptococcus viridans 22.5%; Staphylococcus aureus 12.5%; E. coli 7.5%; Klebsiella 5%; no growth 52.5% (kumari2024diabetesmellitusand pages 2-4, kumari2024diabetesmellitusand pages 4-5) Surgical + medical management 90%; medical only 10%; emergency tracheostomy 12.5%; antibiotics based on culture sensitivity (kumari2024diabetesmellitusand pages 4-5) Necrotizing fasciitis 5%; peritonsillar abscess 2.5%; respiratory distress/stridor 22.5%; death 7.5%; diabetic hospital stay ~10 days vs 5-7 days in non-diabetics (kumari2024diabetesmellitusand pages 2-4, kumari2024diabetesmellitusand pages 4-5) https://doi.org/10.18203/2320-6012.ijrms20241233 Apr 2024
Mahbub, 2024 Prospective observational study; Dhaka Medical College Hospital/ICDDR,B, Bangladesh 100 Dental infection 70%; tooth extraction 10%; diabetes mellitus 25%; rural residence 70%; poor socioeconomic status 70% (mahbub2024bacteriologicalstudyand pages 1-2, mahbub2024bacteriologicalstudyand pages 2-4, mahbub2024bacteriologicalstudyand pages 4-5) Floor-of-mouth and neck swelling 100%; pain/tenderness 100%; fever 100%; dysphagia 80%; trismus 15%; foul smell 24%; respiratory distress 3%; muffled voice 10% (mahbub2024bacteriologicalstudyand pages 2-4, mahbub2024bacteriologicalstudyand pages 4-5) Streptococcus viridans 40%; S. aureus 23%; coagulase-negative staphylococci 20%; Klebsiella 16%; E. coli 13%; Pseudomonas 12%; Proteus 11%; mixed organisms 30%; no organism 5% (mahbub2024bacteriologicalstudyand pages 4-5, mahbub2024bacteriologicalstudyand media 024e80f3, mahbub2024bacteriologicalstudyand media 459caceb) Incision and drainage performed for included cases; empiric IV penicillin G/clindamycin/metronidazole discussed; ceftriaxone most effective antibiotic 65%; ceftazidime 58%; ciprofloxacin 56% (mahbub2024bacteriologicalstudyand pages 1-2, mahbub2024bacteriologicalstudyand pages 2-4, mahbub2024bacteriologicalstudyand pages 4-5, mahbub2024bacteriologicalstudyand media 459caceb) Necrotizing fasciitis 8%; septicemia 7%; mediastinitis 6%; death 2% (2 patients, due to mediastinitis); discharged within 1-2 weeks 36% (mahbub2024bacteriologicalstudyand pages 4-5) https://doi.org/10.3329/mumcj.v6i2.71369 Feb 2024
Sahoo, 2024 Retrospective study; maxillofacial/oral surgery setting 17 Comorbidities 70.5%; diabetes mellitus 50%; all patients had infected lower molar source; risk factors discussed: malnutrition, immunocompromise, old age, obesity, pregnancy, CKD, cirrhosis, COPD, CAD (sahoo2024incidenceofmortality pages 1-2, sahoo2024incidenceofmortality pages 5-6) Painful neck swelling; drooling; tooth pain; dysphagia; shortness of breath; fever; trismus; muffled voice; impending airway crisis signs include cyanosis/stridor (percentages NR) (sahoo2024incidenceofmortality pages 5-6) Polymicrobial; native streptococci, staphylococci, Bacteroides, mixed aerobic/anaerobic oral flora (sahoo2024incidenceofmortality pages 1-2) Oro-tracheal intubation 88.2%; tracheostomy 11.2%; CECT for all cases; OPG and chest X-ray recommended; institutional empiric regimen ceftriaxone-sulbactam + amikacin + metronidazole; early decompression mainstay (sahoo2024incidenceofmortality pages 1-2, sahoo2024incidenceofmortality pages 5-6, sahoo2024incidenceofmortality pages 6-7) Mortality 23.5%; all deaths had comorbidity; necrotizing fasciitis 29.4% with 100% recovery in that subgroup; historical overall mortality cited as 0.3% in a 5,855-patient representative study; cervical necrotizing fasciitis mortality rises to 41% with descending necrotizing mediastinitis and 64% with sepsis (sahoo2024incidenceofmortality pages 5-6, sahoo2024incidenceofmortality pages 1-2, sahoo2024incidenceofmortality pages 6-7) https://doi.org/10.1007/s12663-024-02116-5 Feb 2024
Benhoummad, 2023 Case report and literature review; pediatric emergency/ENT 1 Pediatric case; no dental/systemic etiology in index case; literature notes adult cases usually secondary to oral infections (benhoummad2023ludwig’sanginain pages 1-3) Firm submental/submandibular swelling; pain; fever; respiratory discomfort in supine position; no dysphagia/respiratory distress initially; hyperleukocytosis; CRP 300 (benhoummad2023ludwig’sanginain pages 1-3) Gram-positive cocci in chains; culture grew Staphylococcus aureus (benhoummad2023ludwig’sanginain pages 1-3) Percutaneous drainage of 15 mL pus; broad-spectrum IV antibiotics; wound care; airway control emphasized in review (benhoummad2023ludwig’sanginain pages 1-3) Clinical and biological improvement; discharged after 7 days; no complication at 6-month follow-up (benhoummad2023ludwig’sanginain pages 1-3) https://doi.org/10.1186/s43163-023-00431-1 Apr 2023
Ahmed, 2025 Retrospective emergency department study; Mogadishu Somali Turkey Training and Research Hospital, Somalia 90 Odontogenic infection 65.5%; periodontal abscess 34.4%; post-extraction abscess 21.1%; dental caries 16.7%; diabetes mellitus 5.6%; severe anaemia 13.3%; chronic liver disease 4.4%; no underlying conditions 41.1%; symptom delay 5-7 days in 77.8% (ahmed2025ludwig’sanginain pages 5-8, ahmed2025ludwig’sanginain pages 8-11, ahmed2025ludwig’sanginaina pages 5-7) Submandibular swelling, trismus, tongue elevation, difficulty breathing 52.2%; fever/toothache/submental swelling 35.6%; bilateral swelling 12.2% (ahmed2025ludwig’sanginain pages 8-11) Species breakdown NR in available excerpt (ahmed2025ludwig’sanginain pages 8-11) Airway support for all (oropharyngeal airway + intranasal oxygen); ceftriaxone + metronidazole empirically, then tailored; surgical decompression 38.9%; incision and drainage 14.4%; antibiotics/targeted therapy 46.7%; source removal in 53.3% of operated cases; ICU 4.4% (ahmed2025ludwig’sanginain pages 5-8, ahmed2025ludwig’sanginaina pages 5-7) Complications 48.9%; septicemia 36.7%; sepsis ~30%; necrotizing fasciitis 5.5-5.6%; DIC 3.3%; laryngeal spasm 3.3%; no mortality; hospital stay 3-5 days in 52.3% (ahmed2025ludwig’sanginain pages 5-8, ahmed2025ludwig’sanginain pages 8-11, ahmed2025ludwig’sanginaina pages 5-7) https://doi.org/10.21203/rs.3.rs-7314800/v1 Aug 2025
Chang, 2018 Nationwide population-based cohort study; Taiwan NHIRD; deep neck infection risk in T1DM 5,741 T1DM vs 22,964 matched controls Type 1 diabetes mellitus associated with higher DNI risk; adjusted hazard ratio 10.71 (95% CI 6.02-19.05) (sahoo2024incidenceofmortality pages 5-6) NR for Ludwig-specific presentation in excerpt NR Therapeutic methods did not differ significantly between T1DM and non-DM DNI cohorts (sahoo2024incidenceofmortality pages 5-6) Longer hospitalization for DNI in T1DM: 9.0 ± 6.2 vs 4.1 ± 2.0 days; younger age at DNI in T1DM (sahoo2024incidenceofmortality pages 5-6) https://doi.org/10.3390/jcm7110385 Oct 2018
Lin, 2021 Multicenter retrospective cohort study; 9 hospitals, Guangdong Province; deep neck space abscess airway-risk model 440 Predictors of airway management: multispace involvement OR 6.42; gas formation OR 4.95; dyspnea OR 10.35; neutrophil percentage OR 1.10; platelet/lymphocyte ratio OR 1.01; albumin OR 0.86; diabetes noted in cohort characteristics (sahoo2024incidenceofmortality pages 5-6) Dyspnea used as predictor; other Ludwig-specific symptom percentages NR in excerpt NR Outcome modeled was need for airway management (intubation/tracheostomy); internal validation AUC 0.951, external AUC 0.947 (sahoo2024incidenceofmortality pages 5-6) 60/363 in training cohort and 13/77 in validation cohort required airway management (sahoo2024incidenceofmortality pages 5-6) https://doi.org/10.1186/s40560-021-00554-8 May 2021
Kataria, 2015 Retrospective study of deep neck space infections 76 Odontogenic infection 34.21%; diabetes comorbidity 10.52%; rural background common; poor oral hygiene/smoking/chewing tobacco highlighted (sahoo2024incidenceofmortality pages 5-6) Neck pain 89.47%; Ludwig's angina was the most common presentation 28.94% (sahoo2024incidenceofmortality pages 5-6) Streptococcus/Staphylococcus in 50% of cases (sahoo2024incidenceofmortality pages 5-6) Surgical intervention 89.47%; emergency tracheotomy 5.26%; IV antibiotics recommended for all (sahoo2024incidenceofmortality pages 5-6) Airway obstruction, jugular vein thrombosis, and sepsis noted as DNSI complications (sahoo2024incidenceofmortality pages 5-6) https://doi.org/10.22038/ijorl.2015.4520 Jul 2015

Table: This table compiles the main quantitative findings and clinical takeaways for Ludwig’s angina from the currently available evidence in the conversation. It highlights etiology, risk factors, microbiology, interventions, and outcomes to support rapid synthesis for a disease knowledge base.

Visual evidence from recent study tables

Cropped tables from the 2024 Bangladesh prospective study show bacterial isolate distributions and antibiotic sensitivity counts (Tables IV and VI). (mahbub2024bacteriologicalstudyand media 024e80f3, mahbub2024bacteriologicalstudyand media 459caceb)

Abstract-supported quotes (selected)

  • Definition/anatomy: Ludwig’s angina in a pediatric report is described as “a diffuse cellulitis in the sub-mandibular space, which extends to the sublingual space.” (benhoummad2023ludwig’sanginain pages 1-3)
  • Cohort microbiology/antibiogram relevance: “The knowledge of the local pattern of infection and antibacterial sensitivity in Ludwig’s angina is essential to enable efficacious treatment for it.” (mahbub2024bacteriologicalstudyand pages 1-2)

Limitations of this report

  • Standard identifiers (MONDO/MeSH/ICD/Orphanet/OMIM) and PMID-level indexing were not available in the retrieved full texts; URLs and DOIs are provided where present in the evidence, and identifier curation should be performed using dedicated ontology resources. (sahoo2024incidenceofmortality pages 1-2, mahbub2024bacteriologicalstudyand pages 1-2)
  • Some data (e.g., incidence/prevalence) are not well represented in the retrieved set and may require targeted epidemiology database queries beyond the current corpus.

References

  1. (ahmed2025ludwig’sanginain pages 8-11): Abdullahi Ahmed Ahmed, Ismail Mohamoud Abdullahi, Nasteho Mohamed Sheikh Omar, Abdishakur Mohamed Abdirahman, Resul Nusretoğlu, and Sahra Ali Yusuf. Ludwig’s angina in the emergency department: epidemiology, diagnosis, and outcomes: a retrospective study in somalia. Unknown journal, Aug 2025. URL: https://doi.org/10.21203/rs.3.rs-7314800/v1, doi:10.21203/rs.3.rs-7314800/v1.

  2. (sahoo2024incidenceofmortality pages 1-2): N. K. Sahoo, Ankur Thakral, Swati Pandey, Himani Vaswani, Sahil Vashisht, and Isha Maheshwari. Incidence of mortality and its relation to comorbidity in ludwig's angina: a retrospective study. Journal of maxillofacial and oral surgery, 23 3:581-588, Feb 2024. URL: https://doi.org/10.1007/s12663-024-02116-5, doi:10.1007/s12663-024-02116-5. This article has 3 citations.

  3. (boynton201612–odontogenic pages 13-14): Tyler T. Boynton, Elie M. Ferneini, and Morton H. Goldberg. 12 – odontogenic infections of the fascial spaces. ArXiv, pages 203-221, Jan 2016. URL: https://doi.org/10.1016/b978-0-323-28945-0.00012-0, doi:10.1016/b978-0-323-28945-0.00012-0. This article has 7 citations.

  4. (mahbub2024bacteriologicalstudyand pages 1-2): AHM Rashid E Mahbub, Abdullah Al Mamun, Rokhsana Sarmin, Syed Sanaul Islam, Rashedul Islam, AHM Noor E As Sayeed, and Md Asif Anowar. Bacteriological study and antibacterial susceptibility in ludwig’s angina in a tertiary level hospital in dhaka, bangladesh. Mugda Medical College Journal, 6:71-76, Feb 2024. URL: https://doi.org/10.3329/mumcj.v6i2.71369, doi:10.3329/mumcj.v6i2.71369. This article has 0 citations.

  5. (benhoummad2023ludwig’sanginain pages 1-3): Othmane Benhoummad, Kaoutar Cherrabi, Najib El Orfi, Zineb Mortaji, and Mehdi El Fakiri. Ludwig’s angina in a child: a case report and literature review. The Egyptian Journal of Otolaryngology, Apr 2023. URL: https://doi.org/10.1186/s43163-023-00431-1, doi:10.1186/s43163-023-00431-1. This article has 5 citations.

  6. (kumari2024diabetesmellitusand pages 2-4): Anjana Kumari, Arvinder Singh Maan, Satinderpal Singh, and Simerpreet Kaur Saran. Diabetes mellitus and odontogenic infections: a life threatening combination in ludwig's angina. International Journal of Research in Medical Sciences, 12:1502-1506, Apr 2024. URL: https://doi.org/10.18203/2320-6012.ijrms20241233, doi:10.18203/2320-6012.ijrms20241233. This article has 4 citations.

  7. (sahoo2024incidenceofmortality pages 5-6): N. K. Sahoo, Ankur Thakral, Swati Pandey, Himani Vaswani, Sahil Vashisht, and Isha Maheshwari. Incidence of mortality and its relation to comorbidity in ludwig's angina: a retrospective study. Journal of maxillofacial and oral surgery, 23 3:581-588, Feb 2024. URL: https://doi.org/10.1007/s12663-024-02116-5, doi:10.1007/s12663-024-02116-5. This article has 3 citations.

  8. (sahoo2024incidenceofmortality pages 6-7): N. K. Sahoo, Ankur Thakral, Swati Pandey, Himani Vaswani, Sahil Vashisht, and Isha Maheshwari. Incidence of mortality and its relation to comorbidity in ludwig's angina: a retrospective study. Journal of maxillofacial and oral surgery, 23 3:581-588, Feb 2024. URL: https://doi.org/10.1007/s12663-024-02116-5, doi:10.1007/s12663-024-02116-5. This article has 3 citations.

  9. (mahbub2024bacteriologicalstudyand pages 2-4): AHM Rashid E Mahbub, Abdullah Al Mamun, Rokhsana Sarmin, Syed Sanaul Islam, Rashedul Islam, AHM Noor E As Sayeed, and Md Asif Anowar. Bacteriological study and antibacterial susceptibility in ludwig’s angina in a tertiary level hospital in dhaka, bangladesh. Mugda Medical College Journal, 6:71-76, Feb 2024. URL: https://doi.org/10.3329/mumcj.v6i2.71369, doi:10.3329/mumcj.v6i2.71369. This article has 0 citations.

  10. (mahbub2024bacteriologicalstudyand pages 4-5): AHM Rashid E Mahbub, Abdullah Al Mamun, Rokhsana Sarmin, Syed Sanaul Islam, Rashedul Islam, AHM Noor E As Sayeed, and Md Asif Anowar. Bacteriological study and antibacterial susceptibility in ludwig’s angina in a tertiary level hospital in dhaka, bangladesh. Mugda Medical College Journal, 6:71-76, Feb 2024. URL: https://doi.org/10.3329/mumcj.v6i2.71369, doi:10.3329/mumcj.v6i2.71369. This article has 0 citations.

  11. (ahmed2025ludwig’sanginaina pages 5-7): Abdullahi Ahmed Ahmed, Ismail Mohamoud Abdullahi, Hussein Hassan Mohamud, Nasteho Mohamed Sheikh Omar, Abdishakur Mohamed Abdirahman, Resul Nusretoğlu, and Sahra Ali Yusuf. Ludwig’s angina in somalia: clinical characteristics, management, and outcomes from a tertiary emergency department retrospective study. first report of ludwig’s angina in somalia. Unknown journal, Dec 2025. URL: https://doi.org/10.21203/rs.3.rs-8062782/v1, doi:10.21203/rs.3.rs-8062782/v1.

  12. (kumari2024diabetesmellitusand pages 4-5): Anjana Kumari, Arvinder Singh Maan, Satinderpal Singh, and Simerpreet Kaur Saran. Diabetes mellitus and odontogenic infections: a life threatening combination in ludwig's angina. International Journal of Research in Medical Sciences, 12:1502-1506, Apr 2024. URL: https://doi.org/10.18203/2320-6012.ijrms20241233, doi:10.18203/2320-6012.ijrms20241233. This article has 4 citations.

  13. (mahbub2024bacteriologicalstudyand media 459caceb): AHM Rashid E Mahbub, Abdullah Al Mamun, Rokhsana Sarmin, Syed Sanaul Islam, Rashedul Islam, AHM Noor E As Sayeed, and Md Asif Anowar. Bacteriological study and antibacterial susceptibility in ludwig’s angina in a tertiary level hospital in dhaka, bangladesh. Mugda Medical College Journal, 6:71-76, Feb 2024. URL: https://doi.org/10.3329/mumcj.v6i2.71369, doi:10.3329/mumcj.v6i2.71369. This article has 0 citations.

  14. (mahbub2024bacteriologicalstudyand media 024e80f3): AHM Rashid E Mahbub, Abdullah Al Mamun, Rokhsana Sarmin, Syed Sanaul Islam, Rashedul Islam, AHM Noor E As Sayeed, and Md Asif Anowar. Bacteriological study and antibacterial susceptibility in ludwig’s angina in a tertiary level hospital in dhaka, bangladesh. Mugda Medical College Journal, 6:71-76, Feb 2024. URL: https://doi.org/10.3329/mumcj.v6i2.71369, doi:10.3329/mumcj.v6i2.71369. This article has 0 citations.

  15. (ahmed2025ludwig’sanginain pages 5-8): Abdullahi Ahmed Ahmed, Ismail Mohamoud Abdullahi, Nasteho Mohamed Sheikh Omar, Abdishakur Mohamed Abdirahman, Resul Nusretoğlu, and Sahra Ali Yusuf. Ludwig’s angina in the emergency department: epidemiology, diagnosis, and outcomes: a retrospective study in somalia. Unknown journal, Aug 2025. URL: https://doi.org/10.21203/rs.3.rs-7314800/v1, doi:10.21203/rs.3.rs-7314800/v1.