Life threatening abscess in the visceral space with penicillin and metronidazole resistant Prevotella Denticola following use of a laryngeal mask airway: case report

Abstract

Background Laryngeal mask airways (LMA) are commonly used for airway management. Complications with this device are rare. However, when they do occur, there is a high risk for respiratory problems, necessitating early diagnosis and treatment. We present the first case of a life-threatening abscess spreading in the visceral space caused by a penicillin and metronidazole resistant Prevotella Denticola after the use of an LMA. Case presentation A female patient was admitted to our day care centre for bunion surgery. A single use LMA size 3 (Solus®, intersurgical, Wokingham, Berkshire, United Kingdom) was successfully inserted. After surgery, the patient complained of a sore throat and amoxicillin was prescribed by the general practitioner. Three days after surgery the patient was admitted to the Intensive Care Unit (ICU) for obstructive breathing, due to an abscess in the visceral space. Retropharyngeal and certainly parapharyngeal abscesses in adults are already rare. This case however, is unique because it is the first case of abscess spreading into the visceral space after the use of an LMA. Amoxicillin/clavulanate and vancomycin were started. The abscess was incised 5 days later and microbiology showed 3 positive cultures of the anaerobe Prevotella denticola, resistant for penicillin and metronidazole, but sensitive for amoxicillin/clavulanate. The patient fully recovered. Conclusion LMA’s are easy to use and are established, safe tools to support ventilation of the airway. In this case, the authors hypothesise a small wound in the lateral pharyngeal wall probably created an opening into the visceral space causing infection with Prevotella denticola, supporting the idea that the pharyngeal mucosal space must be part of the visceral space. Additionally, early recognition and treatment of an LMA induced abscess is necessary to prevent evolution of complications leading to airway obstruction.

S-(−)-Oleocanthal Ex Vivo Modulatory Effects on Gut Microbiota

“…In our studies, three purportedly harmless strains of Prevotella ( denticola , ruminicola , and dentalis ) were seen to be suppressed by OC treatment. Notably and importantly, OC reduced the level of Prevotella denticola , which could be of prospective therapeutic value in cases of life-threatening human infections with P. denticola resistant to penicillins and metronidazole [ 39 ].…”

Oral microbiota and oral squamous cell carcinoma: a review of their relation and carcinogenic mechanisms

“…Prevotella , a genus of Gram-negative bacteria, plays a significant role in the microbial ecosystem of the oral cavity ( 76 ). These non-motile, single-celled organisms flourish under anaerobic growth conditions ( 77 ). Two species within this genus, Prevotella intermedia and Prevotella melaninogenica , have been identified as critical players in oral health.…”