{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:17:55Z","timestamp":1756991875085,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,12]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3\u2009days prior. The patient was later diagnosed with insect-bite-induced Ludwig\u2019s angina. <jats:italic>Enterococcus faecalis<\/jats:italic> was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig\u2019s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.<\/jats:p>","DOI":"10.1136\/bcr-2021-243566","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T12:16:00Z","timestamp":1629461760000},"page":"e243566","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Severe Ludwig\u2019s angina caused by an unknown insect bite"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6146-287X","authenticated-orcid":false,"given":"Gihad","family":"Almadhi","sequence":"first","affiliation":[{"name":"College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alkathlan","sequence":"additional","affiliation":[{"name":"Infectious Diseases, King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Othman","family":"Alharbi","sequence":"additional","affiliation":[{"name":"College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Almeman","sequence":"additional","affiliation":[{"name":"College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025082707313253000_14.8.e243566.1","doi-asserted-by":"crossref","first-page":"206","DOI":"10.4103\/0976-9668.101932","article-title":"Ludwig's angina - an emergency: a case report with literature review","volume":"3","author":"Candamourty","year":"2012","journal-title":"J Nat Sci Biol Med"},{"key":"2025082707313253000_14.8.e243566.2","unstructured":"An J , Singhal M . Ludwig Angina. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC, 2019. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482354\/"},{"key":"2025082707313253000_14.8.e243566.3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/2320-3846.183700","article-title":"Ludwig\u2032s angina: analysis of 28 cases seen and managed in Sokoto, northwest Nigeria","volume":"4","author":"Braimah","year":"2016","journal-title":"Saudi Surgical Journal"},{"key":"2025082707313253000_14.8.e243566.4","first-page":"293","article-title":"Deep neck space infections: a study of 76 cases","volume":"27","author":"Kataria","year":"2015","journal-title":"Iran J Otorhinolaryngol"},{"key":"2025082707313253000_14.8.e243566.5","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1177\/000348940111000511","article-title":"Ludwig's angina: report of a case and review of management issues","volume":"110","author":"Barakate","year":"2001","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2025082707313253000_14.8.e243566.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-5876(99)00295-5"},{"key":"2025082707313253000_14.8.e243566.7","doi-asserted-by":"crossref","first-page":"409???435","DOI":"10.1288\/00005537-197003000-00004","article-title":"Cervical fascia and deep neck infections","volume":"80","author":"Levitt","year":"1970","journal-title":"Laryngoscope"},{"key":"2025082707313253000_14.8.e243566.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2008.07.007"},{"key":"2025082707313253000_14.8.e243566.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0163001","article-title":"Enterococcus species in the oral cavity: prevalence, virulence factors and antimicrobial susceptibility","volume":"11","author":"Komiyama","year":"2016","journal-title":"PLoS One"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243566","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:31:37Z","timestamp":1756305097000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":9,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,20]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-243566"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243566","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}