{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:26Z","timestamp":1788415946730,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV\u2013syphilis coinfection poses a substantial challenge in the management of severe odontogenic infections, with few reports addressing maxillofacial multi-space infections in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 50-year-old man developed severe left maxillofacial multi-space infection one week after molar extraction, presenting with respiratory distress, trismus, elevated C-reactive protein (235.20 mg\/L), computed tomography evidence of gas-forming abscesses, reactive HIV antibody, positive syphilis serology, and a CD4+ T-cell count of 133.76 cells\/\u03bcL. Emergency tracheostomy and incision and drainage were followed by multidisciplinary management comprising sequential antibacterial therapy, intravenous aqueous penicillin G, early antiretroviral therapy, and trimethoprim\u2013sulfamethoxazole prophylaxis. The patient was decannulated on postoperative day 23 and discharged on day 25; the CD4+ T-cell count rose to 321.53 cells\/\u03bcL within three weeks. At four-month follow-up, the infection had not recurred, the CD4+ T-cell count reached 415.36 cells\/\u03bcL, and the RPR had reverted to negative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with advanced immunosuppression, odontogenic multi-space infection mandates prompt airway control, adequate surgical drainage, sequenced pathogen-specific pharmacotherapy, and multidisciplinary collaboration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1945372","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:21Z","timestamp":1788412461000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidisciplinary management of severe odontogenic maxillofacial multi-space infection in a patient with HIV\u2013syphilis coinfection and advanced immunosuppression: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Jieying","family":"Li","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]},{"name":"School of Stomatology, Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyong","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]},{"name":"School of Stomatology, Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqiang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Qingdao Women and Children\u2019s Hospital, Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]},{"name":"School of Stomatology, Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]},{"name":"School of Stomatology, Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens15050465","article-title":"Syphilis co-infection among people living with HIV in Romania: Epidemiological and clinical characteristics in a single-center retrospective study","volume":"15","author":"Arbune","year":"2026","journal-title":"Pathogens"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1093\/jac\/dku111","article-title":"The risk of seizures among the carbapenems: A meta-analysis","volume":"69","author":"Cannon","year":"2014","journal-title":"J. Antimicrob. Chemother"},{"key":"B3","first-page":"700","article-title":"Oral lesions in infection with human immunodeficiency virus","volume":"83","author":"Coogan","year":"2005","journal-title":"Bull. World Health Organ."},{"key":"B4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.oooo.2023.07.011","article-title":"Management of cervicofacial infection: A 7-year retrospective study","volume":"137","author":"Garola","year":"2024","journal-title":"Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1097\/QAD.0b013e32830184df","article-title":"Neurosyphilis in a clinical cohort of HIV-1-infected patients","volume":"22","author":"Ghanem","year":"2008","journal-title":"AIDS"},{"key":"B6","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.bjoms.2020.08.102","article-title":"Clinical features and presentation of cervicofacial infection: A maxillofacial trainee research collaborative (MTREC) study","volume":"59","author":"Henry","year":"2021","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5604\/01.3001.0054.8465","article-title":"Deep neck infections. Review of 111 cases","volume":"79","author":"Isankova","year":"2025","journal-title":"Otolaryngol. Pol."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2026.1776587","article-title":"Immune reconstitution efficacy and associated risk factors for immunological non-response in people living with HIV during long-term antiretroviral therapy: A single-center retrospective cohort study at a tertiary care hospital in China","volume":"17","author":"Li","year":"2026","journal-title":"Front. Immunol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"136","DOI":"10.3760\/cma.j.cn112144-20200323-00169","article-title":"Expert consensus on the treatment of oral and maxillofacial space infections","volume":"56","author":"Li","year":"2021","journal-title":"Zhonghua Kou Qiang Yi Xue Za Zhi"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/dj11100231","article-title":"Oral secondary syphilis in an HIV-positive transgender patient: A case report and review of the literature","volume":"11","author":"Mauceri","year":"2023","journal-title":"Dent J. (Basel)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000039617","article-title":"Clinical and laboratory characteristics of asymptomatic and symptomatic neurosyphilis in HIV-infected patients: A retrospective study in China","volume":"103","author":"Miao","year":"2024","journal-title":"Med. (Baltimore)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1177\/09564624231162415","article-title":"Malignant syphilis as the presenting complaint of advanced HIV","volume":"34","author":"Montenegro-Idrogo","year":"2023","journal-title":"Int. J. STD AIDS"},{"key":"B13","unstructured":"Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV\n          \n          \n          Washington, DC\n          Department of Health and Human Services\n          \n          2026"},{"key":"B14","unstructured":"Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV: National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America\n          \n          \n          \n          2026"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1177\/000348940111001111","article-title":"Deep neck abscess: A retrospective review of 210 cases","volume":"110","author":"Parhiscar","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.23311","article-title":"Management of Ludwig's angina at a tertiary care hospital in western region of India","volume":"14","author":"Parmar","year":"2022","journal-title":"Cureus"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/children9070979","article-title":"Paediatric deep neck infection-the risk of needing intensive care","volume":"9","author":"Perina","year":"2022","journal-title":"Children (Basel)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/892427","article-title":"Clinical spectrum of oral secondary syphilis in HIV-infected patients","volume":"2013","author":"Ram\u00edrez-Amador","year":"2013","journal-title":"J. Sex Transm. Dis."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4084\/mjhid.2025.056","article-title":"Atypical dermatological manifestations of syphilis in advanced HIV: A case-based narrative review","volume":"17","author":"Scarvaglieri","year":"2025","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3897\/folmed.67.e137670","article-title":"Potential predictors contributing to an increased hospital stay in odontogenic maxillofacial space infections: A retrospective study","volume":"67","author":"Shah","year":"2025","journal-title":"Folia Med. (Plovdiv)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1007\/s12105-020-01283-4","article-title":"Oral manifestations of syphilis: A review of the clinical and histopathologic characteristics of a reemerging entity with report of 19 new cases","volume":"15","author":"Smith","year":"2021","journal-title":"Head Neck Pathol."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.12659\/ajcr.941731","article-title":"Unusual case of Ludwig angina caused by Clostridium sporogenes in an immunocompromised HIV-positive patient with alcoholism and dental abscess","volume":"24","author":"Truong","year":"2023","journal-title":"Am. J. Case Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1186\/s12903-025-05971-x","article-title":"Epidemiological characteristics and risk factors for prolonged hospitalisation in oral and maxillofacial space infections: A 3-year retrospective study of 217 cases","volume":"25","author":"Wang","year":"2025","journal-title":"BMC Oral. Health"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm Rep."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1327896","article-title":"Clinical and immunological characteristics of HIV\/syphilis co-infected patients following long-term antiretroviral treatment","volume":"11","author":"Wu","year":"2023","journal-title":"Front. Public Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"952","DOI":"10.3760\/cma.j.cn112144-20200217-00062","article-title":"Retrospective analysis of the effectiveness of treating multi-space infection combined with descending necrotizing mediastinitis at oral maxillofacial and cervical region via multidisciplinary team collaboration","volume":"55","author":"Zheng","year":"2020","journal-title":"Zhonghua Kou Qiang Yi Xue Za Zhi"},{"key":"B27","doi-asserted-by":"publisher","first-page":"140","DOI":"10.5582\/bst.2024.01382","article-title":"Combating syphilis resurgence: China's multifaceted approach","volume":"19","author":"Zhou","year":"2025","journal-title":"Biosci. Trends"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1945372\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:24Z","timestamp":1788412464000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1945372\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":27,"alternative-id":["10.3389\/fcimb.2026.1945372"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1945372","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1945372"}}