What is the treatment for Vincent angina?

Treatment of Vincent Angina

The first-line treatment for Vincent angina (fusospirochetal gingivitis) is penicillin VK at a dose of 250-500 mg (400,000-800,000 units) every 6-8 hours for mild to moderate oropharyngeal infections. 1

Disease Overview

Vincent angina, also known as acute necrotizing ulcerative gingivitis, fusospirochetal gingivitis, or Plaut-Vincent angina, is an infection of the oral mucosa caused by a symbiotic relationship between fusiform bacteria and spirochetes (primarily Fusobacterium necrophorum and Borrelia vincenti). It typically presents as necrotizing ulcers on the oral mucosa, particularly affecting the gingiva, tonsils, and pharynx. 2, 3

Diagnostic Approach

• Microscopic examination: Direct microscopic examination of samples from the ulcerated areas is the most reliable method for diagnosis, revealing the characteristic fusospirochetal complex 4
• Clinical presentation: Typically presents as unilateral ulcero-necrotic tonsillitis, most commonly in young adults aged 16-25 years 4
• Culture: Special anaerobic culture conditions are required but are often difficult to perform reliably 2

Treatment Algorithm

First-line Therapy

1. Antimicrobial therapy:

   • Penicillin VK: 250-500 mg orally every 6-8 hours for mild to moderate oropharyngeal infections 1
   • Duration: Continue until clinical resolution, typically 7-10 days

2. Local measures:

   • Oral hygiene improvement
   • Warm saline rinses
   • Necessary dental care should be accomplished for infections involving gum tissue 1

Alternative Therapy (for penicillin-allergic patients)

• Consider macrolides or clindamycin based on clinical judgment

Special Considerations

• Vincent angina appears almost twice as frequently in women as in men 4
• The fusospirochetal complex has relatively low pathogenicity and typically causes disease in patients with reduced local or general immune resistance 4
• In approximately one-third of patients with infectious mononucleosis, the fusospirochetal complex may be present in tonsillar lesions, suggesting a potential association 3, 4
• Do not confuse with angina bullosa hemorrhagica, which is a benign condition presenting as blood blisters on the oral mucosa that resolves spontaneously 5

Monitoring and Follow-up

• Assess clinical response within 48-72 hours of initiating therapy
• Complete resolution of symptoms should occur within 7-10 days with appropriate treatment
• Consider underlying conditions that may predispose to infection, including compromised immune status

Pitfalls and Caveats

• Severe cases may require more aggressive management including hospitalization and IV antibiotics
• Failure to address dental hygiene issues may lead to recurrence
• Misdiagnosis is common due to similarity with other oral conditions
• Specimen collection for diagnosis must be done carefully to preserve anaerobic conditions for proper identification 2

Remember that proper identification of the causative organisms through microscopic examination is crucial for accurate diagnosis, as cultivation of these anaerobic bacteria requires special conditions and can be challenging.