VINCENT'S ANGINA

Vincent angina goes by many other names including acute necrotizing ulcerative gingivitis (ANUG), acute membranous gingivitis, fusospirillary gingivitis, fusospirillosis, fusospirochetosis, fusospirochetal gingivitis, necrotizing gingivitis, phagedenic gingivitis, ulcerative gingivitis, Vincent stomatitis, Vincent gingivitis Vincent infection, anaerobic pharyngitis and trench mouth. This condition is so called after the French physician Henri Vincent (1862-1950). The word "angina" comes from the Latin "angere" meaning "to choke or throttle." Poor oral hygiene coupled with physical or emotional stress, nutritional deficiencies, blood dyscrasias, debilitating diseases, and insufficient rest predispose to this disease. It rarely occurs in nonsmokers.

Etiology:
 It is a mixed infection of spirochetes (Treponema vincenti) and anaerobic fusiforms (Fusobacterium necrophorum). T. vincentii is 5-10 μm long, has 3-8 irregular spirals, stains uniformly and is strict anaerobe. Fusobacteria are thin, curved rods measuring 10-14 μm, fusiform shaped with central portion deeply stained than ends.

Clinical features: 
It is a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums. The chief manifestations are acutely painful, bleeding gingivae, salivation, and overwhelming fetor oris. The condition is characterized by the presence of grayish membrane and foul odor to the breath. The ulcerations, usually limited to the marginal gingiva and interdental papillae, have a characteristic punched-out appearance. They are covered by a grayish membrane and bleed with slight pressure or irritation. Swallowing and talking may be painful. Regional lymphadenopathy is often present. Loss of the gingival papillae is generally permanent. Differential diagnoses include streptococcal pharyngitis and diphtheria.

Laboratory diagnosis:
Throat swabs should be collected for smear and culture. Gram stained smear shows the presence of gram negative fusiform bacilli and spirochete. Since the pathogens are anaerobes, they are difficult to culture. Additionally, both spirochetes and fusobacteria are normally found in oral cavity and their isolation in culture is not always conclusive.

Treatment:  
Treatment of Vincent's angina involves hydrogen peroxide mouthwash, debridement and antibiotic penicillin. Alternatives to penicillin are Ampicillin/sulbactam IV or amoxicillin/clavulanate oral, Penicillin IV plus metronidazole and Clindamycin oral or IV.