Hepatitis B virus infection and metabolic dysfunction associated steatotic liver disease:Rising pandemic with complex interaction

Due to sedentary lifestyle and rising prevalence of obesity,patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disease(MASLD).Both chronic hepatitis B virus(HBV)infection and MASLD can damage hepatocytes in their own way,but concomitant HBV-MASLD has its own clinical implications.Cherry on top is the presence of diabetes mellitus,hypertension or obesity which added more chances of unfavorable outcomes in these patients.In this article,we co-mment on the article by Wang et al published in the recent issue.This article provides a comprehensive overview of the complex interaction between HBV-MASLD,HBV alone and MASLD alone patients.We discuss key findings from recent studies,including the promising outcomes observed in patients with concurrent HBV and MASLD,warrants further research.The insights presented here offer renewed understanding of this complex interaction.

Role of nutrition in diabetes mellitus and infections

In this editorial,we have commented on the article that has been published in the recent issue of World Journal of Clinical Cases.The authors have described a case of unilateral thyroid cyst and have opined that the acute onset of infection may be linked to diabetes mellitus(DM).We have focused on the role of nutrition in the association between DM and infection.Patients with DM are at a high risk of infection,which could also be attributed to nutrition-related factors.Nutritional interventions for patients with diabetes are mainly based on a low-calorie diet,which can be achieved by adhering to a low-carbohydrate diet.However,dietary fiber supplementation is recommended to maintain the diversity of the gut microbiota.Furthermore,high-quality protein can prevent the increased risk of infection due to malnutrition.Supplementation of vitamins C,vitamins A,vitamins D,and folic acid improves blood sugar control and facilitates immune regulation.Mineral deficiencies augment the risk of infection,but the relationship with diabetes is mostly U-shaped and a good intake should be maintained.

Exploring the performance of large language models on hepatitis B infection-related questions:A comparative study

BACKGROUND Patients with hepatitis B virus(HBV)infection require chronic and personalized care to improve outcomes.Large language models(LLMs)can potentially provide medical information for patients.AIM To examine the performance of three LLMs,ChatGPT-3.5,ChatGPT-4.0,and Google Gemini,in answering HBV-related questions.METHODS LLMs’responses to HBV-related questions were independently graded by two medical professionals using a four-point accuracy scale,and disagreements were resolved by a third reviewer.Each question was run three times using three LLMs.Readability was assessed via the Gunning Fog index and Flesch-Kincaid grade level.RESULTS Overall,all three LLM chatbots achieved high average accuracy scores for subjective questions(ChatGPT-3.5:3.50;ChatGPT-4.0:3.69;Google Gemini:3.53,out of a maximum score of 4).With respect to objective questions,ChatGPT-4.0 achieved an 80.8%accuracy rate,compared with 62.9%for ChatGPT-3.5 and 73.1%for Google Gemini.Across the six domains,ChatGPT-4.0 performed better in terms of diagnosis,whereas Google Gemini demonstrated excellent clinical manifestations.Notably,in the readability analysis,the mean Gunning Fog index and Flesch-Kincaid grade level scores of the three LLM chatbots were significantly higher than the standard level eight,far exceeding the reading level of the normal population.CONCLUSION Our results highlight the potential of LLMs,especially ChatGPT-4.0,for delivering responses to HBV-related questions.LLMs may be an adjunctive informational tool for patients and physicians to improve outcomes.Nevertheless,current LLMs should not replace personalized treatment recommendations from physicians in the management of HBV infection.

Ultrasound features of congenital cytomegalovirus infection in the first trimester:A case report

BACKGROUND Congenital cytomegalovirus(CMV)infection represents a significant public health concern as the most prevalent viral infection in newborns,potentially leading to severe neurological and developmental complications.The majority of cases are asymptomatic and remain undetected during pregnancy due to the absence of effective screening methods.CASE SUMMARY A 27-year-old primigravida presented for early pregnancy ultrasound,which revealed an atypical finding:A normal anechoic thalamus appearing hyperechoic on the mid-sagittal view of the fetal head.Subsequent ultrasound examinations during mid and late gestation demonstrated classic intracranial features sug-gestive of congenital CMV infection.Chromosomal karyotyping and microarray analysis of the fetus yielded no significant abnormalities.Following compre-hensive prenatal counseling regarding potential adverse fetal outcomes,the patient elected to continue her pregnancy.She ultimately underwent cesarean delivery at 42 weeks gestation at another facility,resulting in the birth of a female neonate.At five months of age,the infant presented with epilepsy and significant growth and developmental delays.CONCLUSION Congenital CMV infection occurs during the first trimester may manifest as hyperechoic thalamus which can be revealed by ultrasound in the mid-saggital view of the fetal head.Future research should investigate the correlation between echogenic thalamus and developmental outcomes,as well as explore early sc-reening techniques for suspected congenital CMV infection cases.

Pneumonia caused by co-infection with Pneumocystis jirovecii and Trichosporon coremiiforme

Fungal infections are relatively common among patients with systemic lupus erythematosus (SLE), and patients may be infected simultaneously or sequentially with multiple fungal species. Physicians need to select appropriate antifungal agents and therapeutic regimens based on the type and severity of the infection. Herein, we report a young SLE patient who developed concurrent pulmonary infection with Pneumocystis jirovecii and Trichosporon coremiiforme. The patient presented with a variety of imaging manifestations,with specifi c features evolving as the disease progressed.

Fever without source in infants aged 22–60 days:how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?

Febrile infants are at greater risk of invasive bacterial infections (IBI),which include bacterial meningitis and bacteremia.Although bacterial meningitis is uncommon,^([1-2])it remains a concern for clinicians treating infants younger than 90 d.Guidelines for investigating fever without a source(meaning without an apparent source of infection,or of nonobvious origin) are numerous around the world but remain conflicting,particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.

Prevalence of transfusion transmissible infections among various donor groups:A comparative analysis

BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.

Application of myxovirus resistance protein A in the etiological diagnosis of infections in adults

BACKGROUND: Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A(MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of Mx A to distinguish viral from bacterial infections.METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic(ROC) curve analysis were used to determine the diagnostic value of Mx A, either alone or in combination with C-reactive protein(CRP) or procalcitonin(PCT), in patients with viral, bacterial, or co-infections.RESULTS: The value of MxA(ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections(82.3 [24.5–182.9] vs. 16.4 [10.8–26.5], P<0.0001)(82.3 [24.5–182.9] vs. 28.5 [10.2–106.8], P=0.0237). The area under the curve(AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799(95% confidence interval [95% CI] 0.696–0.903), with a sensitivity of 68.9%(95% CI 54.3%–80.5%) and specificity of 90.0%(95% CI 74.4%–96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus(15.8 [9.6–47.6] ng/mL) and Epstein-Barr virus(12.9 [8.5–21.0] ng/mL) infections.CONCLUSION: Our study showed the diagnostic efficacy of Mx A in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, EpsteinBarr virus and human cytomegalovirus infections did not elicit elevated Mx A expression.

Evaluating risk factors for surgical site infections and the effectiveness of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy

BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.

Impact of 222-nm ultraviolet disinfection combined with psychological care on the emotional and hospital infection of critical patients

BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.

Angiotensin-converting enzyme 2 and hepatic SARS-CoV-2 infection:Regulation,association,and therapeutic implications

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)enters host cells via the angiotensin-converting enzyme 2(ACE2)receptor.Mounting evidence has indicated the presence of hepatic SARS-CoV-2 infection and liver injury in pa-tients with coronavirus disease 2019(COVID-19).Understanding the mechanisms of hepatic SARS-CoV-2 infection is crucial for addressing COVID-19–related liver pathology and developing targeted therapies.This editorial discusses the signi-ficance of ACE2 in hepatic SARS-CoV-2 infection,drawing on the research by Jacobs et al.Their findings indicate that hepatic ACE2 expression,frequency of hepatic SARS-CoV-2 infection,and severity of liver injury are elevated in patients with pre-existing chronic liver diseases.These data suggest that hepatic ACE2 could be a promising therapeutic target for COVID-19.

Hepatic eosinophilic pseudotumor due to Fasciola hepatica infection mimicking intrahepatic cholangiocarcinoma: A case report

BACKGROUND Hepatic eosinophilic pseudotumor(HEPT)is a rare condition that mimics ma-lignant hepatic tumors,posing significant diagnostic challenges.This case report highlights the importance of considering parasitic infections like Fasciola hepatica(F.hepatica)in the differential diagnosis of hepatic masses,especially in endemic regions,to prevent unnecessary interventions.CASE SUMMARY A 40-year-old female presented with a 1-month history of epigastric pain and significant weight loss.Imaging revealed a hepatic mass,initially misdiagnosed as intrahepatic cholangiocarcinoma.Laboratory results showed marked eosinophilia,and histopathological examination confirmed significant eosinophilic infiltration without malignancy.Serological testing identified F.hepatica infection.The patient was treated with a single dose of triclabendazole,leading to complete symptom resolution and normalization of hepatic imaging findings within days.CONCLUSION HEPT due to F.hepatica can closely mimic malignancy;timely antiparasitic treat-ment is crucial for resolution.

Deep neck infections mortal complications:Intrathoracic complications and necrotising fasciitis

BACKGROUND We planned this study considering that complications of deep neck infections can be seriously life threatening.AIM To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity.METHODS This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1,2024.When the patient files were retrospectively examined,16 of 188 patients(8.5%)were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications.RESULTS There were a total of 16 patients in this study,9 males(56.25%)and 7 females(43.75%).All patients were adults(>18 years)and the mean age was 50.37 years±15.37 years.Female patients had a mean age of 40.42 years±13.38 years,whereas for male patients was 58.11 years±12.44 years.CONCLUSION Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries,intensive care unit monitoring,and mechanical ventilator support.Higher rates of morbidity and mortality should be expected in Bal KK et al.Deep neck infections mortal complications WJCC https://www.wjgnet.com 6384 October 26,2024 Volume 12 Issue 30 these patients who are hospitalized for longer periods of time.

Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma:A case report

BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common complication after PT,and when combined with organ dysfunction and sepsis,it will result in a poorer prognosis.CASE SUMMARY We report a 25-year-old patient with multiple organ injuries,including the pancreas,due to abdominal trauma,who developed necrotising pancreatitis secondary to emergency caesarean section,combined with intra-abdominal infection(IAI).The patient underwent performed percutaneous drainage,pancreatic necrotic tissue debridement,and abdominal infection foci debridement on the patient.CONCLUSION We report a case of severe AP and IAI secondary to trauma.This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery,and a better outcome was obtained.

Lymphovenous anastomosis and complex decongestive therapy for severe deformed lymphedema with recurrent infection:A case report

BACKGROUND Lower extremity lymphedema is a common complication following treatment for gynecological malignancies.Its incidence rate can reach up to 70%,affecting~20 million people worldwide.However,specialized treatment centers are scarce,and there is a lack of consensus on treatment approaches.Furthermore,there are even fewer reports on the systematic and effective treatment of severe lymphedema with malformations.Effective management of this condition remains a significant challenge for clinicians.CASE SUMMARY A 40-year-old woman developed bilateral leg swelling 6 years after receiving treatment for endometrial cancer.Since August 2018,she experienced>30 episodes of lymphangitis.Upon presentation,she exhibited bilateral leg swelling and deformation,with four large swellings in the posterior thigh that impeded movement,and pain in the limbs.Skin manifestations included lichenoid lesions and features of deep sclerosis.Radionuclide lymphoscintigraphy confirmed the diagnosis of lower limb lymphedema.After 6 mo of complex decongestive therapy(CDT)and three lymphaticovenous anastomosis(LVA)treatments,the patient lost 49 kg in weight.She also experienced a maximum circumference reduction of 35.2 cm in the left lower limb and 37.5 cm in the right lower limb.The leg pain disappeared,her swelling significantly decreased,and she regained the ability to walk,cycle,and run normally.CONCLUSION The combined application of CDT and LVA therapy demonstrates significant positive effects in the treatment of severe,deformed stage III lymphedema.

Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics

Objective:To explore the effect of the Plan-Do-Check-Action(PDCA)cycle on hand hygiene and nosocomial infection quality of or thopedic medical staff.Methods:The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization.Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time,and compare the compliance of hand hygiene before and after implementation,and evaluate the quality of nosocomial infection.Results:The hand hygiene compliance of doctors and nurses in stage P was 82%.The compliance of medical staff in stage D was 93%.The compliance of stage C was 94%and that of stage A was 95%.The quality score of hospital self-examination nosocomial infection was also significantly increased.Conclusions:The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality,which is wor thy of circulatory application in or thopedic nosocomial infection quality control,especially improving the quality of hand hygiene.

Clinical experience of professor LI Xiuhui in treating acquired immune deficiency syndrome(AIDS)complicated with opportunistic infections using the methodology of “turbid toxins entering the blood and expelling pathogens outwardly”

This paper summarized professor LI Xiuhui's experience in treating acquired immune deficiency syndrome(AIDS) complicated with opportunistic infections(OIs) using the methodology of “turbid toxins entering the blood and expelling pathogens outwardly”. OIs are significant cause of morbidity and mortality among AIDS patients. Professor LI Xiuhui believes that the pathogenesis of OIs lies in turbid toxins entering the blood, infecting the Sanjiao, damaging the nutrient Qi and defensive Qi, consuming Qi and essence, and impairing the primordial Qi. As a result, the five organs are weakened, pathogenic toxins overflow, leading to the occurrence of some related opportunistic infectious diseases in various systems throughout the body. Therefore, in treatment, the “penetrating and supporting method” and the “tonifying and supporting method” are used to consolidate and support the healthy Qi, allowing the pathogenic toxins to be expelled smoothly,so that the opportunistic infectious diseases can be cured or controlled.

Urgent call for attention to diabetes-associated hospital infections

In this editorial,we discuss the recent article by Zhao et al published in the World Journal of Diabetes,which highlights the importance of recognizing the risk indicators associated with diabetes mellitus(DM).Given the severe implications of healthcare-associated infections(HAIs)in hospitalized individuals-such as heightened mortality rates,prolonged hospitalizations,and increased costs-we focus on elucidating the connection between DM and nosocomial infections.Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection,with some already harboring co-infections upon admission.Notably,DM is an important risk factor for nosocomial urinary tract infections and surgical site infections,which may indirectly affect the occurrence of nosocomial bloodstream infections,especially in patients with DM with poor glycemic control.Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive,attention to this potential association is warranted.Hospitalized patients with DM should prioritize meticulous blood glucose management,adherence to standard operating procedures,hand hygiene practices,environmental disinfection,and rational use of drugs during hospitalization.Further studies are imperative to explore the main risk factors of HAIs in patients with DM,enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.

Prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections

Osteomyelitis is a devastating disease caused by microbial infection in deep bone tissue.Its high recurrence rate and impaired restoration of bone deficiencies are major challenges in treatment.Microbes have evolved numerous mechanisms to effectively evade host intrinsic and adaptive immune attacks to persistently localize in the host,such as drug-resistant bacteria,biofilms,persister cells,intracellular bacteria,and small colony variants(SCVs).Moreover,microbial-mediated dysregulation of the bone immune microenvironment impedes the bone regeneration process,leading to impaired bone defect repair.Despite advances in surgical strategies and drug applications for the treatment of bone infections within the last decade,challenges remain in clinical management.The development and application of tissue engineering materials have provided new strategies for the treatment of bone infections,but a comprehensive review of their research progress is lacking.This review discusses the critical pathogenic mechanisms of microbes in the skeletal system and their immunomodulatory effects on bone regeneration,and highlights the prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections.It will inform the development and translation of antimicrobial and bone repair tissue engineering materials for the management of bone infections.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.