1/18. 'Corynebacterium ulcerans': a potential cause of diphtheria.Symptoms similar to those of diphtheria may occasionally be caused by micro-organisms other than corynebacterium diphtheriae, such as zoonotic corynebacteria. A case of pharyngitis caused by toxigenic 'C. ulcerans' in a 9 year old girl illustrates the importance of including diphtheroids in the differential diagnosis. The presenting symptoms may have been attenuated by previous immunisation against C. diphtheriae. 'C. ulcerans' should be considered in the differential diagnosis of pharyngitis, especially in patients with a history of contact with farm animals or the consumption of raw dairy products.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/18. Respiratory diphtheria in three paediatric patients.From August till November 1998, the Paediatric and Anaesthetic Units of Hospital Kuala Terengganu managed three patients from Kuala Terengganu District who were ventilated for respiratory diphtheria. Their ages were 5, 4 and 7 years old and their immunisation for diphtheria were not complete. All three patients presented with respiratory distress and were ventilated for upper airway obstruction. Their treatment included intravenous penicillin and diphtheria antitoxin. One patient died of cardiogenic shock with secondary pneumonia. Pharyngeal and tonsillar swabs of all three patients grew toxigenic corynebacterium diphtheriae biotype mitis. There were 765 throat cultures taken from contacts. The confirmed positive cultures grew 2 toxigenic and 3 non-toxigenic corynebacterium diphtheriae biotype mitis and surprisingly, 10 non-toxigenic biotype gravis. A prevalence study is needed to document the endemicity of diphtheria in Kuala Terengganu and to determine the carrier rate of both biotypes. Steps have been taken to increase the immunisation coverage in children. The giving of regular booster doses of diphtheria toxoid to the adult population should be considered.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
3/18. infection of the skin caused by Corynebacterium ulcerans and mimicking classical cutaneous diphtheria.Extrapharyngeal infections caused by Corynebacterium ulcerans have rarely been reported previously, and diphtheria toxin production has usually not been addressed. This case demonstrates that strains of C. ulcerans that produce diphtheria toxin can cause infections of the skin that completely mimic typical cutaneous diphtheria, thereby potentially providing a source of bacteria capable of causing life-threatening diseases in the patient's environment. Therefore, it is recommended to screen wound swabs for coryneform bacteria, identify all isolates, carefully assess possible toxin production, and send questionable strains to a specialist or a reference laboratory.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
4/18. epidemiology of three cases of severe diphtheria in Finnish patients with low antitoxin antibody levels.During the 1990-1998 diphtheria epidemic in the newly independent states of the former Soviet Union, more than 150,000 infections and 5,000 deaths occurred. During this period, more than 10 million trips were made from finland to russia or vice versa. This resulted in only 10 cases of diphtheria in finland. There was no secondary spread to healthcare workers or other close contacts. Three patients had severe respiratory tract diphtheria. All three were middle-aged men who had made a short visit to russia, during which time they had intimate contact with local women. These findings suggest diphtheria was transmitted mainly by direct saliva contact. All patients with severe diphtheria had a non-protective level of antitoxin antibodies during the first days of the disease. Only the patient whose antibody titre rose rapidly to a protective level (>1 IU/ml) had an uncomplicated recovery. The other two, one of whom died, had myocarditis and severe polyneuropathy.- - - - - - - - - - ranking = 2.3792558417703keywords = death (Clic here for more details about this article) |
5/18. Successful electrical pacing for complete heart block complicating diphtheritic myocarditis.A case of severe diphtheria complicated by myocarditis and neurorespiratory paralysis is reported. The myocarditis manifested with severe conduction disturbances including left bundle-branch block and high grade second degree atrioventricular block leading to Adams-Stokes attacks. Temporary transvenous electrical pacing for.3 days was successful in the management of this complication, but positive pressure ventilation was later required for respiratory paralysis. This case illustrates the potential value of electrical pacing in diphtheritic myocarditis. Sporadic cases of diphtheria still occur and the case fatality ratio remains at 10%, much of which is related to the occurrence of myocarditis.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
6/18. Cardiac diphtheria in a previously immunized individual.A previously healthy 19-year-old Asian female without significant past medical history presented to the emergency room complaining of a sore throat, difficulty in swallowing, fever, swollen neck, malaise, and myalgia for three to four days. The patient was initially seen at an outside hospital, evaluated by an ear, nose, and throat physician (ENT), and was found to have desquamative pharyngitis. The patient was transferred to our hospital after she continued to experience progressively worsening shortness of breath and went into acute respiratory distress. The patient was found to have laryngeal edema on exam with greenish-black, necrotic-looking tissue extending to the hypopharynx, nasopharynx, and oropharynx. A culture was taken. ENT was consulted for tracheostomy placement. The patient refused to have tracheostomy placed. She went into severe respiratory distress and required urgent tracheostomy. A cardiac consult was obtained. A 2D echocardiogram performed one day after admission revealed an ejection fraction (EF) of 10-20%, normal left ventricular cavity size, normal wall thickness, and severe global systolic dysfunction. There was mild to moderate mitral regurgitation and trace tricuspid regurgitation. The inferior vena cava was dilated and a 1 cm x 1.5 cm questionable mass or thrombus was seen. The patient's throat culture was positive for diphtheria. The CDC was contacted, and the patient was treated with antitoxin with prompt resolution of cardiac symptoms. A repeat echo done five days post-treatment showed improved EF of 65%, normal left ventricular thickness and function, with no clot visualized. She was treated with ceftriaxone and flagyl for ocular motor neuritis, otitis media, and strep. pneumonia with gradual improvement. These were all secondary to the diphtheria toxins, however, the patient continues to be followed as an outpatient by ENT for ongoing problems with swallowing, speech, and trach management.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
7/18. Subacute infective endocarditis caused by corynebacterium diphtheriae: a case report.The authors report an 11-year-old boy with septicemia and subacute infective endocarditis due to toxigenic-corynebacterium diphtheriae. The patient had underlying congenital heart disease and incomplete immunization. He presented with fever, epistaxis and congestive heart failure. He received high-dose penicillin therapy and diphtheria antitoxin with clinical improvement. While he was receiving a high dose of penicillin for 1 month he developed a generalized tonic clonic seizure. A computerized tomogram revealed intracerebral and ventricular hemorrhage. craniotomy with blood clot removal and ventriculostomy drainage were done. He died 2 days later from brain death and cardiovascular failure.- - - - - - - - - - ranking = 2.3792558417703keywords = death (Clic here for more details about this article) |
8/18. Should we be concerned about diphtheria in the UK?Diphtheria is a very rare condition in the developed world today with the advent of immunisation. Studies from the populations of england and wales, however, suggest a recent increase in the number of notified cases. Sore throat due to a tonsillitis is the most common manifestation and can, thus, present to the clinician. It can also present as, or be complicated by, life-threatening upper airway obstruction. This case demonstrates the former and highlights the latter, in an attempt to raise awareness of a condition which may be seen more frequently in the future.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
9/18. Diphtheritic neuropathy, an analysis based on muscle and nerve biopsy and repeated neurophysiological and autonomic function tests.A patient with diphtheritic neuropathy was investigated with repeated tests of parasympathetic and sympathetic vasomotor and sudomotor functions for one year after the onset of symptoms. Somatic nerve function was tested with nerve conduction studies and an index based on ten variables was used to follow the course of the neuropathy. sural nerve and anterior tibial muscle biopsies were performed. A severe but shortlasting impairment of the parasympathetic vagal reflex arc was found. The recovery of this function paralleled the clinical course. Sympathetic functions were normal. The neurophysiological variables of somatic nerve function showed signs of a mainly demyelinating mixed sensory/motor neuropathy. The recovery of these variables was slow. The nerve and muscle biopsies demonstrated mild changes consistent with a mixed, demyelinating, non-inflammatory neuropathy.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
10/18. Diphtheria presenting in the accident and emergency department.A case of diphtheria encountered in the accident and emergency department is described. In addition, 38 cases of diphtheria have been analysed, and demonstrate that, although now rare in this country, the disease still exists and its clinical features remain unchanged. It presents almost as often in the accident and emergency department as it does to the general practitioner and remains overwhelmingly a disease of children. Diphtheria is still a notifiable disease. The diagnosis must be made clinically and appropriate action taken before the bacteriological confirmation is received. This prevents unnecessary delay in treatment and makes contact tracing less arduous.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
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