Cases reported "Diphtheria"

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1/5. 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.
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2/5. 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.
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3/5. Fatal diphtheria in an older woman.

    A previously healthy 68-year-old woman presented with fever and sore throat. Her condition was initially diagnosed as necrotizing streptococcal tonsillitis and was treated with penicillin g, given intravenously. A swab of her throat taken for culture at the time of admission yielded corynebacterium diphtheriae 48 hours later. At that time an electrocardiogram showed new T-wave inversion--evidence of diphtheritic myocarditis. She was immediately given 60 000 units of equine diphtheria antitoxin (following a test dose), but later that day she began choking, became apneic and died. The patient had not received any immunizing agents as a child, and no antitoxin was detected in a blood sample obtained prior to administration of the antitoxin. Her death re-emphasizes the seriousness of diphtheria, an infection to which many elderly people are susceptible.
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keywords = fever
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4/5. paralysis of accommodation in infectious mononucleosis.

    A case report of a 22-year-old patient with accommodative paralysis is presented including (1) the five-year history beginning with infectious mononucleosis; (2) recent clinical examination showing accomodative paralysis and reduced pupilary responses to light and near; (3) objective recordings confirming both the absence of any accommodation and the presence of pupillary responses to monocular and binocular near stimuli and to light, the latter with pupillary escape; and finally (4) neuropharmacological tests showing 7-diopter accommodative responses to pilocarpine (an acetylcholine substitute acting directly on the ciliary muscle receptor sites) and absent responses to demecarium bromide (a cholinesterase blocking agent which potentiates neurally released acetylcholine). infectious mononucleosis includes ocular signs and symptoms. In young persons with accommodative difficulties, infectious mononucleosis should be suspected.
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ranking = 47107.517353391
keywords = infectious mononucleosis, mononucleosis
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5/5. Bacterial tracheitis caused by corynebacterium diphtheriae.

    Diphtheria has become a rare disease in germany. We report on an unimmunized 3.5-year-old German girl with a 7-day history of respiratory distress and fever, presenting a clinical picture mimicking typical bacterial tracheitis without pharyngeal and laryngeal manifestation. diagnosis of diphtheria was not made until culture of tracheal secretions yielded growth of a toxigenic strain of corynebacterium diphtheriae. The patient died from toxic cardiac failure despite treatment with diphtheria antitoxin. This is the second reported case of isolated bacterial tracheitis caused by corynebacterium diphtheriae. CONCLUSION: The observation of a lethal course of diphtheric tracheitis emphasizes the paramount importance of immunization against diseases like diphtheria.
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keywords = fever
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