1/60. Hereditary neuropathy and vocal cord paralysis in a man with childhood diphtheria. We present the case of a 37-year-old Afghani man with a history of childhood diphtheria, who was diagnosed with bilateral vocal cord paralysis at age 15 years. At about this time he developed progressive muscular wasting and distally predominant weakness, and subsequently developed respiratory insufficiency, necessitating nocturnal ventilatory support. His examination suggested a distal symmetric sensorimotor neuropathy, and his brother was similarly affected, although to a lesser degree. electromyography (EMG) and nerve conduction studies revealed this process to be purely axonal. A diagnosis of possible hereditary motor and sensory neuropathy (HMSN) type IIc, hereditary axonal polyneuropathy with vocal cord paralysis, is proposed, although the question of early diphtheritic involvement of the vocal cords and peripheral nerves is also considered. ( info) |
| We describe a 4.5-year-old girl who presented with severe febrile throat infection and who, after a few days, developed ventricular tachycardia followed by atrioventricular block. Although a pacemaker was inserted, she died of cardiogenic shock. Throat cultures were positive for corynebacterium diphtheriae. ( info) |
3/60. Retrospective diagnosis of diphtheria by detection of the corynebacterium diphtheriae tox gene in a formaldehyde-fixed throat swab using PCR and sequencing analysis. The tox gene of corynebacterium diphtheriae was detected in a formaldehyde-fixed throat swab taken from a 68-year-old man who was reported to have died of suffocation due to a pharyngeal tumor. dna templates prepared from bacterial cells fixed with 10% formaldehyde were subjected to a PCR analysis with tox gene-specific PCR primers. The resultant 112-nucleotide-long PCR product was sequenced using a dye terminator method, and an expected 57-nucleotide-long internal sequence of the tox gene was detected. This method is applicable for retrospective diagnosis in diphtheria cases in which only a formaldehyde-fixed clinical sample is available. ( info) |
4/60. '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. ( info) |
5/60. 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. ( info) |
6/60. 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. ( info) |
7/60. 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. ( info) |
8/60. Laryngopharyngitis by Corynebacterium ulcerans. A 71-year-old female patient was hospitalized with membranous laryngopharyngitis typical of classical diphtheria. A toxigenic strain of Corynebacterium ulcerans was isolated from the throat. The patient was treated for 6 days with amoxicillin-clavulanic acid and recovered without complications. This second reported case of diphtheric laryngopharyngitis caused by C. ulcerans in switzerland is a reminder that C. ulcerans should be included as a possible agent in patients with classical diphtheria symptoms. ( info) |
9/60. 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. ( info) |
| Fulminant endocarditis affecting the mitral valve in an 11-year-old boy was caused by a nontoxogenic strain of corynebacterium diphtheriae. ( info) |