A Case Of Fatal Diphtheria In A Paediatric Patient

Z. Z. Rashid, N. A. Mohamed, T. Fong
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引用次数: 2

Abstract

The introduction of diphtheria immunisation into the Expanded Program of Immunisation in the 1970s has markedly reduced the incidence of diphtheria diseases. We report a case of fatal diphtheria in a 2 year-old girl whose immunisation status was not known. She had presented with acute exudative tonsillitis and was treated with intravenous amoxicillin-clavulanate but showed progressive signs of upper airway obstruction; stridor, drooling of saliva and bull-neck appearance, with bilateral facial swelling around the parotid region that extended to submental and submandibular regions. Initial cultures from blood, throat, nasal and oral cavity revealed no significant organisms. Corynebacterium diphtheriae subspecies gravis which was resistant to penicillin, was isolated from pus specimen a day after her demise. Clinical suspicion is important to aid diagnosis, microbiological confirmation and management of diphtheria, as the disease is rare in the era of successful immunisation programs. Microbiological vigilance plays an important role in early detection of infection as well as outbreaks. Early institution of diphtheria antitoxin may save lives, while delay in diagnosis may increase mortality and the risk of transmission. This case reaffirms the vital role of immunisation and the importance of efforts to ensure a high uptake of the scheduled immunisations.
小儿致死性白喉1例
20世纪70年代将白喉免疫纳入扩大免疫方案,大大降低了白喉疾病的发病率。我们报告了一个2岁女孩的致命白喉病例,她的免疫状况尚不清楚。她曾表现为急性渗出性扁桃体炎,静脉注射阿莫西林-克拉维酸治疗,但表现出上呼吸道阻塞的进行性迹象;喘鸣,流口水和牛颈状外观,双侧面部腮腺周围肿胀,并延伸到颏下和下颌下区域。血液、咽喉、鼻腔和口腔的初步培养未发现明显的微生物。患者死亡后1天从脓标本中分离出对青霉素耐药的白喉棒状杆菌严重亚种。临床怀疑对于帮助白喉的诊断、微生物学确认和管理非常重要,因为这种疾病在成功的免疫规划时代是罕见的。微生物警惕性在早期发现感染和疫情方面起着重要作用。早期使用白喉抗毒素可挽救生命,而延误诊断可增加死亡率和传播风险。这一病例重申了免疫的至关重要作用以及努力确保计划免疫的高接种率的重要性。
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