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A Boy with Diphtheria
Published in Norman Begg, The Remarkable Story of Vaccines, 2023
I was dumbfounded. Diphtheria was a disease I had read about in my medical training. It used to be a common cause of death in young children. In 1914, at the outbreak of World War I, 59,324 cases of and 5,863 deaths from diphtheria were recorded in England and Wales. Within ten years, a vaccination against diphtheria had been developed and started to be widely used with dramatic impact. By 1952, the year I was born, the disease had been all but eliminated. Most doctors in developed countries will never see a case nowadays. Diphtheria had been conquered; but not quite.
Myocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Myocarditis is the most common cause of death in diphtheria by the action of exotoxin produced by Corynebacterium diphtheriae resulting in widespread necrosis of myocytes with little mainly macrophage inflammation. Although still a cause of morbidity and mortality in developing countries, diphtheria is now rare in the West due to vaccination as well as mumps. Bacterial endotoxin is also considered to play a role in meningococcal myocarditis. Myocarditis may be a complication of β-haemolytic streptococci due to bacterial exotoxins.
Respiratory Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Diphtheria, caused by the bacterium Corynebacterium diphtheriae, is a potentially fatal infection that can affect the nose and throat and sometimes the skin. C. diphtheriae infections are rare in vaccinated populations, but there have been recent outbreaks, most notably among Rohingya refugees who fled from their homes in Myanmar to Bangladesh during the 2018 genocide. Suspect diphtheria when there is pharyngeal infection with a white-grey pseudomembrane with patches and lymphadenopathy leading to the characteristic ‘bull neck’. The bacteria produces an exotoxin that mediates effects including cardiac (myocarditis) and neurological (cranial nerve palsies and peripheral neuritis). Note that diphtheria can be a cause of non-healing skin ulcers, which have grey membranes. Notify the local public health body and refer for testing where cases are suspected. Treatment is with antibiotics (penicillin/macrolide), antitoxin and isolation. Close contacts should have prophylaxis and booster vaccination (see WHO guidance).2
A combined DTaP-IPV vaccine (Tetraxim®/Tetravac®) used as school-entry booster: a review of more than 20 years of clinical and post-marketing experience
Published in Expert Review of Vaccines, 2022
Catherine Huoi, Juan Vargas-Zambrano, Denis Macina, Emmanuel Vidor
Strains of Corynebacterium diphtheriae or Corynebacterium ulcerans can cause diphtheria disease. In countries with robust diphtheria vaccination programs, the incidence of diphtheria is extremely low [8–10]. However, diphtheria remains endemic in some areas of the world and regular small diphtheria outbreaks/resurgence are reported, mainly from Southeast Asia, the Indian subcontinent, South America, Africa, and Eastern Europe [11–15]. This reflects inadequate VCR and demonstrates the importance of sustaining high levels of immunity through the highest possible coverage in childhood, adolescence, and adulthood [16]. Individuals who are unvaccinated or incompletely vaccinated can also contract diphtheria during travel to endemic areas, as the bacterium spreads mainly through respiratory droplets. The World Health Organization (WHO) recommends a three-dose primary series as the foundation for building lifelong immunity to diphtheria. But in the absence of natural boosting, the humoral immunity conferred by primary vaccination wanes over time [10,16,17] and booster doses are hence needed for continued protection. WHO’s recommendations include a minimum of three booster doses: one during the second year of life (at 12–23 months of age), one at primary school entry (4–7 years of age), and one during adolescence (9–15 years of age) [16].
Fatal diphtheria myocarditis in a 3-year-old girl—related to late availability and administration of antitoxin?
Published in Paediatrics and International Child Health, 2018
Karlijn Van Damme, Natasja Peeters, Philippe G. Jorens, Tine Boiy, Marjan Deplancke, Hilde Audiens, Marek Wojciechowski, Jozef De Dooy, Margreet te Wierik, Erika Vlieghe
Diphtheria is an acute and fulminant infectious disease caused by toxicogenic strains of corynebacteria, i.e. Corynebacterium diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis. C. diphtheriae is the most common toxicogenic strain and is associated with person-to-person spread [1–3]. Respiratory diphtheria is usually characterised by a variable degree of pharyngitis followed by the formation of unilateral or bilateral tonsillar pseudomembranes. More severe illness can be associated with inflammation and oedema of the surrounding cervical lymph nodes, causing a bull-neck appearance. When it enters the bloodstream, the highly potent exotoxin may cause serious systemic complications, including myocarditis, which is often fatal, and peripheral neuropathy [1–4].
Protein Kinase C-Delta Defect in Autoimmune Lymphoproliferative Syndrome-Like Disease: First Case from the National Iranian Registry and Review of the Literature
Published in Immunological Investigations, 2022
Niusha Sharifinejad, Gholamreza Azizi, Nasrin Behniafard, Majid Zaki-Dizaji, Mahnaz Jamee, Reza Yazdani, Hassan Abolhassani, Asghar Aghamohammadi
The immunological investigations of the index patient were conducted based on the positive family history (Table 1). According to age-adjusted references, flow cytometry revealed a notable reduction in NK cells. A significant elevation of double-negative T cells accompanied by a slight elevation in CD8+ T cells was present in the patient. Other lymphocyte subtypes appeared to be within the normal range. Elevated serum IgG level was detected along with normal IgA and IgM. Despite routine vaccination, the patient’s anti-diphtheria level was beneath the protective level. The anti-nuclear antibody (ANA) test and polymerase chain reaction (PCR) assay for cytomegalovirus (CMV) and Epstein-bar virus (EBV) were all positive.