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A Boy with Diphtheria
Published in Norman Begg, The Remarkable Story of Vaccines, 2023
“He needs antitoxin,” muttered Ed. The boy had advanced diphtheria. His symptoms were being caused by the powerful toxin that is released by the bacterium that causes diphtheria. Diphtheria toxin is extraordinarily potent. It destroys heart and liver tissue and paralyses the nervous system. Seven - millionths of a gram is enough to kill an adult. The only way to reverse this is by giving a specific diphtheria antitoxin, which can neutralise its effects. Ed asked me to call the pharmacist.
Specific Infections in Children
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Neal Russell, Sarah May Johnson, Andrew Chapman, Christian Harkensee, Sylvia Garry, Bhanu Williams
Patients should be admitted and isolated under contact precautions (personal protective equipment [PPE]) from triage. Diphtheria antitoxin (DAT) should be given immediately to all probable cases10 (an intradermal diluted test dose should be given first due to 0.6% risk of anaphylaxis). Doses for DAT vary according to extent of disease, and national guidelines should be consulted. Antibiotics should be given immediately (intramuscular [IM]/IV benzylpenicillin, IV erythromycin or oral equivalents for less ill or probable/suspected cases). Judicious use of oxygen therapy is advised, as it can mask signs of worsening respiratory distress.
Infectious Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Vas Novelli, Delane Shingadia, Huda Al-Ansari
Equine diphtheria antitoxin should be given as soon as possible. The dose prescribed depends on the site and size of the diphtheric membrane, degree of toxicity and duration of the illness (severe disease – 80,000 U). The preferred route of administration is IV; however, before this is given, tests for sensitivity to horse serum should be performed. Penicillin or erythromycin is also given for 14 days to eradicate the organism, stop toxin production and to prevent transmission, but it is not a substitute for antitoxin. General supportive measures are also important (bed rest, hydration, serial ECG, suction of secretions).
Clinical profile and risk factors for mortality in children admitted with diphtheria: an observational study
Published in Infectious Diseases, 2023
Vishnu Mohan, Venkatesh Chandrasekaran, Sujatha Sistla
Due to widespread vaccination, the incidence of diphtheria, which was over a million per year in the first part of the nineteenth century, has dropped by over 95% in the previous three decades [1]. While the global case fatality rate of the disease is estimated to be around 5–10%, the rates are much higher (more than 20%) when it comes to the age group between 5 and 10 years [2]. Because of its vaccine-preventable nature and initial steady reduction, little attention has been paid to this disease of late, in the face of resurgence of cases worldwide with the incidence rate tripling globally from 1.1/1,000,000 population in 2016 to 3.5/1,000,000 population in 2019 according to World Health Organisation (WHO) database [3]. In the Southeast Asian Region of WHO too, the incidence rate has more than doubled over a three-year period from 2.1/1,000,000 population in 2016 to 5.2/1,000,000 population in 2019 [3]. The incidence rate in India for the same period was 2.6/1,000,000 population in 2016 and 7/1,000,000 population in 2019 [3]. The reasons for diphtheria re-emergence and associated deaths have been attributed to lack of awareness, poor immunisation coverage, and unavailability of diphtheria antitoxin [3].
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
Since the commencement of mass immunisation campaigns in the 1940s and 1950s and the introduction of childhood immunisation, this previously endemic disease has become rare in high-income countries, although diphtheria remains endemic in many low- and middle-income countries [1–4]. Whereas most fatalities occur in countries where diphtheria is still endemic, case-fatality rates are highest in countries where it is rare and a lack of familiarity with the disease leads to delayed diagnosis and treatment, and it is increasingly difficult to obtain diphtheria antitoxin (DAT) in time [3,5]. Although, after its resurgence in the 1990s, the incidence of diphtheria decreased by over 95% between 2000 and 2009, sporadic cases are still reported throughout Europe, particularly in 10 countries [3]. In Belgium between 2009 and 2013, only two cases of toxicogenic strains of C. ulcerans, not C. diphtheriae, had been confirmed by the Belgian reference laboratory until the present case in 2016 [6].
A review of the DTaP-IPV-HB-PRP-T Hexavalent vaccine in pediatric patients
Published in Expert Review of Vaccines, 2023
Andrew Dakin, Ray Borrow, Peter D. Arkwright
Immunological protection against diphtheria is antibody mediated. The disease is due to the diphtheria toxin, and immunity is dependent on antitoxin which is primarily IgG and measured in IU/mL by the in vitro seroneutralization assay. Other assays include the passive hemagglutination test and ELISA. The level of circulating diphtheria antitoxin to provide clinical immunity against disease, as determined by seroneutralization is 0.01IU/mL [12].