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Taylor J, Saveedra-Campos M, Harwood D, Pritchard G, Raphaely N, Kapadia S, Efstratiou A, White J, Balasegaram S. Toxigenic Corynebacterium ulcerans infection in a veterinary student in London, United Kingdom, May 2010. Euro Surveill 2010; 15:19634. [PMID: 20738991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We report on a case of toxigenic Corynebacterium ulcerans infection in a fully immunised veterinary student, investigated in London, United Kingdom, in May 2010. There was no ongoing transmission in human contacts. Possible animal sources were identified.
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Affiliation(s)
- J Taylor
- North East and North Central London Health Protection Unit, London, United Kingdom
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2
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Celik T, Selimov N, Vekilova A, Kursaklioglu H, Iyisoy A, Kilic S, Isik E. Prognostic significance of electrocardiographic abnormalities in diphtheritic myocarditis after hospital discharge: a long-term follow-up study. Ann Noninvasive Electrocardiol 2006; 11:28-33. [PMID: 16472279 PMCID: PMC6932265 DOI: 10.1111/j.1542-474x.2006.00062.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the long-term cardiac mortality and the relationship between cardiac mortality and electrocardiographic abnormalities in patients with diphtheritic myocarditis who survived after hospital discharge. MATERIALS AND METHODS Between 1991 and 1996, 32 patients (all males, mean age 21.00 +/- 3.77 years) surviving diphtheritic myocarditis were included in the study and they were followed up for an average of 16.3 months (range 10.3-26.8 months) after hospital discharge. Clinical evaluation, ECG, and echocardiography were performed on admission, daily while in hospital and at the time of discharge. ECG changes were permanent during the follow-up period. The causes of death of the patients during follow-up period were inferred from the death records of the patients and talking to the people witnessing cardiac arrest. RESULTS We observed that the patients with left bundle branch block (LBBB) and T wave inversion at hospital discharge had lower survival rates than that of the patients without these ECG changes in the long term. Although univariate Cox regression analysis identified LBBB (P = 0.001) and T wave inversion (P = 0.014) as the predictors of survival, only LBBB was an independent predictor of survival in multivariate Cox regression analysis. Adjusted hazard ratio was calculated as 13.67 for LBBB (P = 0.001; CI = 2.81-66.28). CONCLUSION Diphtheritic myocarditis does not only demonstrate a malignant clinical course during acute phase of the disease, but also during the long-term follow-up period, especially in patients with LBBB and T wave inversion. Besides, T wave inversion and LBBB can help us to predict survival rate of the patients in long term. Moreover, LBBB is an independent predictor of long-term survival in diphtheritic myocarditis.
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Affiliation(s)
- Turgay Celik
- Department of Cardiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
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Krumina A, Logina I, Donaghy M, Rozentale B, Kravale I, Griskevica A, Viksna L. Diphtheria with polyneuropathy in a closed community despite receiving recent booster vaccination. J Neurol Neurosurg Psychiatry 2005; 76:1555-7. [PMID: 16227550 PMCID: PMC1739381 DOI: 10.1136/jnnp.2004.056523] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND METHODS We report 20 patients aged 18-24 years from Latvia with diphtheritic polyneuropathy. All lived in a closed community and 80% were known to have been fully vaccinated against diphtheria until at least 14 years old. Diphtheria antitoxin had been administered within 3 days of the onset of upper respiratory tract infection in 16 patients and 15 received antibiotics. RESULTS Neurological symptoms developed after a median of 43 days (range 35-58) compared to only 10 days in previous studies of unvaccinated patients. All showed evidence of mild limb polyneuropathy with electrophysiological evidence of polyneuropathy. Only 30% showed early bulbar abnormalities compared to the usual rate of over 95% in diphtheritic polyneuropathy. However, 45% had later bulbar deterioration coinciding with the limb polyneuropathy. CONCLUSIONS These patients show that an attenuated form of polyneuropathy of later onset, with less prominent early bulbar features, can occur in patients vaccinated against diphtheria according to schedule but living in a closed community in a country where diphtheria remains endemic.
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Affiliation(s)
- A Krumina
- Department of Traditional Infectology, Tuberculosis and AIDS, Riga Stradins University, Latvia
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Abstract
PURPOSE To determine the incidence of and risk factors for electrocardiographic (ECG) abnormalities in adults with diphtheria. METHODS A prospective study was conducted involving 122 adult patients with respiratory tract diphtheria. Diphtheria was confirmed by isolation of a toxin-producing strain of Corynebacterium diphtheriae. Patients had serial clinical evaluations and ECGs for a minimum of 21 days. RESULTS Cardiac involvement was detected in 25 (28%) of 88 evaluable patients, with a median time from symptom onset to an abnormal ECG of 9 days (range, 4 to 24 days). In a logistic regression analysis, age (odds ratio [OR] = 4.1; 95% confidence interval [CI]: 1.6 to 11.0), shared accommodation (OR = 2.9; 95% CI: 1.0 to 8.6), fever (OR = 4.2; 95% CI: 1.1 to 16.6), and extensive respiratory tract infection with subcutaneous edema (OR = 7.0; 95% CI: 1.2 to 42.2) were independent risk factors for cardiac involvement. CONCLUSION Cardiac involvement is a common complication of respiratory tract infection with C. diphtheriae, and occurs more often among older patients, those with lower socioeconomic status, and those with severe respiratory tract involvement.
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Affiliation(s)
- Jukka T Lumio
- Department of Medicine, Tampere University Hospital, Tampere, Finland.
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Iushchuk ND, Parkhomenko IG, Chukbar AV, Tishkevich OA, Filippov PG, Ordian AM, El'shinka TM. [Clinical and structural parallels in changes of the myocardial conduction system in diphtheria patients]. TERAPEVT ARKH 2003; 74:33-7. [PMID: 12498123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
AIM Comparison of the results of clinical device investigations of the heart with morphological autopsy evidence in diphtheria. MATERIAL AND METHODS Hearts of 309 patients with diphtheria aged 25 to 80 years and 60 hearts of patients who died of diphtheria were investigated using ECG, echo-CG, doppler echo-CG, Holter ECG monitoring, biochemical tests of blood. Structural study of cardiac conduction included examination of the sinus-atrial node, atrioventricular node and bundle regarding the adjacent myocardium. RESULTS Variants of structural-functional state of the myocardium and conduction system are explained by variability of the pathological processes which arose due to individual features of the conduction system structure and location, relationships with the myocardium. In acute diphtheria (day 1-10) dystrophic, necrobiotic and vascular disorders prevailed followed on days 11-30 by inflammation ending in myocardiosclerosis. Nodes and bundles of the conduction system are affected less frequently than the myocardium. CONCLUSION A correlation exists between structural state of the cardiac conduction system and variants of clinical affection of the heart in diphtheria.
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Wagner J, Ignatius R, Voss S, Höpfner V, Ehlers S, Funke G, Weber U, Hahn H. Infection of the skin caused by Corynebacterium ulcerans and mimicking classical cutaneous diphtheria. Clin Infect Dis 2001; 33:1598-600. [PMID: 11568853 DOI: 10.1086/322969] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2001] [Revised: 05/10/2001] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- J Wagner
- Department of Medical Microbiology and Immunology of Infection, Benjamin Franklin Medical Center, Free University Berlin, Berlin, Germany.
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Parkhomenko IG, Tishkevich OA, Chukbar AV. [Morphological characteristics of heart conduction system in diphtheria]. Arkh Patol 2001; 63:11-5. [PMID: 11242847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Heart conductive system (HCS) including the sinoatrial node (SAN), atrioventricular node (AVN), AV bundle (AVB) and its left and right parts was studied histologically. It is shown that different portions of HCS are damaged in diphtheria with different frequency and intensity, the frequency depending on the depth of their location. Left part of AVB is affected most frequently, followed by the right part of AVB, AVB, AVN and the least frequently SAN.
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Ordian AM, Iushchuk ND, Karetkina GN, Golikov AP, Gazarian GA. [Clinical and prognostic significance of disturbed global and regional contractility of left ventricle in diphtheria myocarditis]. Klin Med (Mosk) 2000; 78:20-3. [PMID: 10723145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Examination of 159 diphtheria patients diagnosed myocarditis in 64 of them. The latter were divided into 3 groups: with mild, moderate and severe myocarditis. The patients with and without diphtheria have undergone two-dimensional echocardiography with estimation of the asinergia index (AI) and left ventricular (LV) ejection fraction. Pronounced systolic dysfunction was revealed only in severe diphtheric myocarditis (DM). AI rose in moderate and severe DM. By the degree of AI elevation it can be judged about myocarditis severity and the disease prognosis. Regional LV contractility and LV systolic dysfunction were correlated. A group of patients with severe DM was identified who had a high risk of death in akinesia of LV segments (IA > 2) and lowering of LV ejection fraction below 35%.
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Abstract
OBJECTIVES AND METHODS Clinical features of 50 adults with diphtheritic polyneuropathy (DP) were studied in Riga, Latvia and compared with 21 patients with Guillain-Barré syndrome (GBS). RESULTS Neurological complications occurred in 15% of patients admitted to hospital with diphtheria and usually after severe pharyngeal infection. Bulbar dysfunction occurred in 98% of patients with DP and only 10% of patients with GBS. Limb weakness was mild or absent in 30% of patients with DP. Ventilation dependent respiratory failure occurred in 20% of patients with DP. The first symptoms of DP occurred 2-50 days after the onset of local diphtheria infection. Neurological deterioration in DP continued for a median of 49 (range 15-83) days and improvement started 73 (range 20-115) days after onset. In 66% of patients with DP, the neuropathy was biphasic with a secondary worsening after 40 days. By contrast patients with GBS worsened for only 10 days on average (range 2-28 days) and improved after 21 (range 4-49) days. Eight patients with DP died, four from severe cardiomyopathy and four from multiple diphtheritic organ failure. Prolonged distal motor latencies (DMLs) were common to both DP and GBS, and more pronounced than motor conduction slowing. Limb symptoms continued after 1 year in 80% of the patients with DP, 6% were unable to walk independently, but independent respiratory and bulbar function had returned in all survivors. By comparison no patients with GBS died and none were severely disabled after 1 year. No death, in patients with DP occurred after antitoxin on days 1 or 2 after onset of diphtheria symptoms, whereas identical rates of death and peak severity of DP were seen both in those who received antitoxin on days 3-6 and those who did not receive it at all. CONCLUSION Diphtheric polyneuropathy is much more likely than GBS to have a bulbar onset, to lead to respiratory failure, to evolve more slowly, to take a biphasic course, and to cause death or long term disability. Antitoxin seems ineffective if administered after the second day of diphtheritic symptoms.
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Affiliation(s)
- I Logina
- Department of Neurology and Neurosurgery, Medical Academy of Latvia, P Stradin's Clinical Hospital, 13 Pilsonu St, Riga, LV-1002, Latvia
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Abstract
INTRODUCTION Diphtheria is a reemerging disease. Two epidemics recently occurred in Algeria and Independent States Community, not so far from Europe. Imported cases were diagnosed in contiguous European countries. This review focuses on the data obtained from these epidemics, with particular emphasis on new clinical forms of Corynebacterium diphtheriae infections. CURRENTS KNOWLEDGE AND KEY POINTS: Sore throat with membranes is no longer the only clinical feature of diphtheria. However, patients' management is identical, with combination of antibiotics, injection of specific antisera, and immunization of patients' close contacts and relatives. French and American sero-epidemiological studies showed that antibody levels does not provide protection, particularly in the elderly. Adult populations would therefore be at risk every 10 years. Recent advances in molecular biology led to the development of gene amplification with polymerase chain reaction, that may be used for the detection of the toxin gene. They also promoted epidemiological surveys of circulating strains via ribotyping. Although this technic evidenced predominant strains in the various countries, genotypes encountered during an epidemics may differ. Besides diphtheria which has apparently been eradicated in France, systemic infections with non-toxigenic strains of C diphtheriae, such as endocarditis, septicemia and arthritis, are evenly diagnosed. FUTURE PROSPECTS AND PROJECTS A French national reference center for C diphtheriae has been recently created. This center collects most of the strains isolated in France, clinical data and assesses the toxigenicity of bacteria, allowing strict epidemiological survey.
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Affiliation(s)
- O Patey
- Service des maladies infectieuses et tropicales, CHI, Villeneuve-Saint-Georges, France
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Anikin VV, Korolev AV, Iastrebov GN, Kuritsyn VM. [Clinicofunctional changes of heart in patients with clinically different variants of toxic diphtheria]. Klin Med (Mosk) 1998; 76:35-7. [PMID: 9770966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A clinicofunctional examination of 72 patients with toxic diphtheria (mean age 36.8 +/- 7.1 years) has been made to study the course and outcome of diphtheria-related damage to the heart. It is shown that clinical symptoms of myocarditis became more prominent with growing severity of diphtheric infection and evidenced for diffuse affection of the left ventricle. EchoCG detected defective systolic function which in patients with unfavorable prognosis was associated with thickening of the myocardium and dilatation of the left ventricular chamber. 24-h Holter monitoring registered shifts in the end part of the ECG ventricular complex and various abnomalities in the heart rhythm. Focal myocardial lesions manifested with supraventricular and solitary ventricular extrasystoles. In diffuse myocarditis frequent ventricular extrasystoles prevailed. At autopsy, structural myocardial changes in toxic diphtheria were confirmed.
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Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, Wain J, Day NP, Tran TH, Parry CM, White NJ. Penicillin vs. erythromycin in the treatment of diphtheria. Clin Infect Dis 1998; 27:845-50. [PMID: 9798043 DOI: 10.1086/514959] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In an open-label, randomized trial, 44 Vietnamese children with diphtheria were given penicillin therapy (intramuscular benzylpenicillin, 50,000 U/[kg.d] for 5 days and then oral penicillin, 50 mg/[kg.d] for 5 days), and 42 were given erythromycin therapy (50 mg/[kg.d] orally for 10 days). There were no differences in times to membrane clearance or bacteriologic clearance, but median times to fever clearance were 27 hours (95% confidence interval [CI], 19-30; range, 0-124 hours) for penicillin recipients and 46 hours (95% CI, 34-54; range, 0-148 hours) for erythromycin recipients (P = .0004). In the penicillin group, acute treatment failed for one patient, and one patient relapsed. Three patients in the penicillin group developed diphtheritic myocarditis as evidenced by abnormal electrocardiograms. Erythromycin did not cause prolongation of the QT interval corrected for heart rate. Cultures of specimens from 15 patients (17.4%) were positive for toxigenic Corynebacterium diphtheriae. All isolates were susceptible to penicillin, but for isolates (27%), all of which were from patients who received penicillin treatment, were resistant to erythromycin (minimum inhibitory concentrations, > 64 mg/L). Penicillin is recommended as first-line treatment for diphtheria in Vietnam.
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Affiliation(s)
- R Kneen
- Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam
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Loukoushkina EF, Bobko PV, Kolbasova EV, Kazakova LV, Krasnov VV, Shipova LG, Lazareva TS, Vlasova IN, Schmaltz AA. The clinical picture and diagnosis of diphtheritic carditis in children. Eur J Pediatr 1998; 157:528-33. [PMID: 9686809 DOI: 10.1007/s004310050871] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
UNLABELLED During 1992 1996 we observed 122 children with diphtheria, 49 with the toxic form, in the region of Nizhny Novgorod in Russia. Sixty-four patients suffered from diphtheric carditis, 9 died. The clinical picture was characterized by a rapid development of heart and circulatory failure. ECG showed QRS alterations with intraventricular conduction impairment, sinus node dysfunction, ectopic rhythm disturbances and repolarization disturbances in all patients with carditis. Infarction-like ECG changes were typical for the pseudocoronary form with the worst prognosis. Echocardiographically there was left ventricular (LV) dilatation and depressed LV function, whereas LV muscle mass was increased. Myoglobin, LDH and CPK levels were elevated in each patient demonstrating significant differences between the various courses of disease. CONCLUSION In diphtheria, the extent of hypermyoglobinaemia (> 2000 ng/ml) and an increased LDH1/LDH2 (> 1) ratio are reliable markers for the development of carditis indicating a poor prognosis.
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Amosova KM, Tkachenko LO, Duda OK. [The clinical course and cardiohemodynamic status of patients with different variants of diphtheritic myocarditis]. Lik Sprava 1998:53-7. [PMID: 9784702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The clinical course was studied as was the condition of cardiohemodynamics in 126 patients with different variants of diphtherial myocarditis (DM) versus 23 patients with unspecific infectious and allergic myocarditis (UIAM). Early DM in the majority of cases runs a moderately severe or severe course because of a stronger--by comparison with late DM and UIAM--predisposition to cardiac insufficiency, sinus bradycardia and heart blocks as well as of a moderately severe systolic dysfunction of the left ventricle (LV), as evidenced by Echo-CG. Late DM runs, on the whole, a mild course, and is associated with minimal LV systolic function inadequacies.
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Gerasimova LI, Meĭgal AI, Sergeev AM, Lupandin IV. [Integral electromyographic characteristics in patients with diphtheritic polyneuropathy]. Fiziol Cheloveka 1998; 24:85-90. [PMID: 9608163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lobzin IV, Zagriadskiĭ PV, Bazhukov OA, Kotel'nikov SA. [The neurological complications of diphtheria]. Voen Med Zh 1996; 317:47-52. [PMID: 8659165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
A 29-year-old Haitian man had a sore throat with a marked tonsillar exudate followed by the onset of increasingly blurred vision with swallowing difficulties and, then, a diffuse acute demyelinating neuropathy. Cerebrospinal fluid showed moderate pleiocytosis and elevated protein content. Serological testing for diphtheria, but not for tetanus and poliomyelitis, was markedly positive. Other tests including HIV1 and 2, HTLV1 and Lyme disease were negative. Diphtheritic neuropathy should be considered in the differential diagnosis of Guillain-Barré syndrome in nonvaccinated patients.
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Affiliation(s)
- A Créange
- Service de Neurologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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18
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Abstract
Diphtheria antibody level in serum samples obtained from 270 subjects aged 4-70 was measured by in vitro seroneutralization test on Vero cells. Of the studied population, 27.8% had an antibody titre below the protective level (< 0.01 IU/ml). The prevalence of susceptible subjects showed a significant age-related increase (p < 0.01), with the highest value (53.8%) in the 31-40 age group. Mean antibody titre was maximum in individuals aged 13-14, then decreased reaching the minimum level in the 41-50 age group. These data suggest that in individuals aged 30-50, diphtheria immunity is not satisfactory, both for prevalence of immune subjects and for antibody levels. Therefore, a revaccination of adults with reduced doses of diphtheria toxoid may be advisable.
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Affiliation(s)
- M Wirz
- Department of Immunology, Istituto Superiore di Sanità, Rome, Italy
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Abstract
The clinical, the 12-lead, and the 24-hour electrocardiographic findings in 15 consecutively studied Vietnamese children (aged 7 months to 16 years) with severe diphtheria were documented. Five patients died, three from respiratory arrest and two from cardiogenic shock; one of these two patients had complete heart block that necessitated insertion of a pacemaker. Electrocardiographic abnormalities were detected by 24-hour monitoring in all 15 cases, even though most patients had no clinical signs of myocarditis. Rates of supraventricular and ventricular ectopy were elevated and remained high long after other clinical manifestations were no longer noted. The degree of ventricular ectopy at the time of presentation was significantly associated with fatal outcome. In this series, more than two ventricular ectopic beats on a recording upon admission to the hospital predicted fatal outcome with 100% sensitivity and 100% specificity. A variety of nonsustained bradyarrhythmias and tachyarrhythmias were also observed up until discharge from the hospital. The time course of recovery from diphtheritic myocarditis is longer than has been appreciated previously.
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Affiliation(s)
- D B Bethell
- Wellcome Trust Clinical Research Unit, Cho Quan Hospital, Ho Chi Minh City, Vietnam
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20
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Fontanarosa PB. Diphtheria in Russia a reminder of risk. JAMA 1995; 273:1245. [PMID: 7715018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Affiliation(s)
- P V Havaldar
- Department of Pediatrics, J. N. Medical College, Karnatak, India
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Pelupessy JM, Makmur R, Daud D. Bull-neck, electrocardiographic changes and creatine phosphokinase blood levels in patients with diphtheria. Paediatr Indones 1991; 31:303-11. [PMID: 1845655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
All paediatric patients with the diagnosis of diphtheria who were seen at the Department of Child Health Ujung Pandang General Hospital from October 1987 to October 1989 were evaluated for bull-neck, ECG patterns and serum creatine phosphokinase (CPK) values. Their ages ranged from 1 year and 2 months to 13 years with a mean of 6.54 +/- 3.09 years. Males and females were affected in a ratio of 1:1. Of 39 patients included in the trial, 28 were classified as having normal ECG and 11 as having abnormal ECG on admission. During hospitalization, 56.4% of cases showed ECG changes. All patients had raised serum CPK levels on admission. This increase was 14.6 times the normal level in cases with abnormal ECG and only 3.0 times in those with normal ECG (p < 0.01). The highest levels of serum CPK were noted in the first week, then returned to normal in the second week and decreased further in the third week. It became also evident that patients who developed abnormal ECG later on, had already demonstrated an increased serum CPK level of 5.2 times the normal levels on admission. Bull-neck appeared in 19 out of the 39 patients. Patients with bull-neck differed very significantly (p < 0.001) from those without bull-neck in either the frequency of the occurrence of abnormal ECG patterns or the mean CPK serum levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J M Pelupessy
- Department of Child Health, Medical Faculty, Hasanuddin University, Ujung Pandang
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Roche S, Stone S, Allen CM, Lange LS. Diphtheritic polyneuritis in an elderly woman: clinical and neurophysiological follow-up. Br J Clin Pract 1990; 44:285-7. [PMID: 2169838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 71-year-old English lady initially presented with a bulbar paralysis and, six weeks later, developed a generalised sensori-motor neuropathy. Corynebacterium diphtheriae mitis was cultured from her throat swab. Despite a good clinical recovery at one month, nerve conduction velocity was at its lowest. As far as the authors are aware, this is one of the few cases of neurophysiological and clinical follow-up in a British subject with diphtheritic peripheral neuropathy. This case emphasises the importance of giving antitoxin early.
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Affiliation(s)
- S Roche
- Department of Medicine, St Charles Hospital, London
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Frolov VA, Shkirmante BK. [Protective lysosomal autoregulatory mechanism and its disorders in diphtheric intoxication]. Biull Eksp Biol Med 1990; 109:434-6. [PMID: 2378949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diphterial intoxication was established in rabbits by means of bolus 1 DLM/kg intravenous injection of diphterial toxin. Different types of N-acetyl-beta-1)-galactosaminidase's activity were determined in lysosomal fraction which had been obtained after ultracentrifugation of the left and right ventricles' tissue of the heart. It has been found that the mechanism of fixation's reinforcement of this enzyme exists in lysosomes in case of increasing of its activity. This mechanism was damaged on the different stages of diphterial intoxication that influenced negatively the heart's contractility.
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Solders G, Nennesmo I, Persson A. Diphtheritic neuropathy, an analysis based on muscle and nerve biopsy and repeated neurophysiological and autonomic function tests. J Neurol Neurosurg Psychiatry 1989; 52:876-80. [PMID: 2549201 PMCID: PMC1031936 DOI: 10.1136/jnnp.52.7.876] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A patient with diphtheritic neuropathy was investigated with repeated tests of parasympathetic and sympathetic vasomotor and sudomotor functions for one year after the onset of symptoms. Somatic nerve function was tested with nerve conduction studies and an index based on ten variables was used to follow the course of the neuropathy. Sural nerve and anterior tibial muscle biopsies were performed. A severe but shortlasting impairment of the parasympathetic vagal reflex arc was found. The recovery of this function paralleled the clinical course. Sympathetic functions were normal. The neurophysiological variables of somatic nerve function showed signs of a mainly demyelinating mixed sensory/motor neuropathy. The recovery of these variables was slow. The nerve and muscle biopsies demonstrated mild changes consistent with a mixed, demyelinating, non-inflammatory neuropathy.
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Affiliation(s)
- G Solders
- Department of Neurology, Huddinge University Hospital, Sweden
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Frolov VA, Efimova LV. [Cardiac muscle and seasonal lipid metabolism in the rabbit during development of diphtheritic poisoning]. Patol Fiziol Eksp Ter 1983:34-8. [PMID: 6664695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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27
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Rozenman BM. [Homeostatic importance of adrenergic mediator processes in infectious toxic shock (the model of diphtheria intoxication)]. Anesteziol Reanimatol 1983:53-56. [PMID: 6303163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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28
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Abstract
Infectious processes that can cause acute upper airway obstruction in adults include Ludwig's angina, retropharyngeal infection, acute epiglottis, diphtheria, tetanus, and peritonsillar abscess. They are uncommon but potentially lethal. Ludwig's angina in particular quickly progresses to airway obstruction. In most cases, the mainstays of management are antibiotics, surgical drainage, and if necessary, airway maintenance by tracheostomy, cricothyrotomy, or nasotracheal or endotracheal intubation. Hereditary angioneurotic edema causes episodes of laryngeal edema that may lead to suffocation. In an acute episode the airway must be maintained by endotracheal intubation.
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Centers for Disease Control (CDC). Fatal diphtheria--Wisconsin. MMWR Morb Mortal Wkly Rep 1982; 31:553-5. [PMID: 6817057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chandra R, Srivastava DK, Singh R, Bansal A, Saxena SK, Sur BK. Serum aldolase and electrocardiographic changes in diphtheritic myocarditis. J Assoc Physicians India 1979; 27:943-7. [PMID: 541315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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31
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Abstract
Eleven patients with acute diphtheritic neuritis were studied clinically and electrophysiologically. Decreased conduction velocity and increased distal motor latency were present in most patients within two weeks of the onset of neurological symptoms. Velocities later fell to approximately 45% of mean normal values. Wasting with electrophysiological evidence of denervation was present in 3 patients. Nerve conduction studies had returned to normal within 3 months in 8 patients. There was a striking dissociation between the time course of the clinical and the neurophysiological abnormalities: early in the illness, peripheral nerve conduction was normal in some patients despite the presence of severe weakness, and later, the maximum electrophysiological abnormalities were sometimes found after clinical recovery had commenced. The nature and sequence of the clinical and electrophysiological changes are in accord with the known pattern and distribution of the pathological changes in the disease.
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Fasshauer K, Haupt W, Huffmann G, Leven B. [Electrodiagnostic findings in 5 patients with diphtheria-polyneuropathy (author's transl)]. Nervenarzt 1977; 48:391-6. [PMID: 198691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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33
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Affandi M, Madiyono B, Sonityo OW, Purwana KG. Electrocardiographic pattern in children suffering from diphtheria during 1973 at Dr. Cipto Mangunkusumo Hospital, Jakarta. Paediatr Indones 1976; 16:81-8. [PMID: 967494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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34
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Medvedeva GI, Niselovskaia LI. [Influence of "centrogenic" fever on the suppression of oxidative phosphorylation in the liver during diphtheria intoxication]. Patol Fiziol Eksp Ter 1975:81-3. [PMID: 1187233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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35
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raju VB, Parvathi VR. Clinical study of diphtheria, pertussis and tetanus. Prog Drug Res 1975; 19:356-60. [PMID: 1219889 DOI: 10.1007/978-3-0348-7090-0_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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36
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Kuz'menko VV, Bochkova VA, Fomenko OP, Sizemov AN. Diphtheria bacteria carrier state in children. Zh Mikrobiol Epidemiol Immunobiol 1974:41-4. [PMID: 4499230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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37
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Müller HE, Geller W. [Abortive form of diphteria. Clinical aspects and diagnosis]. Med Klin 1972; 67:1242-5. [PMID: 4630467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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39
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Lemańczyk M, Kamińska E. [Description of diphtheria focus and discussion of changes in the cardiovascular system]. Wiad Lek 1971; 24:597-9. [PMID: 5573341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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40
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Garanina IP. [The functional mobility of the respiratory center and its alteration in experimental diphtheria]. Patol Fiziol Eksp Ter 1971; 15:73-6. [PMID: 5138379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Wisniewski H, Raine CS. Demyelination and remyelination in diphtheria induced C.N.S. lesions. J Neuropathol Exp Neurol 1971; 30:131. [PMID: 5542513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Mikhaĭlov VV, Voronina LA. [The mechanism of disorders in the bile secreting, concentrating and purifying function of the liver in experimental botulism and diphtheria]. Patol Fiziol Eksp Ter 1970; 14:36-41. [PMID: 5518612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Utiumova-Malova AV. [hanges in the sate of the hypothalamo-hypophyseal-adrenal system in the dynamics f experimental diphtheria intoxication]. Biull Eksp Biol Med 1969; 68:38-9. [PMID: 5400657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Utiumova-Malova AV, Brumshteĭn MS. [Various parallels in the pathophysiologic and pathomorphologic changes in experimental diphtheria intoxication]. Patol Fiziol Eksp Ter 1968; 12:67-9. [PMID: 5747639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kassur B, Woloszczuk I. [Evaluation of cardiac muscle in diphtheria by policardiographic studies]. Pediatr Pol 1966; 41:677-682. [PMID: 5964715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Mikhaĭlov VV, Aslanova NK. [On the mechanism of disturbed concentration and clearance capacity of the kidneys in botulism and diphtheria]. Patol Fiziol Eksp Ter 1965; 9:43-7. [PMID: 5874323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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48
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Turchetto B, Pellegrini P, Dusi U, Talamini G. [Electrocardiographic aspects of diphtherial heart disease]. Cardiol Prat 1965; 16:164-75. [PMID: 5832453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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