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Multidisciplinary approach to the management of a case of classical respiratory diphtheria requiring percutaneous endoscopic gastrostomy feeding.

Abstract We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on culture for Corynebacterium ulcerans, with toxin expression confirmed on PCR and Elek testing. A diagnosis of classical respiratory diphtheria was made, with subsequent confirmation of the patient's domesticated dog as the source of infection. The dog had recently been attacked by a wild badger and was being treated for an ear infection. The patient made a good recovery with intravenous antimicrobial and supportive therapy; however, she subsequently developed a diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild sensorimotor peripheral neuropathy was also diagnosed. The patient eventually made an almost complete recovery.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj case reports
Publication Year Start




PMID- 28264806
OWN - NLM
STAT- MEDLINE
DA  - 20170307
DCOM- 20170313
LR  - 20170313
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2017
DP  - 2017 Mar 06
TI  - Multidisciplinary approach to the management of a case of classical respiratory
      diphtheria requiring percutaneous endoscopic gastrostomy feeding.
LID - bcr2016218408 [pii]
LID - 10.1136/bcr-2016-218408 [doi]
AB  - We present a case of a Caucasian woman aged 67 years referred with a 4-day
      history of sore throat, dysphagia, fever and nasal blockage. Examination revealed
      a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on
      culture for Corynebacterium ulcerans, with toxin expression confirmed on PCR and 
      Elek testing. A diagnosis of classical respiratory diphtheria was made, with
      subsequent confirmation of the patient's domesticated dog as the source of
      infection. The dog had recently been attacked by a wild badger and was being
      treated for an ear infection. The patient made a good recovery with intravenous
      antimicrobial and supportive therapy; however, she subsequently developed a
      diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank
      aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild
      sensorimotor peripheral neuropathy was also diagnosed. The patient eventually
      made an almost complete recovery.
CI  - 2017 BMJ Publishing Group Ltd.
FAU - Haywood, Matthew James
AU  - Haywood MJ
AD  - Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
FAU - Vijendren, Ananth
AU  - Vijendren A
AD  - Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
FAU - Acharya, Vikas
AU  - Acharya V
AD  - Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
FAU - Mulla, Rohinton
AU  - Mulla R
AD  - Department of Microbiology, Luton and Dunstable University Hospital, Luton, UK.
FAU - Panesar, Miss Jaan
AU  - Panesar MJ
AD  - Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170306
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Anti-Infective Agents)
SB  - IM
MH  - Aged
MH  - Animals
MH  - Anti-Infective Agents/*therapeutic use
MH  - Corynebacterium/genetics/*isolation & purification
MH  - Diphtheria/*microbiology/*therapy/transmission
MH  - Disease Management
MH  - Dog Diseases/microbiology
MH  - Dogs
MH  - Enteral Nutrition
MH  - Female
MH  - Gastrostomy
MH  - Humans
MH  - Lung Diseases/*microbiology/*therapy
MH  - Zoonoses/microbiology
EDAT- 2017/03/08 06:00
MHDA- 2017/03/14 06:00
CRDT- 2017/03/08 06:00
AID - bcr-2016-218408 [pii]
AID - 10.1136/bcr-2016-218408 [doi]
PST - epublish
SO  - BMJ Case Rep. 2017 Mar 6;2017. pii: bcr2016218408. doi: 10.1136/bcr-2016-218408.

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