A Case of Necrotizing Epiglottitis Due to Nontoxigenic<i>Corynebacterium diphtheriae</i>

Lake, Jessica; Ehrhardt, Matthew J.; Suchi, Mariko; Chun, Robert H.

doi:10.1542/peds.2014-3157

Cited by 16 publications

(7 citation statements)

References 20 publications

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“…Fibrinoid necrosis of the larynx following supraglottitis has been reported in the literature in relation to the immunocompromised population. The most recent case to develop in an immunocompromised patient was caused by a nontoxigenic Corynebacterium diphtheria infection and the paediatric patient was found at presentation to be pancytopenic due to acute lymphoblastic leukaemia [6].…”

Section: Discussionmentioning

confidence: 99%

Multipathogenic necrotising supraglottitis in an immunocompetent patient

Ahmed¹

2018

Preprint

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History 38-year-old, British male, with 10 day history of upper respiratory tract infection 24 hour progressive worsening; now drooling, stridorous, with dysphonia and odynophagia Examination Primary survey: Biphasic stridor, tachypnoea, tachycardia, pyrexial, normotensive Neck examination: Tender laryngeal skeleton Intra-oral examination: Palatal and oropharyngeal erythema and oedema Fibroptic nasendoscopy (FoNE): Epiglottic erythema and oedema, left-sided laryngopharyngeal swelling with significant airway compromise Initial treatment Benzylpenicillin; Metronidazole; Dexamethasone; analgesia; IV fluids Awake fibroptic-intubation in theatres; 3 days in level 3 care setting Ward treatment Cefuroxime; Metronidazole; Oseltamivir (guided by throat swab cultures) Cultures indicated heavy growth of Group A β-haemolytic streptococcus and Influenza A virus Microbiology guidance lead to Benzylpenicillin and Oseltamivir At which point the patient began to decline Repeat FoNE revealed epiglottic slough; this coalesced and ulcerated over the next 24 hours Acute symptoms returned CT scan (Images 1-4) Reported as left-sided parapharyngeal abscess and laryngeal abscess Epiglottis Hyoid Vocal cords Sagittal mid-line section Procedure Tracheostomy formation. Incision and drainage (attempt). Debridement. Findings at microlaryngoscopy: (Images 5-7) Membranous necrotic slough over left hemi-larynx extending to right false cord; no pus was found. The debrided tissue sample was sent for microscopy, culture and sensitivities. Microbiological analysis reveled growth of Enterococcus faecalis sensitive to the final course of treatment; Ceftriaxone, Clindamycin and Metronidazole. Histology revelaed necrotic tissue composed of fibrin and inflammatory cell infiltrate; indicative of a necrotising inflammatory process (Images 8 and 9).Low-power microscopy High-power microscopyPost-operatively the patient went to level 3 care for a further 2 days after which he was transferred to the ward and made a complete recovery.

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Section: Discussionmentioning

confidence: 99%

Multipathogenic necrotising supraglottitis in an immunocompetent patient

Ahmed¹

2018

Preprint

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“…As evident from few studies, toxin production does not always correlate with the pathogenicity, since non-toxigenic strains are equally seen to be contributing to the harmful effects and severe disease [15,22]. On the other hand, organism carrying the toxin gene may not always express its toxin [23].…”

Section: Discussionmentioning

confidence: 99%

Isolation of Toxigenic Corynebacterium diphtheriae from Chronic Suppurative Otitis Media

Gaikwad¹,

Arora²,

Gade³

et al. 2017

JCR

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Background: A major shift in the pathogenic potential of Corynebacterium diphtheriae is being witnessed globally, consequent to the successful diphtheria immunization. However, its isolation from unconventional sites like middle ear has been rarely implicated in the available literature. Case Report: Here we describe a case of chronic suppurative otitis media (CSOM) in a fully immunized young adult patient from whom, Pseudomonas aeruginosa and Klebsiella pneumoniae were isolated as the major pathogens with simultaneous isolation of toxigenic Corynebacterium diphtheriae. The patient had no evidence of Corynebacterium diphtheriae infection on clinical examination, until the organism was incidentally isolated on culture suggesting the possibility of colonization or superimposed infection. Conclusion: Although, the condition was successfully managed with surgical and medical intervention with good outcome, this incidence warrants clinician's attention towards unusual occurrence of a potentially dangerous pathogen. Considering the likelihood of its passive environmental shedding which may pose unseen threat of emergence of fatal diphtheria in the contacts and other susceptible local population, active screening for its carriage is advisable.

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“…C.diphtheriae'nın toksin dışında hastalığa yol açan adezin ve fimbrial proteinler gibi virülans faktörlerinin, toksijenik olmayan C.diphtheriae'ya bağlı enfeksiyonlardan sorumlu olduğu düşünülmüştür 13,14 . Toksin üretimi olmadığında bile C.diphtheriae'nın bakteremi ve menenjit, endokardit, osteomiyelit, septik artrit, hepatit ve periferik embolik hastalık gibi ciddi komplikasyonlara yol açtığı bildirilmiştir 11,[15][16][17][18] .…”

Section: Discussionunclassified

“…Nontoksijenik suşlar ile ciddi solunum sistemi enfeksiyonları çok nadir olmakla birlikte immün sistemi baskılanmış hastalarda ortaya çıkabilir. Literatürde nontoksijenik C.diphtheriae ile ilişkili nekrotizan epiglotit gelişen akut lenfoblastik lösemili 3 yaşında bir çocuk hasta ile afebril pnömoni gelişen 60 yaşında amiyotrofik lateral sklerozlu bir hasta bildirilmiştir 13 . Çalışmamızdaki boğaz sürüntü örneğinde toksijenik olmayan C.diphtheriae saptanan olgular, sadece ÜSYE semptomu olan sağlıklı çocuklardan oluşmaktaydı.…”

Section: Discussionunclassified