title: 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 forCorynebacterium 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.
authors.affiliation: Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
authors.forename: Matthew James
authors.initials: MJ
authors.lastname: Haywood
authors.affiliation: Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
authors.forename: Ananth
authors.initials: A
authors.lastname: Vijendren
authors.affiliation: Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
authors.forename: Vikas
authors.initials: V
authors.lastname: Acharya
authors.affiliation: Department of Microbiology, Luton and Dunstable University Hospital, Luton, UK.
authors.forename: Rohinton
authors.initials: R
authors.lastname: Mulla
authors.affiliation: Department of ENT, Luton and Dunstable University Hospital, Luton, UK.
authors.forename: Miss Jaan
authors.initials: MJ
authors.lastname: Panesar
mesh_terms: D000368:Aged; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003352:Corynebacterium / Q000235:genetics / Q000302:isolation & purification*; D004165:Diphtheria / Q000382:microbiology* / Q000628:therapy* / Q000635:transmission; D019468:Disease Management; D004283:Dog Diseases / Q000382:microbiology; D004285:Dogs; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology* / Q000628:therapy*; D015047:Zoonoses / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents