Naveed Ur Rehman Siddiqui, MBBS, FCPS, EPIC dip
Assistant Professor, Consultant Pediatric Intensivist
Aga Khan University Hospital
Karachi, Pakistan
Disclosure information not submitted.
.jpg "Arsheen Zeeshan, MBBS FCPS photo")
Arsheen Zeeshan, MBBS FCPS
Senior instructor
Aga Khan University Hospital
KARACHI, Pakistan
Disclosure information not submitted.
Awais Abbas, MBBS FCPS
Fellow PCCM
Aga Khan University Hospital, Pakistan
Disclosure information not submitted.
Abid Shah, MBBS FCPS
Fellow PCCM
Aga Khan University Hospital, Pakistan
Disclosure information not submitted.
iram iqbal, MBBS FCPS
Fellow PCCM
Aga Khan University Hospital, Pakistan
Disclosure information not submitted.
Title: Case report of acute diphtheria infection with COVID 19 sever pneumonia
Case Report Body:
Introduction: SARS-CoV-2 (COVID 19) is responsible for more than 176 million infections and over 3.8 million deaths worldwide, with a wide range of clinical spectrum, including mild, moderate, and severe which vary from patient to patient. On the other hand, diphtheria is an acute infection caused by the bacterium Corynebacterium diphtheria. Signs and symptoms usually start 2 – 5 days after exposure and range from mild to severe disease.
Description: A 10 year-old-girl unvaccinated one week history of sore throat, fever and shortness of breath with neck swelling since one day presented in ER with failed previous intubation in previous hospital. She was rushed to OR for emergency tracheostomy. After securing airway with tracheostomy 6.0, throat examination revealed purulent yellow grey membrane in the throat and tonsils for which throat swabs culture was sent which later came positive for Corynebacterium diphtheria and child was shifted to PICU for further management. She presented in MODS with refractory septic shock, Oliguric AKI, with diffuse neck swelling and poor left ventricular ejection fraction of 30%. She also came positive for COVID 19 PCR. She was optimized with diphtheria Antitoxin, Clarithromycin and broad spectrum antibiotics, fluid resuscitation, inotropic support, subsequent diuresis, blood transfusion to keep hemoglobin around 8-10gm/dl, low mechanical ventilatory support. She recovered during the initial phase of 1 week and her cardiac function on repeated ECHO recovered to 60% on cardiac failure medications off inotropes and weaned to trach mask on the 8th PICU day started to show respiratory compromise with hypoxemic respiratory failure with PF ratio >300 to < 100 within 24 hrs requiring high ventilatory support with rapidly progressive post lung B/L infiltrates with Rising ferritin from 856 to 2096 and elevated D-dimers from 2.7 to > 5, She didn’t respond to High ventilatory settings as well as prone positioning and went into Ventricular tachycardia and arrest requiring Cardiopulmonary resuscitation followed by death.
Discussion: According to the data collected by WHO, UNICEF, GAVI, and the Sabin Vaccine Institute, the suspension of vaccination services in over 68 countries have put at least 80 million children under the age of one at risk. There is an emergent need esp in the LMIC for highlighting the importance of primary immunization in children at government level esp for the preventable diseases like diphtheria and other preventable communicable diseases.