Severe immune thrombocytopenia following diphtheria, tetanus, pertussis and polio vaccination in a 36-year-old Caucasian woman: a case report.

BACKGROUND: Immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles-mumps-rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination. CASE PRESENTATION: This case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature. CONCLUSION: Although a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions.

Immunogenicity of Diphtheria Booster Vaccination in Adolescents With Inflammatory Bowel Disease.

The aim of this prospective study was to assess the immunogenicity and safety of booster vaccine against diphtheria in children with inflammatory bowel disease on and without immunosuppression treatment. Immunoprotection was achieved in 93% of the children. No significant differences depending on the treatment used and no serious adverse events or flares of inflammatory bowel disease were observed.

Diphtheria Outbreaks in Schools in Central Highland Districts, Vietnam, 2015-2018.

During 2015-2018, seven schools in rural Vietnam experienced diphtheria outbreaks. Multilocus sequence types were the same within schools but differed between schools. Low vaccine coverage and crowded dormitories might have contributed to the outbreaks. Authorities should consider administering routine vaccinations and booster doses for students entering the school system.

Infection of laparoscopically inserted inguinal hernia repair mesh following subsequent emergency open surgery: a report of two cases.

We present two cases of laparoscopically inserted mesh for inguinal hernia repair that became infected following emergency open bowel surgery. We believe that there is an increased risk of infection due to the larger size of mesh used in the laparoscopic repair but also due to the patient not volunteering the information because of the minimally invasive nature of the procedure.

Adhesion by pathogenic corynebacteria.

Pathogenic members of the genus Corynebacterium cause a wide range of serious infections in humans including diphtheria. Adhesion to host cells is a crucial step during infection. In Corynebacterium diphtheriae, adhesion is mediated primarily by filamentous structures called pili or fimbriae that are covalently attached to the bacterial cell wall. C. diphtheriae produces three distinct pilus structures, SpaA-, SpaD- and SpaH-type pili. Similar to other types, the prototype SpaA pilus consists of SpaA forming the pilus shaft and two minor pilins SpaB and SpaC located at the base and at the tip, respectively. The minor pilins SpaB/SpaC are critical for bacterial binding to human pharyngeal cells, and thus represent the major adhesins of corynebacteria. Like pili of many other gram-positive microbes, the assembly of corynebacterial pili occurs by a two-step mechanism, whereby pilins are covalently polymerized by a transpeptidase enzyme named pilin-specific sortase and the generated pilus polymer is subsequently anchored to the cell wall peptidoglycan via the base pilin by the housekeeping sortase or a non-polymerizing sortase. This chapter reviews the current knowledge of corynebacterial adhesion, with a specific focus on pilus structures, their assembly, and the mechanism of adhesion mediated by pili.

Emergence of an invasive clone of nontoxigenic Corynebacterium diphtheriae in the urban poor population of Vancouver, Canada.

Invasive disease due to Corynebacterium diphtheriae is rare in North America. Here we describe the emergence of a predominant clone of a nontoxigenic strain of C. diphtheriae in the impoverished population of Vancouver's downtown core. This clone has caused significant morbidity and contributed to at least two deaths. Over a 5-year period, seven cases of bacteremia due to C. diphtheriae were detected in patients admitted to Vancouver hospitals. Injection drug use, diabetes mellitus, skin colonization/infection with C. diphtheriae, and homelessness all appeared to be related to the development of bacteremia with the organism. Ribotyping of isolates recovered from blood culture revealed a predominant ribotype pattern that has not previously been reported in North America.

Prevalence of IgG diphtheria antitoxin in blood donors in Rio de Janeiro.

The lack of information on the immunity of adults in Brazil against diphtheria prompted us to analyse sera from 234 blood donors aged 18-61 years (30.3% females and 69.7% males). IgG diphtheria antitoxin levels determined by means of an ELISA, validated by toxin neutralization test in Vero cells, showed that 30.7% (95% CI 25.0-37.1) of the population was fully protected (>or=1 IU/ml). The highest percentage of subjects fully protected was in the 31-40 years age group. Most of the subjects with uncertain or no protection (<1 IU/ml) were found in the 18-30 years age group (43.8%, OR 2.18, P=0.01). Antitoxin levels were not influenced by the increase in age. Males were more protected than females (80.5%, OR 0.44, P=0.01). The prevalence of 30% of individuals fully protected against diphtheria in blood donors in Rio de Janeiro supports the fact that immunity to diphtheria among healthy Brazilian adults is inadequate. To avoid diphtheria epidemics in the future the immunity among adults should be raised in the coming years.

Difteria

La difteria es una infecci�n localizada en las mucosas y/o la piel, causada por una bacteria. El hombre es el reservorio de la bacteria, el contagio se produce por contacto con enfermos dift�ricos o los portadores

Subacute infective endocarditis caused by Corynebacterium diphtheriae: a case report.

The authors report an 11-year-old boy with septicemia and subacute infective endocarditis due to toxigenic-Corynebacterium diphtheriae. The patient had underlying congenital heart disease and incomplete immunization. He presented with fever, epistaxis and congestive heart failure. He received high-dose penicillin therapy and diphtheria antitoxin with clinical improvement. While he was receiving a high dose of penicillin for 1 month he developed a generalized tonic clonic seizure. A computerized tomogram revealed intracerebral and ventricular hemorrhage. Craniotomy with blood clot removal and ventriculostomy drainage were done. He died 2 days later from brain death and cardiovascular failure.

[Diphtheria and Renaissance Spanish physicians]. / La difteria y los médicos españoles del renacimiento.

Along the history of medicine, diphtheria has been the cause of many deadly epidemics. Up to the incorporation of microbiology in medicine and the definition of diphtheria provided by Bretonneau in 1826, this disease was studied with all types of sore throut into the galenic system. Spanish physicians in Renaissance started the way to its systematisation, taking it off the rest of sore throat types, with other laryngeal diseases, as it was known later as "croup", giving it the name of "garrotillo". They were the first to describe some important questions about this disease, as the specificity of the diphtheric pseudomembranes, the ineffective potential of salivary drops and the palsy of the soft palate.

Nontoxigenic corynebacterium diphtheriae: an emerging pathogen in England and Wales?

Confirmed isolates of nontoxigenic Corynebacterium diphtheriae in England and Wales increased substantially from 1986 to 1994. Ribotyping of 121 isolates confirmed in 1995 showed that 90 were of a single strain isolated exclusively from the throat; none had previously been identified in toxigenic strains from U.K. or non-U.K. residents. The upward trend in nontoxigenic C. diphtheriae probably represented increased ascertainment, although dissemination of a particular strain or clone may have been a factor.

[Diphtheroids and nontoxigenic Corynebacterium diphtheriae in the etiology of diphtheria]. / Difteroidy i netoksigennye Corynebacterium diphtheriae v étiologii difterii.

The review raises a problem of cooperation between a laboratory and clinics for diphtheria diagnosis. According to scientific literature nontoxigenic diphtheroids cause different nosocomial infections of immunocompromised patients. Nontoxigenic Corynebacterium diphtheriae may cause such systemic infections as septic arthritis and endocarditis in people belonging to unsecured strata of the society. A toxin which can be produced not only by C. diphtheriae but also by diphtheroids is the sole reason of diphtheric inflammation. The role of the C. diphtheriae nontoxigenic strains should be elucidated by the improving of standard methods and introduction of the methods of molecular biology for the toxigenicity assay of diphtheria strains (e.g. polymerase chain reaction). But a complexity of gene expression and difficulties in distinguishing between the infection and the microorganism colonization of a vaccinated person reserve the last word in the diagnosis of diphtheria for a clinical physician.

[Diagnostic problems in diphtheria infection]. / Problemy diagnostiki difteriinoi infektsii.

The problem of diagnosis of diphtherial infection has come to acquire especially significance at the present stage because here in Ukraine we have no legitimate standard procedure for identification of a case of diphtheria and because interpretation of results of bacteriological and serological studies in patients who might have diphtheria is often faulty. The diagnosis of atypical cases of mild localized diphtheria in the vaccinated subjects relies on the presence of chronic ENT-affections and a history of predisposition to sore throat. It is necessary that parallel culturing be done of smears obtained from the nasopharynx for diphtheria and pathogen microflora in order that no possibility of angina of other microbe etiology might be entertained. Isolation of nontoxicogenic strains C diphtheria in the absence of clinical signs of diphtheria should not prompt us to diagnose a patients as having this problem. Serologic investigation of the patients serum in the passive hemagglutination test for the presence of antitoxic antibodies can be recommended for use to verify the vaccination history in those having been taken ill rather than to aid in the differential diagnosis of diphtheria and bacteria-carrier states. Results of bacteriological and serological investigations do not give much ground for rejection or confirmation of the diagnosis made.