Lee J K, Huda S, Francis A, Jusoh M
Paediatrics Unit, Hospital Kuala Terengganu.
Med J Malaysia. 1999 Sep;54(3):377-82.
From August till November 1998, the Paediatric and Anaesthetic Units of Hospital Kuala Terengganu managed three patients from Kuala Terengganu District who were ventilated for respiratory diphtheria. Their ages were 5, 4 and 7 years old and their immunisation for diphtheria were not complete. All three patients presented with respiratory distress and were ventilated for upper airway obstruction. Their treatment included intravenous penicillin and diphtheria antitoxin. One patient died of cardiogenic shock with secondary pneumonia. Pharyngeal and tonsillar swabs of all three patients grew toxigenic Corynebacterium diphtheriae biotype mitis. There were 765 throat cultures taken from contacts. The confirmed positive cultures grew 2 toxigenic and 3 non-toxigenic Corynebacterium diphtheriae biotype mitis and surprisingly, 10 non-toxigenic biotype gravis. A prevalence study is needed to document the endemicity of diphtheria in Kuala Terengganu and to determine the carrier rate of both biotypes. Steps have been taken to increase the immunisation coverage in children. The giving of regular booster doses of diphtheria toxoid to the adult population should be considered.
1998年8月至11月期间，瓜拉丁加奴医院的儿科和麻醉科收治了3名来自瓜拉丁加奴地区的因呼吸性白喉接受通气治疗的患儿。他们的年龄分别为5岁、4岁和7岁，白喉免疫接种均未完成。所有3例患者均出现呼吸窘迫，因上呼吸道梗阻接受通气治疗。他们的治疗包括静脉注射青霉素和白喉抗毒素。1例患者死于心源性休克并继发肺炎。所有3例患者的咽拭子和扁桃体拭子培养均生长出产毒的轻型棒状杆菌生物型白喉杆菌。对接触者进行了765次咽喉培养。确诊的阳性培养物中生长出2株产毒和3株不产毒的轻型棒状杆菌生物型白喉杆菌，令人惊讶的是，还生长出10株不产毒的重型生物型白喉杆菌。需要开展一项患病率研究，以记录瓜拉丁加奴白喉的地方性流行情况，并确定两种生物型的带菌率。已采取措施提高儿童免疫接种覆盖率。应考虑对成年人群定期给予白喉类毒素加强剂量。
