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一名未接种疫苗儿童的白喉性心肌炎

Diphtheritic Myocarditis in an Unvaccinated Child.

作者信息

Esmel-Vilomara Roger, Figueras-Coll Marc, Rosés-Noguer Ferran, Balcells Joan, Gran Ferran

机构信息

Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Pediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Pediatric Cardiology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.

Pediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Pediatric Cardiology, Hospital Universitari Doctor Josep Trueta, Girona, Spain.

出版信息

JACC Case Rep. 2025 Mar 19;30(6 Pt 1):102972. doi: 10.1016/j.jaccas.2024.102972. Epub 2025 Jan 22.

Abstract

BACKGROUND

Diphtheria, a preventable yet potentially fatal childhood disease, remains a significant threat to unimmunized children, despite its decreased prevalence due to widespread vaccination.

CASE SUMMARY

A 6-year-old unvaccinated Spanish boy presented with diphtheritic myocarditis. His condition rapidly deteriorated, leading to cardiogenic shock and ventricular tachycardia, necessitating the use of venoarterial extracorporeal membrane oxygenation and the international procurement of diphtheritic antitoxin (DAT).

DISCUSSION

Myocarditis stands as the primary cause of mortality in diphtheria. Early DAT administration is crucial, but its effectiveness diminishes once the diphtheria toxin binds to tissues, and global accessibility may be challenging due to limited production. In scenarios of refractory cardiogenic shock, the employment of mechanical circulatory support, specifically with left cavity drainage systems, can be vital.

TAKE HOME MESSAGES

Timely vaccination is crucial in preventing diphtheria-related fatalities. Global access to essential treatments like DAT remains a significant challenge.

摘要

背景

白喉是一种可预防但可能致命的儿童疾病,尽管由于广泛接种疫苗其发病率有所下降,但对未接种疫苗的儿童仍然构成重大威胁。

病例摘要

一名6岁未接种疫苗的西班牙男孩患白喉性心肌炎。他的病情迅速恶化,导致心源性休克和室性心动过速,需要使用静脉-动脉体外膜肺氧合,并在国际上采购白喉抗毒素(DAT)。

讨论

心肌炎是白喉死亡的主要原因。早期给予DAT至关重要,但一旦白喉毒素与组织结合,其有效性就会降低,而且由于产量有限,全球可及性可能具有挑战性。在难治性心源性休克的情况下,采用机械循环支持,特别是使用左心腔引流系统,可能至关重要。

要点

及时接种疫苗对于预防白喉相关死亡至关重要。全球获得DAT等基本治疗方法仍然是一项重大挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5bba/12011179/e92f946ca2f1/ga1.jpg

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