{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:47:25Z","timestamp":1771490845236,"version":"3.50.1"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,2,19]]},"abstract":"<jats:p>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 for <jats:italic>Corynebacterium ulcerans<\/jats:italic>, 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.<\/jats:p>","DOI":"10.1136\/bcr-2016-218408","type":"journal-article","created":{"date-parts":[[2017,3,6]],"date-time":"2017-03-06T10:45:24Z","timestamp":1488797124000},"page":"bcr2016218408","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Multidisciplinary approach to the management of a case of classical respiratory diphtheria requiring percutaneous endoscopic gastrostomy feeding"],"prefix":"10.1136","volume":"2017","author":[{"given":"Matthew James","family":"Haywood","sequence":"first","affiliation":[{"name":"Department of ENT, Luton and Dunstable University Hospital, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ananth","family":"Vijendren","sequence":"additional","affiliation":[{"name":"Department of ENT, Luton and Dunstable University Hospital, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of ENT, Luton and Dunstable University Hospital, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohinton","family":"Mulla","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Luton and Dunstable University Hospital, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miss Jaan","family":"Panesar","sequence":"additional","affiliation":[{"name":"Department of ENT, Luton and Dunstable University Hospital, Luton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,3,6]]},"reference":[{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.1","unstructured":"Diphtheria Guidelines Working Group. Public health control and management of diphtheria in England and Wales. Public Health England. PHE publications gateway number: 2014837, February. 2015."},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.2","unstructured":"BMJ. Diphtheria. BMJ Best Practice. 2016. http:\/\/bestpractice.bmj.com\/best-practice\/monograph\/738.html (accessed 20 Aug 2016)."},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.3","unstructured":"American Academy of Pediatrics. Diphtheria. In: Kimberlin DW , Brady MT , Jackson MA , et al . eds. Red book online. 2015 report of the Committee of Infectious Diseases 30th Edition (ebook). Illinois: American Academy of Pediatrics, 2015:325\u20139. http:\/\/aapredbook.aappublications.org (accessed 1\/9\/16)."},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.4","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268810001895"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.5","doi-asserted-by":"publisher","DOI":"10.3201\/eid1802.110987"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.6","unstructured":"De Zoysa A , Fry NK , Efstratiou A , et al . Detection of diphtheria toxin gene-bearing and non-toxin gene-bearing Corynebacterium diphtheriae and Corynebacterium ulcerans\/Corynebacterium pseudotuberculosis using a quadruplex Rotor-Gene Q PCR assay. Stockholm, Sweden: European Scientific Conference on Applied Infectious Diseases Epidemiology (ESCAIDE), 5\u20137 November 2014."},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.7","unstructured":"Public Health England. Diphtheria\u2014epidemiological data. London: PHE, 2014. https:\/\/www.gov.uk\/government\/collections\/diphtheria-guidance-data-andanalysis#epidemiology-and-surveillance (accessed 28 Jun 2016)."},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.8","first-page":"77","article-title":"Notes from the field: respiratory diphtheria-like illness caused by toxigenic Corynebacterium ulcerans\u2014Idaho, 2010","volume":"60","author":"Blue","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.9","doi-asserted-by":"publisher","DOI":"10.1086\/525262"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.10","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jhin.2013.06.020","article-title":"Guidance on the use of respiratory and facial protection equipment","volume":"85","author":"Coia","year":"2013","journal-title":"J Hosp Infect"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.11","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/47.1.27"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.12","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.3201\/eid1909.130117","article-title":"Detection of diphtheritic polyneuropathy by acute flaccid paralysis surveillance, India","volume":"19","author":"Mateen","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.13","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.58.9.1438"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.14","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/00005072-195607000-00002","article-title":"Diphtheritic polyneuritis; a pathological study","volume":"15","author":"Fisher","year":"1956","journal-title":"J Neuropathol Exp Neurol"},{"key":"2025082804012054000_2017.mar06_1.bcr2016218408.15","unstructured":"McDonald WI , Kocen RS . Diphtheritic neuropathy. In: Dyck PJ , Thomas PK , Lamert EH , et al , eds. Peripheral neuropathy, vol II. 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