{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T21:34:15Z","timestamp":1757453655291,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,10,17]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>A 65-year-old male patient presented with fever, fast atrial fibrillation and frank haematuria on return to Ireland from travel in East Africa. He had a systolic murmur leading to a clinical suspicion of endocarditis. He had no specific clinical features of diphtheria. Blood cultures were taken and empiric therapy commenced with benzylpenicillin, vancomycin and gentamicin. <jats:italic>Corynebacterium diphtheriae<\/jats:italic> was detected on blood culture. The isolate was submitted to a reference laboratory for evaluation of toxigenicity. While initially there was concern regarding the possibility of myocarditis, a clinical decision was made not to administer diphtheria antitoxin in the absence of clinical features of respiratory diphtheria, in the presence of invasive infection and with presumptive previous immunisation. There is no specific guidance on the role of antitoxin in this setting. The issue is not generally addressed in previous reports of <jats:italic>C. diphtheriae<\/jats:italic> blood stream infection.<\/jats:p>","DOI":"10.1136\/bcr-2019-231914","type":"journal-article","created":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T10:06:13Z","timestamp":1572689173000},"page":"e231914","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["<i>Corynebacterium diphtheriae<\/i> bloodstream infection: the role of antitoxin"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4109-6665","authenticated-orcid":false,"given":"Una","family":"Sutton-Fitzpatrick","sequence":"first","affiliation":[{"name":"Clinical Microbiology, Galway University Hospitals, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conor","family":"Grant","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Galway University Hospitals, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitar","family":"Nashev","sequence":"additional","affiliation":[{"name":"Clinical Microbiology, Galway University Hospitals, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Fleming","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Galway University Hospitals, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,2]]},"reference":[{"key":"2025082700485801000_12.11.e231914.1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00452-11"},{"key":"2025082700485801000_12.11.e231914.2","unstructured":"Springer . Corynebacterium diphtheriae and related toxigenic species, 2014."},{"key":"2025082700485801000_12.11.e231914.3","doi-asserted-by":"publisher","DOI":"10.1093\/clind\/16.2.271"},{"key":"2025082700485801000_12.11.e231914.4","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jiph.2014.05.006","article-title":"Non-toxigenic penicillin-resistant cutaneous C. diphtheriae infection: a case report and review of the literature","volume":"8","author":"FitzGerald","year":"2015","journal-title":"J Infect Public Health"},{"key":"2025082700485801000_12.11.e231914.5","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2008001100007"},{"key":"2025082700485801000_12.11.e231914.6","doi-asserted-by":"crossref","DOI":"10.1186\/1476-0711-4-8","article-title":"The first case of septicemia due to nontoxigenic Corynebacterium diphtheriae in Poland: case report","volume":"4","author":"Zasada","year":"2005","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2025082700485801000_12.11.e231914.7","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.44.5.1625-1629.2006"},{"key":"2025082700485801000_12.11.e231914.8","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/pit022"},{"key":"2025082700485801000_12.11.e231914.9","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2334-7-4","article-title":"Corynebacterium endocarditis species-specific risk factors and outcomes","volume":"7","author":"Belmares","year":"2007","journal-title":"BMC Infect Dis"},{"key":"2025082700485801000_12.11.e231914.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2011.04.003"},{"key":"2025082700485801000_12.11.e231914.11","unstructured":"Center for Disease Control and Prevention . Diphtheria antitoxin, 2018. Available: https:\/\/www.cdc.gov\/diphtheria\/dat.html"},{"key":"2025082700485801000_12.11.e231914.12","unstructured":"World Health Organisation . Operational protocol for clinical management of diphtheria, 2017. Available: https:\/\/www.who.int\/health-cluster\/resources\/publications\/WHO-operational-protocols-diphtheria.pdf?ua=1"},{"key":"2025082700485801000_12.11.e231914.13","unstructured":"John E , Bennett RD , Martin J . Blaser principles and practice of infectious diseases. Elsevier, 2009."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:49:10Z","timestamp":1756280950000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,2]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bcr-2019-231914"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231914","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}