{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T15:06:01Z","timestamp":1777302361371,"version":"3.51.4"},"reference-count":34,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,12]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>We report the case of a girl in her middle childhood who presented with progressive neck swelling, sore throat, dysphagia, low-grade fever and malaise, and with no prior vaccinations. Examination revealed a \u2018bull neck\u2019 appearance with pseudomembranous pharyngitis, which showed bleeding on membrane removal. The patient did not have any respiratory distress, but RT-PCR confirmed the concurrent coinfection of DPT with SARS-CoV-2. The laboratory investigations exhibited a leucocyte count of 17.2 \u00d7 10\u2079\/L and ALT raised at 113\u2009U\/L, indicative of systemic involvement. Imaging showed mild tonsillar calcifications with ground-glass opacities on the chest CT, which placed a CT severity score for cough severity of 13\/25, indicating moderate COVID-19 pneumonia. Treatment was intravenous DPT antitoxin (100\u2009000 units) and cefotaxime (1\u2009g two times per day for 14 days). Symptomatic resolution occurred within 10 days, including clearing inflammatory markers and membranes. Recovery was complete and uncomplicated, with no sequelae after 3\u2009months.<\/jats:p>","DOI":"10.1136\/bcr-2024-264530","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T20:35:19Z","timestamp":1739997319000},"page":"e264530","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Concurrent diphtheria and COVID-19 infection in an unvaccinated child"],"prefix":"10.1136","volume":"18","author":[{"given":"Shivanand","family":"Gundalli","sequence":"first","affiliation":[{"name":"District Hospital Vijayapura, Vijayapura, KA, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sriharish","family":"Pujari","sequence":"additional","affiliation":[{"name":"District Hospital Vijayapura, Vijayapura, KA, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aakash","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"District Hospital Vijayapura, Vijayapura, KA, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4839-9152","authenticated-orcid":false,"given":"Sayandeep","family":"Das","sequence":"additional","affiliation":[{"name":"Pathology, Shri B.M. Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Bijapur, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"2025082712431196000_18.2.e264530.1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1038\/s41572-019-0131-y","article-title":"Diphtheria","volume":"5","author":"Sharma","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2025082712431196000_18.2.e264530.2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2510.190271"},{"key":"2025082712431196000_18.2.e264530.3","first-page":"330","article-title":"Respiratory diphtheria caused by Corynebacterium ulcerans--Terre Haute, Indiana, 1996","volume":"46","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082712431196000_18.2.e264530.4","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18030988"},{"key":"2025082712431196000_18.2.e264530.5","article-title":"Assessment of Disruption of Routine Childhood Immunization in Developing Countries Due to Pandemic","volume":"14","author":"Poshattiwar","year":"2022","journal-title":"Cureus"},{"key":"2025082712431196000_18.2.e264530.6","doi-asserted-by":"crossref","first-page":"104715","DOI":"10.1016\/j.jcv.2020.104715","article-title":"Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis","volume":"135","author":"Badal","year":"2021","journal-title":"J Clin Virol"},{"key":"2025082712431196000_18.2.e264530.7","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1093\/qjmed\/hcab206","article-title":"Epidemiological, clinical and biomarker profile of pediatric patients infected with COVID-19","volume":"114","author":"Shah","year":"2021","journal-title":"QJM"},{"key":"2025082712431196000_18.2.e264530.8","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.3390\/vaccines10122039","article-title":"COVID-19 Epidemiology, Immunity, and Vaccine Development in Children: A Review","volume":"10","author":"Fergie","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2025082712431196000_18.2.e264530.9","doi-asserted-by":"crossref","first-page":"1291048","DOI":"10.3389\/fimmu.2023.1291048","article-title":"Low pre-existing endemic human coronavirus (HCoV-NL63)-specific T cell frequencies are associated with impaired SARS-CoV-2-specific T cell responses in people living with HIV","volume":"14","author":"Ng\u2019uni","year":"2023","journal-title":"Front Immunol"},{"key":"2025082712431196000_18.2.e264530.10","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1186\/s12889-024-17905-3","article-title":"Immune Dysregulation in SARS-CoV-2 patients coinfected with Mycobacterium tuberculosis (Mtb) or HIV in China","volume":"24","author":"Li","year":"2024","journal-title":"BMC Public Health"},{"key":"2025082712431196000_18.2.e264530.11","article-title":"Understanding COVID-19 Vaccine Hesitancy Through an Organizational Behaviour Lens","volume":"14","author":"Khan","year":"2022","journal-title":"Cureus"},{"key":"2025082712431196000_18.2.e264530.12","doi-asserted-by":"crossref","first-page":"296","DOI":"10.21101\/cejph.a7593","article-title":"The lingering challenge: addressing vaccine hesitancy in a post-pandemic world","volume":"31","author":"Mir","year":"2023","journal-title":"Cent Eur J Public Health"},{"key":"2025082712431196000_18.2.e264530.13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s41182-023-00522-y","article-title":"Diphtheria in Pakistan post-COVID-19, a potential public health threat: an update","volume":"51","author":"Saeed","year":"2023","journal-title":"Trop Med Health"},{"key":"2025082712431196000_18.2.e264530.14","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1186\/s12931-024-02862-7","article-title":"Influenza A, Influenza B, human respiratory syncytial virus and SARSCoV-2 molecular diagnostics and epidemiology in the post COVID-19 era","volume":"25","author":"Lu\u0161trek","year":"2024","journal-title":"Respir Res"},{"key":"2025082712431196000_18.2.e264530.15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/cid\/ciz808","article-title":"Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis","volume":"71","author":"Truelove","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2025082712431196000_18.2.e264530.16","doi-asserted-by":"crossref","first-page":"pgac071","DOI":"10.1093\/pnasnexus\/pgac071","article-title":"SARS-CoV-2 and influenza coinfection throughout the COVID-19 pandemic: an assessment of coinfection rates, cohort characteristics, and clinical outcomes","volume":"1","author":"Pawlowski","year":"2022","journal-title":"PNAS Nexus"},{"key":"2025082712431196000_18.2.e264530.17","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/01.ccm.0000807420.79049.73","article-title":"274: A CASE REPORT OF ACUTE DIPHTHERIA INFECTION WITH COVID-19 SEVERE PNEUMONIA","volume":"50","author":"Siddiqui","year":"2022","journal-title":"Crit Care Med"},{"key":"2025082712431196000_18.2.e264530.18","first-page":"11","article-title":"Diphtheritic Polyneuropathy: A Case Report","volume":"71","author":"L","year":"2023","journal-title":"J Assoc Physicians India"},{"key":"2025082712431196000_18.2.e264530.19","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.2009128"},{"key":"2025082712431196000_18.2.e264530.20","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S0140-6736(21)01337-4","article-title":"Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study","volume":"398","author":"Causey","year":"2021","journal-title":"Lancet"},{"key":"2025082712431196000_18.2.e264530.21","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7343a4"},{"key":"2025082712431196000_18.2.e264530.22","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7243a1"},{"key":"2025082712431196000_18.2.e264530.23","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-infections in people with COVID-19: a systematic review and meta-analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J Infect"},{"key":"2025082712431196000_18.2.e264530.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.6266"},{"key":"2025082712431196000_18.2.e264530.25","doi-asserted-by":"crossref","first-page":"459","DOI":"10.4103\/0971-5916.169212","article-title":"Persistence of Corynebacterium diphtheriae in Delhi & National Capital Region (NCR)","volume":"142","author":"Bhagat","year":"2015","journal-title":"Indian J Med Res"},{"key":"2025082712431196000_18.2.e264530.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2021.08.015"},{"key":"2025082712431196000_18.2.e264530.27","doi-asserted-by":"crossref","unstructured":"Simpson A , Douglas P , Draper J . Respiratory diphtheria in the time of Omicron. Commun Dis Intell 2018;48. doi:10.33321\/cdi.2024.48.41","DOI":"10.33321\/cdi.2024.48.41"},{"key":"2025082712431196000_18.2.e264530.28","doi-asserted-by":"crossref","first-page":"D66","DOI":"10.1016\/j.vaccine.2015.09.035","article-title":"Vaccine hesitancy: Causes, consequences, and a call to action","volume":"33","author":"Salmon","year":"2015","journal-title":"Vaccine (Auckl)"},{"key":"2025082712431196000_18.2.e264530.29","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.ijid.2022.04.005","article-title":"Impact of the SARS-CoV-2 pandemic on vaccine-preventable disease campaigns","volume":"119","author":"Ho","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2025082712431196000_18.2.e264530.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-076607","article-title":"COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review","volume":"14","author":"Hartner","year":"2024","journal-title":"BMJ Open"},{"key":"2025082712431196000_18.2.e264530.31","doi-asserted-by":"crossref","first-page":"4142","DOI":"10.1016\/j.vaccine.2022.05.074","article-title":"COVID-19 impact on routine immunisations for vaccine-preventable diseases: Projecting the effect of different routes to recovery","volume":"40","author":"Toor","year":"2022","journal-title":"Vaccine (Auckl)"},{"key":"2025082712431196000_18.2.e264530.32","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-038282","article-title":"Digital health for real-time monitoring of a national immunisation campaign in Indonesia: a large-scale effectiveness evaluation","volume":"10","author":"Jusril","year":"2020","journal-title":"BMJ Open"},{"key":"2025082712431196000_18.2.e264530.33","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3390\/vaccines9040314","article-title":"Vaccination as a Control Tool in Bovine Tuberculosis: Social Media Monitoring to Assess Public Response to Government Policy Development and Implementation","volume":"9","author":"Dicks","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"2025082712431196000_18.2.e264530.34","doi-asserted-by":"crossref","first-page":"847","DOI":"10.3390\/vaccines12080847","article-title":"Integrating Digital Health Solutions with Immunization Strategies: Improving Immunization Coverage and Monitoring in the Post-COVID-19 Era","volume":"12","author":"Pavia","year":"2024","journal-title":"Vaccines (Basel)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:43:20Z","timestamp":1756323800000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,19]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-264530"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264530","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}