Case Report
Year: 2020 | Month: January-March | Volume: 5 | Issue: 1 | Pages: 198-203
A Fatal Diphtheria Case in a 4-Years-Old Child with Protective Diphtheria IgG Antibody in 2014
Kambang Sariadji1, Rudi Hendro Putranto2
1Center for Biomedical and Basic Technology in Health, National Research and Development Agency, Ministry of Health Republic of Indonesia
2Center for Health Resources and Health Services, National Research and Development Agency, Ministry of Health Republic of Indonesia
Corresponding Author: Kambang Sariadji
ABSTRACT
Background: Basic Health Research Data 2010 show that the coverage of basic complete immunization was 48.8%. The lower of Immunization coverage will lead to vulnerability of diphtheria. A case of diphtheria was reported in the Regional General Hospital of Serang Banten, in a 4-years-old boy with symptoms of fever, difficulty swallowing, breathing and bullneck onset. The next day after sampling of throat swab, nose swab and blood, the patient died.
Objective. This study aims to identify the cause of death of patients with suspected diphtheria based on laboratory data.
Methods. Descriptive method by describing the events occurred. The sample cases and 2 close contacts were inoculated into the medium Cystine Tellurite Blood Agar (CTBA) and Blood Agar (BA). The toxigenic was detected by PCR, then the anti-IgG serology using reagents from AccuDiag TM.
Results. Culture of diphtheria cases showed the characteristics of diphtheria colonies and confirmed by microscopic evaluation, then biochemical tests by using API showed Corine>89.5% possibility of species Corynebacterium diphtheriae gravis type. Results of PCR showed positive results by the presence of tox gene (dtx) of C. diphtheriae. Serologic immune status showed the protective titers 1:18 IU/mL. (Protective titer > 0.1 IU / mL). The results of two close contacts were negative for diphtheria.
Conclusion. The death of patients could be caused by the faster activity of diphtheria toxin than the formation of toxin antibody to eliminate the toxin.
Keywords: Corynebacterium diphtheriae, IgG diphtheria, Serology