A case of toxigenic, pharyngeal diphtheria in Australia

Sarah Grigg, David Hogan, F Shaun Hosein, Dean Johns, Amy Jennison and Shradha Subedi
Med J Aust 2020; 213 (2): . || doi: 10.5694/mja2.50566
Published online: 4 May 2020

A 42‐year‐old woman presented to the Sunshine Coast University Hospital, Queensland, with a 5‐day history of odynophagia, orthopnoea and rapid onset of neck swelling over 12 hours. She had returned one week prior from a year‐long trip to Central America, Sri Lanka and Indonesia. Relevant past medical history included nephrotic syndrome due to minimal change disease, use of prednisolone 2.5 mg daily and previous treatment with rituximab. Childhood vaccinations were reported, but she had no booster travel vaccinations.

  • 1 Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD
  • 2 Griffith University, Sunshine Coast, QLD
  • 3 Forensic and Scientific Services, Brisbane, QLD


Competing interests:

No relevant disclosures.

  • 1. Nakao H, Pruckler JM, Mazurova IK, et al. Heterogeneity of diphtheria toxin gene, tox, and its regulatory element, dtxR, in Corynebacterium diphtheriae strains causing epidemic diphtheria in Russia and Ukraine. J Clin Microbiol 1996; 34: 1711–1716.
  • 2. Sing A, Berger A, Schneider‐Brachert W, et al. Rapid detection and molecular differentiation of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by LightCycler PCR. J Clin Microbiol 2011; 49: 2485.
  • 3. Queensland Government, Queensland Health. Diphtheria [website]. Queensland Health, 2012. (viewed Mar 2020).
  • 4. Hadfield TL, McEvoy P, Polotsky Y, et al. The pathology of diphtheria. J Infect Dis 2000; 181 (Suppl): S116–S120.
  • 5. World Health Organization. Diphtheria [website]. WHO, 2017. (viewed Mar 2020).
  • 6. NNDSS Annual Report Working Group. Australia's notifiable disease status, 2014: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell Q Rep 2016; 40: E48–E145.
  • 7. Lubran MM. Bacterial toxins. Ann Clin Lab Sci 1988; 18: 58–71.
  • 8. Adler NR, Mahony A, Friedman ND. Diphtheria: forgotten, but not gone. Intern Med J 2013; 43: 206–210.
  • 9. Lumio JT, Groundstroem KW, Melnick OB, et al. Electrocardiographic abnormalities in patients with diphtheria: a prospective study. Am J Med 2004; 116: 78–83.
  • 10. Tiwari TSP, Wharton M. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, editors. Plotkin's vaccines, 7th ed. Elsevier, 2018: 261–275.


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