Tonsilopharyngitis diphtheriae in 13th Years Old Girl at Dr.

Kariadi Hospital
Ridha wahyutomo1,2, Leonardus Widyatmoko1, Adinta Anandani1, Rahayu1 1. Department of Clinical Microbiology , Faculty of Medicine Diponegoro University/Dr. Kariadi Hospital Semarang 2. Department of Clinical Microbiology , Faculty of Medicine Sultan Agung Islamic University Semarang

Abstract Introduction/ Background : Diphtheria is most often an upper respiratory tract illness characterized by sore throat, low fever, malaise, anorexia and pseudomembrane on the tonsils, pharynx, larynk and nasal cavity. Diphtheria toxin produced by Corynebacterium diphtheriae, can cause myocarditis, polyneuropathy, and other systemic toxic effects. Case description/Objective : It was reported that 13th years old girl from Kudus was reffered to Dr.Kariadi hospital with sore throat, low fever, hoarseness, cough, anorexia and malaise. Patient has complete history of immunization. From the results of the physical examination, in emergency room, we found enlarged tonsil grade II and pseudomembranous in the area of the tonsils, uvula, and pharynx. There was no bull neck. Throat swab culture and Neisser staining result possitive, Blood agar culture, and Telurit agar culture leads to the Corynebacterium diphtheriae. From the results of the ECG, CK-MB and Troponin I show no myocarditiss sign. Patient should be nursed in strict isolation room until 3 times of cultures show negative results, bed rest to prevent complications, provision of adequate fluids to prevent dehydration. The theraphy was ADS 80,000 units i.v (DAT treatment), penicillin procaine 50000-100000 IU / kg / day intramuscularly for 10 days. Patient was given prednisone for reducing inflammatory reaction that can lead to airway obstruction. Examination of serial ECG is important to look at the complications of myocarditis. Having obtained the results of 2 times negative cultures, and/or at least 24 hours after completing treatment and show an improvement of symptoms, the patient eventually transferred to the inpatient ward. Discussion : The incidents of diphteriae reappear in Indonesia. Begin in East Java on July 2012, than in Kudus, Central Java on February 2013. The decision of treatment not only from clinical presentation but also from microbiology examination. Particularly, Neisser staining on first coming in emergency room. This staining can give rapid information that patient is true diphteriae. Swab of pseudomembranous specimens were taken for diphteriae cultures. This

cultures result for confirming stain preparat. In this case Corynebacterium diphteriae was found in three preparates and grew in three Telurite medium. There was no growth in cultur and and Coryneform preparates in staining from fourth until sixth day. The best initial therapy for this patients is ADS as soon as possible. Conclusion : Management of tonsilopharyngitis diphteriae in children are early treatment and accurate diagnosis to prevent complications. Keyword : Corynebacterium diphtheriae, tonsilopharyngitis diphteriae