INTRODUCTIONIn the mid-nineteenth century, with the world in the grip of repeated diphtheria epidemics, tracheostomy evolved as a potentially lifesaving tool for pediatric patients. Though intubation and antitoxin eventually made the procedure all but unnecessary in diphtheria, this period spurred discussion of technique, complications, and aftercare that advanced the field of airway surgery. Growing acceptance for tracheostomy allowed twentieth-century physicians to adapt the procedure to chronic respiratory failure and pulmonary toilet and paved the way for it to become one of the most common airway surgeries performed today.METHODSWe performed a literature review with an emphasis on the use of primary sources with the objective of describing the development of tracheostomy during the mid-nineteenth to twentieth century.RESULTSTracheostomy has been used in the treatment of upper airway obstruction from foreign body since the second and third centuries B.C.E. In the nineteenth century, obstruction from pharyngeal pseudomembrane related to Corynebacterium diphtheriae infection became commonplace and associated with significant risk of mortality. Pierre Fidele Bretonneau and his pupil Armand Trousseau were the first to perform tracheostomy in cases of diphtheria. By 1887, over 20,000 tracheostomies had been performed in the treatment of diphtheria in Europe and America. Disagreements abounded over preferred timing, the role of anesthesia, placement technique, and post-operative care, with widespread discussion in the medical literature. Though intubation and diphtheria antitoxin ultimately replaced tracheostomy in the treatment of these patients, the use of tracheostomy in the management of upper airway obstruction from other etiologies increased after this period.DISCUSSIONThe use of tracheostomy in pediatric patients with diphtheria was instrumental in standardizing the procedure, identifying its complications and their management, and promoting public acceptance of the practice as a treatment for upper airway obstruction. Today, although most of us will never see a case of diphtheria, we continue to face patients in what Scottish surgeon James Spence called "the agonies of suffocation." That we have the tools to manage complex airway obstruction comes in part from the heroic efforts of the physicians of the nineteenth century who, despite heartbreaking losses, advanced the technique of tracheostomy in their fight against childhood diphtheria.

01 Dec 2024·Infectious Diseases Now

The resurgence of diphtheria in Zinder, Niger

Article

Author: Sahada, Moussa ; Mahamadou, Doutchi ; Zaratou, Ali ; Mahaman Moustapha, Lamine ; Adoum Fils, Souleymane ; Paul Eholié, Serge ; Idrissa, Hamadou ; Bara Abdoul-Aziz, Adamou ; Ousmane, Sani ; Thomas Abraham, George ; Abdoulaye, Ousmane ; Abdoul Aziz, Garba ; Hassane, Diongolé ; Hamsatou, Bagnou ; Eric, Adehossi

BACKGROUNDDiphtheria is a re-emerging bacterial disease in developing countries with low vaccination coverage.OBJECTIVESThis is a descriptive cross-sectional study of diphtheria cases reported to the DRSP/Zinder from March 14, 2022 through June 26, 2023.METHODSIt includes cases reported through epidemiological surveillance and data on patients hospitalized in the infectious and tropical diseases department of the Zinder National Hospital (SMIT).RESULTSA total of 32 patients were included in this study. The median age was 12 years [4-22 years]. Key symptoms included dysphagia and odynophagia (100 %), false membranes (84.4 %), fever (46.9 %), thrombocytopenia (39.3 %), cervical lymphadenopathy (37 %), respiratory distress (15.6 %), epistaxis (12.5 %), gingival bleeding (9.4 %), agitation (6.2 %) and paresis (3.1 %). Renal function was altered in 74 % of cases. Diagnostic confirmation was procured through culture on oropharyngeal swabs. Corynebacterium diphtheriae was isolated in 26.31 % (5/19) of cases. Patients were treated with macrolides and diphtheria antitoxin. The case fatality rate was 31.2 %. Poor prognostic factors included gingival bleeding (p = 0.0262), respiratory distress (p = 0.0374), and thrombocytopenia below 50,000 platelets/mm³ (p = 0.0020).CONCLUSIONDiphtheria is a deadly re-emerging disease. The fight against this condition necessitates improved vaccination coverage.

01 Dec 2023·The American Surgeon™

The Christmas Miracle of Emil von Behring

Author: Nakayama, Don K.

The foundation story of immunology is the Christmas miracle of Emil von Behring, whose diphtheria antitoxin was first used to save the life of a child on Christmas Day 1891. Modern scholarship has dismissed it as historically and scientifically implausible: Behring’s lab did not have enough antitoxin serum for use in humans, and Ernst von Bergmann had prohibited its use at the Charité. But antitoxin was tried that December by their assistants, Erich Wernicke, who processed injected rams and horses and harvested the serum for Behring, and Heinrich Geissler, who was one of Bergmann’s house physicians. Especially during the Christmas season, it is easy to imagine Wernicke and Geissler bypassing protocol and giving the serum a try as a last-ditch effort to save a dying child. Derek Linton, a Behring biographer, wrote: A harried nurse confronted by a dying infant belatedly remembers that a doctor with a promising remedy for diphtheria urged her to bring hopeless cases to his attention and has him roused from his slumber on the other side of Berlin in the middle of the night on December 20, 1891. The injection of his wonder serum then rapidly resuscitates the comatose infant. Five days later, the parents celebrate the most joyous Christmas of their lives with their fully recovered daughter.

100 Deals associated with Diphtheria Antitoxin(KM Biologics)

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KEGG	Wiki	ATC	Drug Bank
D06480	-	J06AA01	-

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Indication	Country/Location	Organization	Date
Diphtheria	Japan	KM Biologics KK	01 Dec 2005

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