Corynebacterium amycolatum as a cause of acute pharyngitis in a 2 years old child: a case report

Abstract

Acute pharyngitis is an inflammatory syndrome of the pharynx and/or tonsils caused by several different groups of microorganisms. Pharyngitis can be part of a generalized upper respiratory tract infection or a specific infection localized in the pharynx. A two years old child presented with low grade fever (37.8 oc), rainy nose, congested pharynx, and loss of appetite in A1-Door city at October 2007. Primarily diagnosed as a pharyngitis case of viral origin, He was given antipyretics and antihistamines and kept under observation. After 3 days, a sudden increase of fever (39.2 oc) with vomiting began, and a grayish membrane appeared over the tonsils and uvula together with malar thrush over the gums, with deteriorated general condition. A swab was taken from the pharynx and sent for gram stained smear. The result of the stained smear was gram positive bacilli arranged in Chinese letter appearance (no metachromatic granules were noticed) giving the possibility of diphtheria as a diagnosis. The child was giving Procaine Penicillin (0.6
MIU) i.m. as a single daily dose with antifungal gel (miconazole gel) as a treatment in addition to the previous therapy. No diphtheria antitoxin was available in the governorate hospitals to be given to the child. After isolation and identification with conventional methods, the resulted bacterium was surprisingly C. amycolatum rather than C. diphtheria, and sensitivity tests suggest that this bacterium was sensitive only to ceftriaxone and tobramycin. The child was then given ceftriaxone vial injection (0.5 gm) as a single i.m. daily dose instead of the penicillin (after 4 days of non response on treatment) and continued for 7 days. On day 4 of ceftriaxone regimen, the child started to get better and healed by the end of therapy.