Otolaryngology Book

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Diphtheria

Aka: Diphtheria, Pseudomembranous Pharyngitis, Corynebacterium diphtheriae
  1. See Also
    1. Pharyngitis
    2. Pharyngitis Causes
    3. Dysphagia
    4. Tonsillitis
    5. Group A Streptococcal Pharyngitis
    6. Peritonsillar Abscess
    7. Retropharyngeal Abscess
    8. Lemierre Syndrome
    9. Diphtheria
    10. Chronic Pharyngeal Carriage of Streptococcus pyogenes
    11. Tonsillectomy Indications
  2. Epidemiology
    1. Rare in United States due to Immunization (DTP, DTaP)
      1. However 20% of adults may be inadequate immune status
    2. Ongoing epidemic in the former USSR
  3. Pathophysiology
    1. Causative Organisms
      1. Corynebacterium diphtheriae
      2. Other Corynebacterium species (ulcerans, pseudotuberculosis) may be rarely transmitted from animals to humans
  4. Symptoms
    1. Sore Throat
    2. Dysphagia
    3. Weakness
    4. Malaise
  5. Signs
    1. Toxic appearance
    2. Low grade fever
    3. Tachycardia (out of proportion to fever)
    4. Pharyngeal erythema
    5. Gray-white tenacious exudate or "membrane" adheres to posterior pharynx
      1. Occurs at Tonsillar Pillars and posterior pharynx
      2. Leaves focal hemorrhagic raw surface when removed
    6. Cervical Lymphadenopathy
  6. Differential Diagnosis
    1. Vincent's Angina (Trench Mouth)
      1. Also shows pseudomembrane formation
    2. Pharyngitis
  7. Labs
    1. Complete Blood Count (CBC)
      1. Leukocytosis
    2. Throat Culture and nasal culture
      1. Positive for Corynebacterium organisms
  8. Management
    1. Droplet precautions
    2. Diphtheria antitoxin (Equine serum from CDC)
      1. Scratch test before use
    3. Antibiotics for 14 day duration
      1. Erythromycin 20 mg/kg/day divided every 6 hours IV or
      2. Penicillin G 50,000 units/kg up to 1.2 MU/day IV every 12 hours, then transition to Penicillin VK when able
    4. Culture and Treat contacts
      1. Procaine Penicillin for 1 dose OR
      2. Erythromycin for 7-10 days
  9. Prognosis
    1. Without treatment, Diphtheria has a mortality rate as high as 50%
    2. With treatment, mortality may still approach 5-10%
  10. Prevention
    1. DTP Vaccination or DTaP Vaccination
  11. Resources
    1. CDC - Diphtheria
      1. https://www.cdc.gov/diphtheria/clinicians.html
  12. References
    1. Sanford Guide, accessed on IOS 12/29/2019

Corynebacterium diphtheriae (C0010150)

Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Corynebacterium diphtheriae.
Definition (NCI) A species of aerobic or facultatively anaerobic, Gram-positive, coryneform, pleomorphic bacilli assigned to the phylum Actinobacteria. This species is nonmotile, non-spore forming, catalase positive, non-lipophilic, produces diphtheria toxin which inhibits elongation factor 2 (EF-2) thus preventing protein synthesis, forms polar granules, and is cultured in Loeffler's serum in a low iron environment or on tellurite agar. C diphtheriae is commensal in the skin and nasopharynx, but toxin producing strains are pathogenic to humans causing diphtheria; both an antitoxin and vaccine are available for disease prevention.
Definition (MSH) A species of gram-positive, asporogenous bacteria in which three cultural types are recognized. These types (gravis, intermedius, and mitis) were originally given in accordance with the clinical severity of the cases from which the different strains were most frequently isolated. This species is the causative agent of DIPHTHERIA.
Definition (CSP) species of gram positive, asporogenous bacteria in which three cultural types are recognized; these types (gravis, intermedius, and mitis) were originally given in accordance with the clinical severity of the cases from which the different strains were most frequently isolated; the causative agent of diphtheria.
Concepts Bacterium (T007)
MSH D003353
SnomedCT 5851001
LNC LP16683-2, MTHU006922
English Corynebacterium Diphtheriae, CORYNEBACT DIPHTHERIAE, C. diphtheriae, Corynebacterium diphtheriae (Kruse 1886) Lehmann and Neumann 1896, Bacillus diphtheriae, Bacterium diphtheriae, Microsporon diphthericum, Microsporon diphtheriticum, Mycobacterium diphtheriae, Pacinia loeffleri, CORYNEBACTERIUM DIPHTHERIAE, Diphtheria bacillus, Klebs-Loeffler bacillus, Corynebacterium diphtheriae (organism), Corynebacterium diphtheriae
Swedish Corynebacterium diphtheriae
Czech Corynebacterium diphtheriae
Finnish Corynebacterium diphtheriae
Russian KORINEBAKTERII DIFTERII, PALOCHKA LEFLERA, CORYNEBACTERIUM DIPHTHERIAE, BACILLUS DIPHTHERIAE, BACTERIUM DIPHTHERIAE, MICROSPORON DIPHTHERICUM, PACINIA LOEFFLERI, КОРИНЕБАКТЕРИИ ДИФТЕРИИ, ПАЛОЧКА ЛЕФЛЕРА
Polish Corynebacterium diphtheriae, Maczugowce błonicy
Norwegian Corynebacterium diphtheriae
Spanish Corynebacterium diphteriae, Bacilo diftérico, Corynebacterium diphtheriae (organismo), bacilo de Klebs - Loeffler, Corynebacterium diphtheriae
French Bacille diphtérique, Corynebacterium diphtheriae
German Bacterium diphtheriae, Corynebacterium diphtheriae, Diphtherie-Bakterium
Italian Corynebacterium diphtheriae
Dutch Corynebacterium diphtheriae
Portuguese Corynebacterium diphtheriae
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Diphtheria (C0012546)

Definition (MEDLINEPLUS)

Diphtheria is a serious bacterial infection. You can catch it from a person who has the infection and coughs or sneezes. It usually affects the nose and throat and causes a bad sore throat, swollen glands, fever, and chills. But if it is not properly diagnosed and treated it produces a poison in the body that can cause serious complications such as heart failure or paralysis.

The diphtheria, pertussis and tetanus (DPT) vaccine can prevent diphtheria, but its protection does not last forever. Adults should get another dose, or booster, every 10 years. Diphtheria is very rare in the United States because of the vaccine.

Centers for Disease Control and Prevention
Definition (NCI) A Gram-positive bacterial infection caused by Corynebacterium diphtheria. It usually involves the oral cavity, pharynx, and nasal cavity. Patients develop pseudomembranes in the affected areas and manifest signs and symptoms of an upper respiratory infection. The diphtheria toxin may cause myocarditis, polyneuritis, and other systemic effects.
Definition (MSH) A localized infection of mucous membranes or skin caused by toxigenic strains of CORYNEBACTERIUM DIPHTHERIAE. It is characterized by the presence of a pseudomembrane at the site of infection. DIPHTHERIA TOXIN, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects.
Definition (CSP) localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae; it is characterized by the presence of a pseudomembrane at the site of infection; diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects.
Concepts Disease or Syndrome (T047)
MSH D004165
ICD9 032.9, 032
ICD10 A36, A36.9
SnomedCT 154299004, 186349009, 187323007, 3739008, 397428000, 276197005
LNC LA10452-3
English Diphtheria, Diphtherias, Diphtheria, unspecified, [X]Diphtheria, unspecified, diphtheria, diphtheria (diagnosis), Diphtheria NOS, Diphtheria [Disease/Finding], Diphtheria NOS (disorder), Corynebacterium diphtheriae infection, [X]Diphtheria, unspecified (disorder), Infection due to Corynebacterium diphtheriae, Diphtheria (disorder), Infection due to Corynebacterium diphtheriae (disorder), diphtherial; infection, infection; Corynebacterium diphtheriae, infection; diphtherial, Corynebacterium diphtheriae; infection, Diphtheria, NOS
Dutch difterie, niet-gespecificeerd, Corynebacterium diphtheriae-infectie, Corynebacterium diphtheriae; infectie, difterisch; infectie, infectie; Corynebacterium diphtheriae, infectie; difterisch, Difterie, niet gespecificeerd, difterie, Difterie
French Diphtérie, non précisée, Infection à Corynebacterium diphtheriae, Diphtérie
German Diphtherie, unspezifisch, Corynebacterium diphtheriae-Infektion, Diphtherie, nicht naeher bezeichnet, Diphtherie
Italian Infezione da Corynebacterium diphtheriae, Difterite non specificata, Difterite
Portuguese Difteria NE, Infecção por Corynebacterium diphtheriae, Difteria
Spanish Infección por Corynebacterium diphtheriae, Difteria no especificada, [X]difteria, no especificada, [X]difteria, no especificada (trastorno), difteria, SAI, infección por Corynebacterium diphteriae, difteria, SAI (trastorno), difteria, difteria (trastorno), infección por Corynebacterium diphtheriae (trastorno), infección por Corynebacterium diphtheriae, Difteria
Japanese ジフテリア、詳細不明, ジフテリア, コリネバクテリウム・ジフテリア感染, ｼﾞﾌﾃﾘｱｼｮｳｻｲﾌﾒｲ, ｺﾘﾈﾊﾞｸﾃﾘｳﾑｼﾞﾌﾃﾘｱｶﾝｾﾝ, ｼﾞﾌﾃﾘｱ
Swedish Difteri
Czech záškrt, Infekce způsobená Corynebacterium diphteriae, Difterie, Difterie, blíže neurčená, difterie, diftérie, mázdřivka
Finnish Kurkkumätä
Russian DIFTERIIA, ДИФТЕРИЯ
Korean 디프테리아, 상세불명의 디프테리아
Polish Dyfteryt, Błonica, Zakażenie Corynebacterium diphtheriae
Hungarian diphtheria, nem meghatározott, diphtheria, Corynebacterium diphtheriae fertőzés
Norwegian Difteri
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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