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