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Diphtheria

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Diphtheria, Pseudomembranous Pharyngitis, Corynebacterium diphtheriae

  • 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
  • Pathophysiology
  1. Causative Organisms
    1. Corynebacterium diphtheriae
    2. Other Corynebacterium species (ulcerans, pseudotuberculosis) may be rarely transmitted from animals to humans
  • Symptoms
  1. Sore Throat
  2. Dysphagia
  3. Weakness
  4. Malaise
  • 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
  • Differential Diagnosis
  1. Vincent's Angina (Trench Mouth)
    1. Also shows pseudomembrane formation
  2. Pharyngitis
  • Labs
  1. Complete Blood Count (CBC)
    1. Leukocytosis
  2. Throat Culture and nasal culture
    1. Positive for Corynebacterium organisms
  • 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
  • Prognosis
  1. Without treatment, Diphtheria has a mortality rate as high as 50%
  2. With treatment, mortality may still approach 5-10%
  • Prevention
  1. DTP Vaccination or DTaP Vaccination
  • References
  1. Sanford Guide, accessed on IOS 12/29/2019