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Diphtheria

  • usually child

Clinical Features

  • insidious onset
  • tachycardia
  • low-grade fever
  • Nasal diphtheria
    • unilateral serosanguinous nasal discharge
    • crusting around external nares
  • Pharyngeal diphtheria
    • marked tonsillar and pharyngeal inflammation
    • tough greyish-yellow membrane
      • firmly attached to underlying tissues
      • composition
        • fibrin
        • bacteria
        • epithelial cells
        • mononuclear cell
        • PMNs
    • regional lymphadenopathy ("bull neck")
  • Laryngeal diphtheria
    • extension of membrane from pharynx
    • husky voice
    • brassy cough
    • dyspnoea
    • cyanosis
  • Myocarditis
    • often weeks later (after pharyngeal / laryngeal diphtheria)
    • acute circulatory failure
      • 10th of illness
      • usually fatal
  • Neurological
    • early
      • palatal / pharyngeal wall palsy
    • severeal weeks later
      • cranial nerve palsy
      • paraesthesiae
      • polyneuropathy
      • encephalitis

Variants

  • Cutaneous diphtheria
    • with burns or poor hygeine
    • punched out ulcer
      • undermined edges
      • greyish-white to brownish adherent membrane
    • constitutional symptoms uncommon

Complications

Diagnosis

  • clinical due to urgency

Treatment

  • isolation
  • bed rest
  • 20,000 to 100,000 U of antitoxin IM (after test dose)
  • Benzylpenicillin 2-4g / day for 7 days

Contacts