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Diphtheria
From WikEM
Contents
Background
- An upper respiratory tract illness caused by Corynebacterium diphtheriae, an anerobic Gram positive bacteria
- Children are usually vaccinated with the DPT vaccine[1]
Clinical Features
- Symptoms usually begin 5-7 days post initial infection and are often nonspecific mailaise and fatigue
- Fever of 38°C (100.4°F)
- Cyanosis in severe disease
- Sore throat ± difficulty swallowing
- Hoarseness, cough
- Lymphadenopathy
- "Bull neck" in laryngeal diphtheria[2]
- Dense, grey pseudomembrane covering the posterior aspect of the pharynx[2]
- Croup-like cough
Differential Diagnosis
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [3]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackievirus
- HIV (Acute Retroviral Syndrome)
Noninfectious
- Stevens-Johnson Syndrome
- Pemphigus
- Angioedema
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
Evaluation
Workup
- Throat culture will provide definitive diagnosis
Management
- Airborne isolation
- Severe disease with respiratory compromise may require intubation
- Diphtheria antitoxin is not recommended in prophylaxis but can be used to treat confirmed disease[4]
- Antitoxin will not neutralize toxin that is already fixed to tissues, but it will neutralize circulating (unbound) toxin and will prevent progression of disease
- Administration should be with an ID specialist at the CDC Emergency Operations Center at (US phone: 770-488-7100)
Treatment Antibiotics
Options
- Erythromycin 40mg/kg/day maximum, 2 gm/day
- Procaine penicillin G daily, IM (300,000 U/day for those weighing 10 kg or less, and 600,000 U/day for those weighing more than 10 kg) for 14 days.
Post-Exposure Prophylaxis
Given to close contacts, especially household contacts
- Diphtheria booster[4]
- Antibiotics (one of the following):
- Benzathine Penicillin G
- 600,000 units for persons younger than 6 years old
- 1,200,000 units for those 6 years old and older
- Erythromycin 40mg/kg/day for children and 1 g/day for adults x 10 days
- Benzathine Penicillin G
Disposition
- Admission for disease with moderate to severe respiratory symptoms or while awaiting cultures due to high disease suspicion in an unvaccinated host
See Also
References
- ↑ Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older -- United States, 2013. MMWR. 2013;62(Suppl 1):1-19
- ↑ 2.0 2.1 MacGregor RR. Corynebacterium diphtheriae. In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 205
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
- ↑ 4.0 4.1 ../docss/dip.pdf
Authors
Daniel Ostermayer, Ross Donaldson, Michael Holtz, Neil Young
