Diphtheria: Difference between revisions

(Created page with "==Background== *An upper respiratory tract illness caused by Corynebacterium diphtheriae, an anerobic Gram Positive Bacteria *Children are usually vaccinated with the DPT...")
 
 
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==Background==
==Background==
*An upper respiratory tract illness caused by Corynebacterium diphtheriae, an anerobic [[Gram Positive Bacteria]]
*An upper respiratory tract illness caused by Corynebacterium diphtheriae, an anerobic [[Gram positive bacteria]]
*Children are usually vaccinated with the DPT vaccine<ref>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</ref>
*Children are usually vaccinated with the DPT vaccine<ref>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</ref>
==Clinical Features==
==Clinical Features==
[[File:Dirty white pseudomembrane classically seen in diphtheria 2013-07-06 11-07.jpg|thumb|An adherent, dense, grey pseudomembrane covering the tonsils classically seen in diphtheria.]]
[[File:A doctor with the UK's Emergency Medical Team checks a child for symptoms of Diphtheria in a makeshift clinic in the Kutupalong camp for Rohingya refugees in Bangladesh (39015940254).jpeg|thumb|Thick grey-white coating at the back of the pharynx consistent with diptheria.]]
[[File:Diphtheria bull neck.5325 lores.jpg|thumb|Swollen "bull neck" from diphtheria.]]
[[File:A diphtheria skin lesion on the leg. PHIL 1941 lores.jpg|thumb|A diphtheria skin lesion on the leg.]]
*Symptoms usually begin 5-7 days post initial infection and are often nonspecific mailaise and fatigue
*Symptoms usually begin 5-7 days post initial infection and are often nonspecific mailaise and fatigue
*Fever of 38°C (100.4°F)  
*Fever of 38°C (100.4°F)  
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*"Bull neck" in laryngeal diphtheria<ref name="macgregor">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</ref>
*"Bull neck" in laryngeal diphtheria<ref name="macgregor">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</ref>
*Dense, grey pseudomembrane covering the posterior aspect of the pharynx<ref name="macgregor"></ref>
*Dense, grey pseudomembrane covering the posterior aspect of the pharynx<ref name="macgregor"></ref>
*[[Croup]] like cough
*[[Croup]]-like cough
 
===Systemic Manifestations===
''Diphtheria toxin can lead to toxin damage of the heart (myocarditis), nervous system, and kidneys''
*[[Myocarditis ]]
**Occurs in 10 to 25% of patients
**Typically occurs 7 to 14 days after onset of respiratory symptoms
**[[Heart block]], [[arrhythmias]], [[heart failure]], circulatory collapse.
*Neurologic toxicity
**Occurs in 5% of patients
**Local [[neuropathies]] are followed by cranial neuropathies
 
==Differential Diagnosis==
==Differential Diagnosis==
*[[Strep. Pharyngitis]]
{{Sore throat DDX}}
*Tonsillitis
 
*[[Epiglotitis]]
==Evaluation==
*[[Mononucleosis]]
===Workup===
*Laryngitis
*[[Acute Bronchitis]]
*[[Bacterial Tracheitis]]
*[[Oral Thrush]]
*Viral URI
==Workup==
*Throat culture will provide definitive diagnosis
*Throat culture will provide definitive diagnosis


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===Treatment Antibiotics===
===Treatment Antibiotics===
{{Diphtheria Antibiotics}}
{{Diphtheria Antibiotics}}
===Post-Exposure Prophylaxis===
''Given to close contacts, especially household contacts''
#Diphtheria booster<ref name="cdc"></ref>
#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


==Disposition==
==Disposition==
*Admission for disease with moderate to severe respiratory symptoms or while awaiting cultures due to high disease suspicion in an unvaccinated host
*Admission for disease with moderate to severe respiratory symptoms or while awaiting cultures due to high disease suspicion in an unvaccinated host


==Exposure Prophylaxis==
*For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given.<ref name="cdc"></ref>
===Antibiotics===
*Should be given to close contacts and family members
'''Options:'''
#[[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]] 40 mg/kg/day for children and 1 g/day for adults x 10 days
==See Also==
==See Also==


==External Links==
==References==
 
==Sources==
<references/>
<references/>


[[Category:ID]]
[[Category:ID]]

Latest revision as of 21:14, 2 October 2024

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

An adherent, dense, grey pseudomembrane covering the tonsils classically seen in diphtheria.
Thick grey-white coating at the back of the pharynx consistent with diptheria.
Swollen "bull neck" from diphtheria.
A diphtheria skin lesion on the leg.
  • 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

Systemic Manifestations

Diphtheria toxin can lead to toxin damage of the heart (myocarditis), nervous system, and kidneys

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

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

  1. Diphtheria booster[4]
  2. 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

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

  1. ↑ 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. ↑ 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
  3. ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  4. ↑ 4.0 4.1 http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf
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