Diphtheria: Difference between revisions
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==Background== | ==Background== | ||
*An upper respiratory tract illness caused by Corynebacterium diphtheriae, an anerobic [[Gram | *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== | ||
*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 | ||
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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 | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Strep. Pharyngitis]] | *[[Strep. Pharyngitis]] | ||
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*[[Oral Thrush]] | *[[Oral Thrush]] | ||
*Viral URI | *Viral URI | ||
==Workup== | |||
==Diagnosis== | |||
===Workup=== | |||
*Throat culture will provide definitive diagnosis | *Throat culture will provide definitive diagnosis | ||
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*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== | ==Post-Exposure Prophylaxis== | ||
*For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given.<ref name="cdc"></ref> | *For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given.<ref name="cdc"></ref> | ||
===Antibiotics=== | ===Antibiotics=== | ||
*Should be given to close contacts and family members | *Should be given to close contacts and family members | ||
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#*1,200,000 units for those 6 years old and older | #*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 | #[[Erythromycin]] 40 mg/kg/day for children and 1 g/day for adults x 10 days | ||
==See Also== | ==See Also== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 11:23, 17 August 2015
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
- Strep. Pharyngitis
- Tonsillitis
- Epiglotitis
- Mononucleosis
- Laryngitis
- Acute Bronchitis
- Bacterial Tracheitis
- Oral Thrush
- Viral URI
Diagnosis
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[3]
- 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.
Disposition
- Admission for disease with moderate to severe respiratory symptoms or while awaiting cultures due to high disease suspicion in an unvaccinated host
Post-Exposure Prophylaxis
- For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given.[3]
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
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
- ↑ 3.0 3.1 http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf