Diphtheria
Revision as of 08:09, 19 August 2015 by Rossdonaldson1 (talk | contribs)
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.
Post-Exposure Prophylaxis
Given to close contacts, especially household contacts
- Diphtheria booster[3]
- 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 40 mg/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
- ↑ 3.0 3.1 http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf