Diphtheria: Sabah Mohsin Al-Maamuri MD
Diphtheria: Sabah Mohsin Al-Maamuri MD
Diphtheria: Sabah Mohsin Al-Maamuri MD
Essentials of diagnosis & typical features: toxic injury to heart muscle, liver, kidneys, and
adrenals, and is sometimes accompanied by
A gray, adherent pseudomembrane, most
hemorrhage. The toxin also produces neuritis,
often in the pharynx but also in the
resulting in paralysis of the soft palate, eye muscles,
nasopharynx or trachea.
or extremities. Death may occur as a result of
Sore throat, serosanguineous nasal discharge,
respiratory obstruction or toxemia and circulatory
hoarseness, and fever in a nonimmunized
collapse. The patient may succumb after a somewhat
child.
longer time as a result of cardiac damage. The
Peripheral neuritis or myocarditis.
incubation period is 1–6 days.
Positive culture.
Treatment should not be withheld pending
culture results.
A. Symptoms and signs:
Page 1 of 3
then performed. Cultures may be negative in kg), active immunization with diphtheria toxoid, and
individuals who have received antibiotics. The white observation daily.
blood cell count is usually normal, but hemolytic
Treatment:
anemia and thrombocytopenia are frequent.
A. Specific measures:
Complications:
1. Antitoxin—To be effective, diphtheria antitoxin
A. Myocarditis: Diphtheritic myocarditis is
should be administered within 48 hours.
characterized by a rapid, thready pulse; indistinct
heart sounds, ST-T wave changes, conduction 2. Antibiotics—Penicillin G (150,000 units/ kg/d
abnormalities, dysrhythmias, or cardiac failure; intravenously) should be given for 10 days. For
hepatomegaly; and fluid retention. Myocardial penicillin-allergic patients, erythromycin (40 mg/ kg/d)
dysfunction may occur from 2 to 40 days after the is given orally for 10 days.
onset of pharyngitis.
B. General measures:
B. Polyneuritis: Neuritis of the palatal and
Bed rest in the hospital for 10–14 days is usually
pharyngeal nerves occurs during the first or second
required. All patients must be strictly isolated for 1–7
week. Nasal speech and regurgitation of food through
days until respiratory secretions are noncontagious.
the nose are seen. Diplopia and strabismus occur
Isolation may be discontinued when three successive
during the third week or later. Neuritis may also
nose and throat cultures at 24-hour intervals are
involve peripheral nerves supplying the intercostal
negative. These cultures should not be taken until at
muscles, diaphragm, and other muscle groups.
least 24 hours have elapsed since the cessation of
Generalized paresis usually occurs after the fourth
antibiotic treatment.
week.
C. Treatment of carriers:
C. Bronchopneumonia: Secondary pneumonia is
common in fatal cases. All carriers should receive treatment. Erythromycin
(40 mg/kg/d orally in three or four divided doses),
Prevention:
penicillin V potassium (50 mg/kg/d for 10 days), or
A. Immunization: Immunization with diphtheria toxoid benzathine penicillin G (600,000–1,200,000 units
combined with pertussis and tetanus toxoids (DTP) intramuscularly) should be given. All carriers must be
should be used routinely for infants and children. quarantined. Before they can be released, carriers
must have three negative cultures of both the nose
B. Care of exposed susceptibles: Children exposed to
and the throat taken 24 hours apart and obtained at
diphtheria should be examined, and nose and throat
least 24 hours after the cessation of antibiotic therapy.
cultures obtained. If signs and symptoms of early
diphtheria are found, antibiotic treatment should be Prognosis:
instituted. Immunized asymptomatic individuals
Mortality varies from 3% to 25% and is particularly
should receive diphtheria toxoid if a booster has not
high in the presence of early myocarditis. Neuritis is
been received within 5 years. Unimmunized close
reversible; it is fatal only if an intact airway and
contacts should receive either erythromycin orally (40
adequate respiration cannot be maintained.
mg/kg/d in four divided doses) for 7 days or
Permanent damage due to myocarditis occurs rarely.
benzathine penicillin G intramuscularly (25,000 units/
Page 2 of 3
Page 3 of 3