DIPTHERIA
Dr. Kona Chowdhury
Etiology
• C. diphtheriae is an aerobic gram-positive
bacillus.
Transmission
• Respiratory droplets mainly
• Skin and fomites rarely
Pathogenesis
Organism produces toxin
Toxin inhibits protein synthesis
and cause local tissue destruction
Formation of pseudomembrane
Pseudomembrane in toxin produced at the site of the
pharynx cause pseudomembrane is absorbed
into the bloodstream and then
airway obstruction
distributed to the tissues of the
body.
Clinical manifestations
• For clinical purposes, it is convenient to
classify diphtheria into four categories
depending on the site of disease (or
pseudomembrane).
o Faucial or Pharyngeal
o Laryngial
o Nasal
o Cutineous
Pharyngeal diphtheria
• It’s the most common type, >80%.
• The sites of infection are the tonsils and the
pharynx.
• Sore throat, dysphagia
• Toxic look, bull neck appearance ( due to neck
oedema along with submandibular
lymphadenopathy)
Pharyngeal diphtheria cont.
• Pseudomembrane in fauces and beyond,
which is grayish brown in colour with areas of
green or black necrosis surrounded by
minimal erythema
Diphtheria of the tonsils, localized,
membranous (moderate)
Diphtheria of the tonsils, spread
(moderate)
Diphtheria of the tonsils, toxic (severe)
Laryngeal diphtheria
• Laryngeal diphtheria can be either an
extension of the pharyngeal form (often) or
the only site involved (rarely).
• Dyspnea, hoarseness, and a barking cough.
• The pseudomembrane can lead to airway
obstruction, coma, and death.
Nasal Diphtheria
• Serosanguineous ( blood and serous fluid )
discharge from the nose
• Excoriation of upper lip
• Toxemia is minimal
Cutaneous and Other site diphtheria
• Skin infections may be manifested by a scaling
rash or by ulcers with clearly demarcated
edges and pseudomembrane.
• Other sites of involvement include the mucous
membranes of the conjunctiva and vaginal
area, as well as the external auditory canal.
COMPLICATIONS
• Upper airway obstruction : respiratory
distress, stridor, cyanosis
• Myocarditis; Undue tachycardia, arrhythmia,
heart failure
• Polyneuritis
• Adrenal failure: Curculatory collapse
• Pneumonia
Diagnosis
• Based on C/F, particularly the presence of
pseudomembrane and relevant investigations
Investigations
• Swabs sent for:
o Gram stain – Gram positive bacilli, straight or
slightly curved and often enlarged (clubbing) at
one or both ends as chinese letters or V shaped
o Albert staining (KLB): metachromatic granules
giving a beded appearance
o Culture: Telurite agar media
• Elek test: Toxigenecity
• CBC: hemolytic anemia and
thrombocytopenia
Differential diagnosis
• Streptococcal pharyngitis
• Oral candidiasis
• Infectious mononucleosis
• Vincent’s angina
• Streptococcal pharyngitis
The pus covering on the tonsils sometimes is
misunderstood as the pseudomembrane of
diphtheria. It’s usually yellow in color, and
easy to remove.
Bacterial tonsillitis (follicular)
Tonsillitis in
patient with
scarlet fever
Oral candidiasis
• The oral candidiasis often occurs in infants.
The general conditions of such patients are
very well. The membrane is very white, and
easy to remove
Infectious mononucleosis and
Vincent’s angina
Sometimes also have
things like
membranes on the
surface of tonsils or
pharynx. However,
they can be remove
without bleeding of
the tissues.
Treatment
• Principles :
o Neutralization of free circulating toxin by
administration of antitoxin
o Antibiotic to eradicate bacteria
o Supportive and symptomatic therapy
o Management of complication
Supportive Treatment
• Isolation of the patient
• Bed rest usually at least for 2 weeks
• IV fluid, Nutrition and Oxygen if necessary
• Close monitoring for respiratory distress
Specific treatment
• Diphtheria antitoxin
o Anti diptheria serum (ADS)
o It will not neutralize toxin that is already fixed to
tissues, but will neutralize circulating toxin.
o The earlier, the better.
• Antibiotics
o Penicillin G or Erythromycine
• Isolation and Treatment of the carriers with
same antibiotic
• Care of exposed persons
Mumps
• Organism – Mumps virus
• Transmission : Inhalation of air borne
droplets
Clinical features
• Initially fever, vomiting, headache, achiness
• Painful swelling of the parotid gland
• As swelling progresses the angle of the jaw
(mandibular angle) is obscured and the ear is
lifted upwards and outwards
• Swelling is unilateral initially but later on
becomes bilateral (70%)
• Opening of Parotid duct may be red and
oedmatous
• Submandibular glands may be involved with or
without parotid swelling
Complications
Complications
• Orchitis or epididymo- • Myocarditis
orchitis. Sometimes • Transient myelitis
testicular atrophy, but • Polyneuritis
sterility is rare
• Hearing loss
• Oophoritis
• Aseptic meningitis
Diagnosis
• Charecteristic clinical feature
• H/O contact with an affected person
Treatment
• Diet – normal
• Plenty of fluid
• Fever and pain – paracetamol
• Maintainance of oral hygiene
• Orchitis – Steroid to reduce pain and oedema
only
