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diphtheria

Diphtheria (Greek for tanned hide) Etiology: - Corynebacterium diphtheriae Epidemiology: 1) humans are the only known reservoir - asymptomatic carriers may act as reservoir 2) transmission a) airborne contact b) direct contact with respiratory secretions or skin exudate 3) in the 19th century, diphtheria had a high fatality rate, especially in children 4) diptheria is now rare due to an effective vaccine first introduced in 1880 5) 2 cases in USA in 2001 6) case of cutaneous diphtheria reported in a fully vaccinated child visiting Sierra Leone [6] 7) consider cutaneous diphtheria in travelers with wound infections returning from diphtheria-endemic countries [7] Pathology: - severe inflammation that can form a membranous coating, with formation of a thick fibrinous exudate of the mucous membrane of the pharynx, the nose & sometimes the tracheobronchial tree. - the diphtheria toxin produces a degeneration of peripheral nerves, heart muscle & other tissues Clinical manifestations: 1) pharyngitis with gray membrane in tonsillar regions 2) cervical lymphadenopathy 3) dysphagia 4) weakness 5) fever 6) carriers may be asymptomatic 7) cutaneous diphtheria can appear as nonhealing, well-demarcated cutaneous ulcers [6] (images) Laboratory: 1) complete blood count: leukocytosis 2) throat culture plated on Loeffler's or tellurite (Tinsdale) selective media 3) culture of skin ulcer [6] 4) see ARUP consult [5] Management: 1) diphtheria antitoxin within 48 hours 2) prophylaxis a) most US citizens are immunized as children b) immunity may diminish, especially in the elderly; immunization is suggested every 10 years [3] 3) cutaneous diphtheria responds to clarithromycin [6]

Related

Corynebacterium diphtheriae diphtheria CRM197 protein conjugate vaccine diphtheria toxoid

General

bacterial infection

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Majno & Joris AM J Pathol 146:3 1995
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Journal Watch 24(12):99, 2004 Kruszon-Moran DM, McQuillan GM, Chu SY. Tetanus and diphtheria immunity among females in the United States: are recommendations being followed? Am J Obstet Gynecol. 2004 Apr;190(4):1070-6. PMID: 15118644
  5. ARUP Consult: Corynebacterium diphtheriae - Diphtheria The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/corynebacterium-diphtheriae
  6. Wilson IE, Menson EN. Cutaneous Diphtheria. N Engl J Med 2018; 378:e17. March 29, 2018 PMID: 29590546 http://www.nejm.org/doi/full/10.1056/NEJMicm1701825
  7. Griffith J, Bozio CH, Poel AJ, et al. Imported Toxin-Producing Cutaneous Diphtheria - Minnesota, Washington, and New Mexico, 2015-2018. MMWR Morb Mortal Wkly Rep 2019;68:281-284 https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a2.htm