Check List for Assessing a Patient with Suspected Diphtheria

Suspect Case : 
Symptom or event:
Pharyngitis, naso-pharyngitis, tonsillitis, laryngitis, tracheitis (or any combination of these), absent or low-grade fever . Yes/No: _______________
Grayish adherent pseudo-membrane present. Yes/No: _______________
Membrane bleeds, if manipulated or dislodged . Yes/No: _______________

Probable Case:
Symptom or event:
Suspect case above + 1 or more of the following. Yes/No: _______________ 
- Stridor. Yes/No: _______________
- Bull-neck (cervical edema). Yes/No: _______________
- Toxic circulatory collapse. Yes/No: _______________
- Acute renal insufficiency. Yes/No: _______________
- Sub-mucosal or sub-cutaneous petechiae . Yes/No: _______________
- Myocarditis. Yes/No: _______________
- Death. Yes/No: _______________

Recently returned (<2 weeks) from travel to area with endemic diphtheria? 
Yes/No: _______________
Recent contact (<2 weeks) with confirmed diphtheria case or carrier? 
Yes/No: _______________
Recent contact (<2 weeks) with visitor from area with endemic diphtheria?
Yes/No: _______________
Recent contact with dairy or farm animals? Domestic pets?
Yes/No: _______________
Immunization status:  Up-to-date - any DTaP/DT/Tdap/Td shot within past 10 years?
Yes/No: _______________
Laboratory Confirmed case
Symptom or event:
Positive culture of C. diphtheriae (or C. ulcerans) AND, Yes/No: _______________
- Positive Elek Test  OR, Yes/No: _______________
- PCR for tox gene (Positive for subunit A and B)  OR Yes/No: _______________

What other conditions may be considered in the differential diagnosis of respiratory diphtheria?
Respiratory diphtheria is an uncommon disease in the US. The symptoms of respiratory diphtheria are due to diphtheria toxin. Corynebacterium species which produce diphtheria toxin are C. diphtheriae (biotypes mitis, gravis, intermedius, or belfanti), C. ulcerans, C. pseudotuberculosis.  Symptoms of respiratory diphtheria may also be associated with non-toxigenic strains of C. diphtheriae. 

•	Other biological disease agents which may also cause a membranous pharyngitis include:

1.	Group A β-hemolytic Streptococcus 
2.	Staphylococcus aureus 
3.	Arcanobacter hemolyticum
4.	Candida albicans
5.	Borellia vincenti (Vincent’s angina)
6.	H. influenzae (acute epiglottitis)
7.	Viruses – EBV (Infectious mononucleosis), adenovirus, Herpes simplex 
8.	Other agents - Toxoplasma

•	Use of some anti-neoplastic agents may also result in formation of a pharyngeal membrane e.g methotrexate.
•	Long term use of corticosteroids (e.g. prednesolone) can cause oral candidiasis. 

This document can be found on the CDC website at:
http://www.cdc.gov/vaccines/vpd-vac/diphtheria/dat/downloads/dip_cklist_diag.rtf