| Disease/Syndrome |
Diphtheria |
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| Category |
Infection, Occupational |
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| Acute/Chronic |
Acute-Severe |
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| Synonyms |
Corynebacterium diphtheriae infection |
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| Biomedical References |
Search PubMed |
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| Comments |
FINDINGS: Initial symptoms include sore throat, low-grade fever, dysphagia, and a membrane in the tonsillar area ("dirty gray, tough, fibrinous, and adherent"). Neck swelling, hoarseness, stridor, and dyspnea may develop. [Merck Manual, p. 1452] Swelling of the neck may give patients a "bull neck" appearance. The main complications of diphtheria are airway obstruction, myocarditis, and neuropathy. Myocarditis, usually first detected by EKG about 7-14 days after disease onset, can cause severe conduction abnormalities and death. Neuropathy may begin with palatal weakness and later progress to cranial nerve palsies and paralysis of the diaphragm and extremities. Other complications of severe disease include thrombocytopenia, acute renal failure, and disseminated intravascular coagulation. [Guerrant, p. 289-91] Other infections, including mononucleosis, can cause a membranous tonsillitis. [Lexi-ID, p. 93] A potent toxin, produced by the growing bacteria, injures the nerves, heart, and kidneys. Neuropathy of some kind develops in about 15% of untreated patients and in about 75% of patients with severe disease. A polyneuropathy, resembling Guillain-Barre syndrome, is delayed in onset and usually appears about 2-3 months after onset of the illness. Patients with skin lesions may act as chronic carriers, but do not usually suffer from the toxic manifestations of the disease. Patients with nasal diphtheria have blood-tinged discharge and also may act as carriers. [ID, p. 1339, 1625] Patients with obstructive laryngotracheitis caused by the membrane have hoarseness, cough, and dyspnea. [5MCC] Infection is fatal in about 4% to 12% of cases. Death usually occurs in the first 3-4 days, and it is caused by asphyxiation or myocarditis. Pharyngitis, fever, and dysphagia are the most common symptoms. A membrane and cervical lymphadenopathy are observed in only about 1/2 of patients. Peripheral neuritis becomes manifest as weakness or paralysis from 10 days to 3 months after the primary throat infection. Invasive disease (endocarditis, osteomyelitis, and arthritis) caused by nontoxigenic strains has been recently described. Drug addicts and alcoholics are at increased risk. [PPID, p. 2457-65] Diphtheria can cause membranous conjunctivitis and residual corneal scarring. Cranial neuropathy may paralyze eye movements and accommodation. [eMedicine: Diphtheria by Dahl AA] EPIDEMIOLOGY: Only 18 cases were reported in the USA between 1980 and 1994. Transmission occurs by contact with infected patients through respiratory droplets or skin lesions. [Guidelines for Infection Control in Health Care Personnel. CDC. 1998] Unimmunized children under the age of 15 are most susceptible. Outbreaks in recent years occurred in Ecuador and countries of the former Soviet Union. Transmission by raw milk has been reported. [CCDM, p. 171-6] |
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| Latency/Incubation |
2-5 days |
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| Diagnostic |
Clinical--treat if suspected; Culture (selective media required); Definitive test is detection of C. diphtheriae exotoxin in blood. [ID, p. 1339] Methylene blue stain of exudate is positive in >75% of cases. More accurate is FA staining. [Wallach, p. 912] |
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| ICD-9 Code |
032 |
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| Available Vaccine |
Yes |
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| Effective Antimicrobics |
Yes |
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| Reference Link |
CDC - Diphtheria |
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| Image |
Virtual Children's Hospital: Diphtheria Pseudomembrane |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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| Job Tasks |
High risk job tasks associated with this disease:
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