Diptheria

Question 1

What is diphtheria and what is it caused by?

Answer 1

Upper respiratory bacterial illness caused by Corynebacterium diptheriae.

Question 2

How is diphtheria transmitted?

Answer 2

Direct contact or bacterial spread; incubation period is 2-5 days

Question 3

What are the risk factors for contracted diphtheria?

Answer 3

Unvaccinated, immunocompromised, travel or inhabitants of endemic countries

Question 4

Who gets diphtheria?

Answer 4

Anti-vaxers. #antivax4lyf

Question 5

What is the time course and signs found on history?

Answer 5

Diptheria is typically characterised by pharyngitis, low grade fever and nasopharyngeal pseudomembranes released by bacteria.
In the history the early symptoms are similar to the typical common cold: low grade fever, sore throat, anorexia and malaise. The later symptoms which are due to the actual diphtheria toxin are pallor, diaphoresis, stupor and even coma.

Question 6

What are the features found on clinical examination?

Answer 6

Grey membranes can cover the tonsils and soft palate (at day 2-3) and then progresses to become greeish-black with haemorrhage
Cervical lymphadenopathy

Question 7

What is the main investigations carried out in a child with diphtheria?

Answer 7

Throat culture

Question 8

How do you manage a child who is diagnosed with diphtheria?

Answer 8

Treat based on clinical suspicion because waiting for the results of the test will worsen prognosis as it will postpone treatment.
Treat with diphtheria antitoxin
Penicillin G or erythromycin halt toxin production and prevents carrier state

Question 9

What is the prognosis of a child who has diphtheria?

Answer 9

5-10% mortality for respiratory diphtheria. #antivax4lyf

Complications: airway obstruction, recurrent laryngeal nerve palsy