Case Report
I saw this young Iranian girl who is a student in India with very severe sore throat, fever, malaise and difficulty to breathe. She took oral antibiotics but no avail. The Tonsils and pharyngeal wall were covered by thick membrane. Throat swab did not reveal any Corynebacterium diphtheriae. Full blood work was carried out. The CRP and ESR was elevated. Throat swab was negative. She got better after IV antibiotics (Ceftriaxone and Metrogyl) and Hydrocortisone.
About Diptheria
Diphtheria is a serious bacterial infection. You can catch it from a person who has the infection and coughs or sneezes. It usually affects the nose and throat and causes a bad sore throat, swollen glands, fever and chills. But if it is not properly diagnosed and treated it produces a poison in the body that can cause serious complications such as heart failure or paralysis.
The diphtheria, pertussis and tetanus (DPT) vaccine can prevent diphtheria, but its protection does not last forever. Adults should get another dose, or booster, every 10 years. Diptheria is rare these days after prompt DPT vaccination in this country.
Reminder
and Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae.
and Diphtheria is primarily transmitted via airborne respiratory droplets or by direct contact with secretions from infected people.
and The symptoms of diphtheria include sore throat, fever, malaise, difficulty swallowing, and difficulty breathing.
and Diphtheria is treated with both antitoxin and antibiotics.
and Diphtheria can lead to cardiac and neurological complications, as well as death.
and Immunization is the best prevention against diphtheria.
What causes diphtheria?
Diphtheria is caused by toxin-producing strains of the gram-positive bacillus Corynebacterium diphtheriae.
Signs and Symptoms
In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.
The toxin, or poison, caused by the bacteria can lead to a thick coating (or membrane) in the nose, throat, or airway, which makes a diphtheria infection different from other more common infections that cause sore throat such as strep throat. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing.
As the infection progresses, patient develops
and difficulty breathing or swallowing
and complain of double vision
and have slurred speech
and even show signs of going into shock (skin that’s pale and cold, rapid heartbeat, sweating, and an anxious appearance)
In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys’ ability to clear wastes. It also can cause nerve damage, eventually leading to paralysis. Up to 40% to 50% of those who don’t get treated can die.
DPT Vaccination
The diphtheria–Pertussis–Tetanus (DPT) vaccine is recommended for all school-age children in this country., and boosters of the vaccine are recommended for adults, since the benefits of the vaccine decrease with age without constant re-exposure; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
Laboratory Diagnosis
and Isolation of Corynebacterium diphtheriae from a gram stain or throat culture from a clinical specimen.
and Histopathologic diagnosis of diphtheria by a stain called “Albert’s Stain”.
Treatment
Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others.
Protocol:
and Metronidazole
and Erythromycin or Cephalosporins (orally or by injection) for 14 days
Treatment of Complications
ICU Care
The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy.
Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure.
Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit and be given a diphtheria antitoxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.
