Definition: Acute specific infection of the pharynx (throat).
Etiology:
Gram positive bacillus (corynebacterium diphtheriae) transmitted by droplets.
Incidence:
Pathology:
Site: pharynx, larynx & nose (secondary), conjunctiva (rare). It is a pseudo membranous type of inflammation
Symptoms of Diphtheria Pharyngitis:
Insidious onset
General: low grade fever, headache, malaise, anorexia & may be vomiting.
Local: severe sore throat & dysphasia.
Signs:
General: low grade fever, severe toxemia, tachycardia disproportionate to fever.
Local: False membrane over the tonsil which is:
- Unilateral, yellow white or dirty gray.
- Thick & firm, adherent & leaves a bleeding surface on removal & reforms rapidly
- Often exceeds limits of the tonsils
- Enlarged tender cervical LN: Bull’s neck
+ Clinical picture of laryngeal & nasal diphtheria
Investigations:
Throat swab:
a: Direct smear
b: Culture on loeffler’s serum
Complications of Diphtheria Pharyngitis
These complications occur due to the effect of toxins on different body systems, as follows:
Body system/organ | Possible complication |
Cardio vascular system |
|
Neurological (Nerves) |
|
Respiratory system |
|
Renal system |
|
Differential Diagnosis
This should be diiferentiated from other causes of membrane over tonsils:
- Acute follicular tonsillitis
- Vincent’s angina
- Infectious mononucleosis
- Acute leukaemia & granulocytosis
Comparison between Acute follicular tonsillitis and Diphtheria
Acute follicular tonsillitis | Diphtheria | |
Onset | Acute | Gradual |
Fever | High (39-40) | Low (38) |
Toxemia | Mild | Severe |
Face | Flushed | Pale |
Pulse | Full, rapid, proportionate to fever | Weak,rapid, disproportionate to fever |
Vomiting | Uncommmon | More common |
Exudation | Yellow spots, confined to tonsils, easily removed and no bleeding | Dirty gray membrane, exceeds the tonsils, adherent and leaves bleeding surface |
Side | Bilateral | Unilateral |
Swab | Negative for Diphtheria | Positive for Diphtheria |
Treatment of Pharyngitis due to Diphtheria:
1. Hospitalization, isolation, and complete bed rest.
2. Diphtheria antitoxic serum
- To: neutralize circulating toxins.
- Dose: 40000-100000 I.U I.M or I.V repeated after 24-48 h.
- When: diphtheria is suspected, within 48 h.
- Precautions: do skin sensitivity before, if positive start desensitization or shift to another serum, be ready with antihistaminics ,and steroids.
3. Antibiotics: penicillin ½ million day IV/ IM for 10 days.
4. Observe airway if stridor…………>> tracheostomy.
5. Treatment of complications.
Prophylaxis of Diphtheria:
1- Active: DPT vaccine.
2- Passive: 5000-10000 IV antitoxic serum I.M for contacts
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