12. Diphteria of fauces
1. Forms and variants of the disease
i. According to localization of affection
o Local form
a. insular
b. catarrhal lesion
c. membranous – pseudomembranous on tonsils
o Diffuses form
o Inside spread form
ii. According to toxicity
o Hemorrhagic forms
o Hypertoxicity
2. Clinical features
o Local form:
- sore throat
- fever 38-39ºC
- nausea
- vomiting
- cough
- pseudomembrane ovoer
the tonsils (white/grey
o Diffuse form
- acute onset
- temp 38.5-39ºC fever
- chill
- weakness
- headache
- deranged sleep
o Toxic form
- fulminant type
- tmep 39-40ºC
- severe weakness
- pallid face & slightly
edematous
- CVS dull
- Abdominal pain
- Efema of tonsils
- Edema of neck:
Degrees 1: edema extends to neck
2: edema extends to clavicle
3: edema extends below clavicle
-
-
-
-
exudates. Bleeding at
removal, very thick)
rhinorrhea (nasal
discharge)
thick speech
tonsils edematous &
enlarged, thick grey
membrane on both sides
of the tonsils
extends to palatine
arches, soft palate and
nasopharynx
Pallor face
Pseudomembrane is large
(gray black color)
Noisy and hoarse4
respiration
Foul breath and sweetish
Nasal discharge seroanginous
3. Complications
o Myocarditis
o Nephrotic syndrome
o Pharyngeal paralysis
o Difficulty in swallowing
o Dropping of soft palate
o Paralysis of facial muscles,
oculomotos, ciliary
o
o
o
o
Peripheral polynephritis
Cerebral encephalitis
Pulmonary embolism
Fluid regurgitates through
nose
4. Diagnostics
o Rickettsia agglutination reaction - diagnostics titres 1:160 or higher
o Complement fixation test – diagnostics 1:160 and higher
o Indirect hemagglutination and immunofluorescent – performed on the 3-5th
day, diagnostic titre is 1:250 or higher, maximum antibody level in serum
14-20days
o Allergic tests
o Immunological tests
5. Specific therapy
o Bed rest
o Entropic therapy
o Specific antibiotics indicates for the 1st day of illness
o Antitoxins – neutralized toxins given: a. 20 000 – 40 000 units 48 hours
b. 40 000 – 60 000 for less involving
of nasopharynx
c. 80 000 – 100 000 extensive carrier
o Antibiotics: a. Erythromycin 500mg for orally
b. Penicillin 600000 units 2 intervals for 10-14days
c. Rifampin 600mg daily – 7 days