Diphtheria: Clinical Manifestation& Management

พ.ญ. จริยา แสงสัจจา
๘ ตุลาคม ๒๕๕๕
 Acute
toxicoinfection caused
by Corynebacterium
 Exclusively inhabitant of
human mucous membrane
and skin
Corynebacterium diphtheriae
 Pathogenesis&
local inflammation, exotoxin ,
tissue necrosis, grey-brown
adherent pseudo-membrane,
toxic myocardiopathy,
peripheral neuropathy
: Droplet and contact: intimate contact
with a patient or carrier
:Discharge from respiratory tract, eyes
and skin lesions
:2-6 weeks transmissible without
treatment, communicable <4days
after appropriate antibiotics
 Incubation
2-7 days or longer
fever: <39 c
 Serosanguinous, purulent erosive
 Sore throat
 Upper airway obstruction
 Dysphagia,
 Tonsillar membrane formation,
extends to uvular, soft palate,
pharynx, larynx
 Low-grade
 Bull-neck:
soft tissue edema and
enlarged lymph nodes
 Cutaneous diphtheria: indolent, nonprogressive
 Purulent and ulcerative conjunctivitis,
Nasal Diphtheria
Cutaneous Diphtheria
Streptococcus Sore Throat
Toxic myocardiopathy
:10-25% of cases, : occurs in the 2nd-3rd
:Responsible for 50-60% of death
:Correlates directly with the extent and
severity of exudative local oropharyngeal
: Tachycardia, prolong PR interval, ST-T
change, V-tach, congestive heart failure
 Toxic
:Acutely or 2-3 weeks after onset
:local paralysis of soft palate
:Weakness of posterior and facial nerve
:Dysphagia, aspiration
:Cranial neuropathy occur in the 5 th week
:Symmetric polyneuropathy occur in 10
days to 3 months
 Antitoxin
 Antimicrobial
 Immunization
DAT IV after sensitivity test for reaction,
 Pharyngeal or laryngeal lesions ,48 hr.
duration or less, 20,000-40,000 U
 Nasopharyngeal lesions, 40,000-60,000 U
 Extensive disease of 3 or more days
duration or diffuse swelling of the
neck,80,000-120,000 U of antitoxin
 Skin lesions only:20,00-40,000U
 Antimicrobial
:14 days of erythromycin or penicillin G
IV or IM or procaine pen. G IM
 Immunization: 3 doses of diphtheria
toxoid,1 st dose at the end of 1st week
of illness
 Standard
and droplet precautions
for patients and carriers with
pharyngeal diphtheria until 2 cultures
from both the nose and the throat are
 Contact precautions for patient with
cutaneous diphtheria until 2 cultures
of skin lesions are negative
 Care
of close contact
:Surveillance 7 days for evidence of
: Culture for C. diphtheriae
: Antimicrobial prophylaxis:
erythromycin40-50 mg/kg 7days or
single dose benzathine pen. G
(1.2mU for patient BW>=30kg.,0.6mU
for patient BW <30kg.)
 Care
of close contact
:Follow up pharyngeal culture from
carrier at 2 weeks after completion of
therapy, if culture is positive 10 days
course of erythromycin should be
given, and follow up culture
:Immunization of carriers