Diphtheria

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This is a serious bacterial infection usually affecting the mucous membranes of the nose and sore throat. It usually causes a sore throat, fever, swollen lymph nodes and weakness. The hallmark sign is a sheet of thick, grey material covering the back of the throat, which can block the airway, causing difficulty with breathing.

Causes

The bacterium Corynebacterium diphtheriae causes diphtheria:

  • Airborne droplets
  • Contaminated personal items
  • Contaminated household items

Signs and symptoms

  • Thick grey membrane covering the throat and tonsils
  • Sore throat and hoarseness
  • Difficulty with breathing (dyspnoea) or rapid breathing (tachypnoea)
  • Nasal discharge
  • Fever and chills
  • Malaise

Differential diagnosis

  • Streptococcal pharyngitis
  • Viral pharyngitis
  • Vincent’s angina
  • Infectious mononucleosis
  • Oral syphilis
  • Candidiasis

Complications

  • Breathing difficulties due to airway blockage
  • Damage to the heart muscle (myocarditis)
  • Nerve damage (polyneuropathy)
  • Loss of the ability to move (paralysis)
  • Kidney failure

Investigations

  • Throat swab for microscopy, culture and sensitivity

Treatment objectives

  • Eliminate pain and other symptoms
  • Define transmission pattern and monitor disease burden
  • Identify new cases and prevent spread or outbreak

Non-pharmacological treatment

  • Isolate individual patients in separate patient care areas
  • Avoid movement of patients out of isolation areas
  • Advise patients to use medical-surgical masks when leaving isolation area

Pharmacological treatment

Diphtheria Anti Toxin (DAT) immunoglobulins 

 

Metronidazole Oral

Adult:

7.5 mg/kg y

OR

Metronidazole IV

Administer (over 1 hour) every 6 hours for 7-10 days (or up to 2-3 weeks) 

 

Child:

Metronidazole oral

30 mg/kg/day

OR

Metronidazole IV injection over 1 hour, in divided doses every 6 hours; not to exceed 4 g/day, for 7-10 days

AND

Erythromycin Oral or IV

40 mg/kg per day up to a maximum of 2 g/d) for 14 days

OR

Procaine penicillin G IM

<10 kg: 300,000 Units/day

>10 kg: 600,000 Units/day for 14 days

Note: Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

Prevention

For healthcare workers

  • Hand hygiene
  • Appropriate use of medical-surgical masks; gloves, eye protection (face shield or goggles), and long-sleeved-gown - PPEs - when within one metre of the patient or when entering the room.
  • Removes PPEs after leaving patient care areas
  • Use disposable or dedicated patient care equipment when possible. If not possible, clean and disinfect between use
  • Refrain from touching eyes, nose or mouth with contaminated gloved or un-gloved hands
  • Avoid contaminating surfaces not involved with direct patient care (i.e. door knobs, light switches, mobile phones, etc.)