Diphtheria

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An acute bacterial infection caused by Corynebacterium diphtheriae, which is spread through droplet infection and mainly occurs in the nasopharynx. The bacteria produce a toxin which is responsible for the systemic effects. Incubation period is 2-7 days.

Cause

Toxin of Corynebacterium diphtheriae

Clinical features

  • Pseudomembranous tonsillitis (grey, tough and very stickly membranes) with dysphagia, cervical adenitis, at times progressing to massive swelling of the neck
  • Airway obstruction and possible suffocation when infection extends to the nasal passages, larynx, trachea and bronchi
  • Low grade fever
  • Effects of the toxin: cardiac dysfunction (myocarditis with heart failure), neuropathies 1-3 months after the onset affecting swallowing, vision, breathing and ambulation
  • Renal failure

Investigation

  • Culture from throat swab

Management

Treatment LOC
  • Refer urgently to hospital
  • Isolate (contact and droplet precautions) until 3 throat swabs (nose, throat, or skin) are negative
  • Give procaine benzylpenicillin 1.2 MIU daily IM until patients can switch to oral
    • Child: procaine benzylpenicillin 50,000 IU/kg per day IM once daily until patient can swallow
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When patient is able to swallow

  • Give Penicillin V 250 mg every 6 hours per day to complete 14 days.
    • Child 1-6 years: 125 mg 6 hourly
    • Child< 1 years: 12.5 mg/kg every 6 hours

In case of penicillin allergy give

  • Erythromycin 500 mg every 6 hours for 14 days
    • Child: 50 mg/kg every 6 hours
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Prevention

  • Isolation of patient and proper management of close contacts
    • Monitor close contacts for 7 days and give prophylactic antibiotics: single dose benzathine penicillin IM (child <10 years: 600,000 IU, child >10 yrs and adults: 1.2 MIU)
    • Verify immunisation status, complete if needed, give a booster if the last dose was more than a year before
  • Immunise all children during routine childhood immunisation