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For further information, see CMDT Part 33-07: Diphtheria
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Essentials of Diagnosis
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Tenacious gray membrane at portal of entry in pharynx
Sore throat, nasal discharge, hoarseness, malaise, fever
Myocarditis, neuropathy
Culture confirms the diagnosis
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General Considerations
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An acute infection with a toxin-producing strain of Corynebacterium diphtheriae
Usually attacks the respiratory tract but may involve any mucous membrane or skin wound
The organism is spread primarily by respiratory secretions
Exotoxin produced by the organism is responsible for myocarditis and neuropathy
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Rare in the United States and Western Europe
More likely to be encountered in persons from developing countries and those from the former Soviet Union, where vaccine programs are lacking or inadequate
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Nasal, laryngeal, pharyngeal, and cutaneous forms of diphtheria occur
Nasal infection produces few symptoms other than a nasal discharge
Laryngeal infection may lead to upper airway and bronchial obstruction
In pharyngeal diphtheria, the most common form, a tenacious gray membrane covers the tonsils and pharynx
Mild sore throat, fever, and malaise are followed by toxemia and prostration
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Differential Diagnosis
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Streptococcal pharyngitis
Oral candidiasis
Infectious mononucleosis
Viral pharyngitis, eg, adenovirus, herpes simplex virus
Necrotizing gingivostomatitis (Vincent angina, trench mouth)
Arcanobacterium haemolyticum pharyngitis
Other causes of cranial nerve or motor neuropathy, eg, myasthenia gravis, botulism, Guillain-Barré syndrome
Myocarditis due to other causes
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Prepared from horse serum
Must be given in all cases when diphtheria is suspected
For mild early pharyngeal or laryngeal disease, dose of antitoxin is 20,000–40,000 units
For moderate nasopharyngeal disease, dose is 40,000–60,000 units
For severe, extensive, or late (3 days or more) disease, dose is 80,000–100,000 units
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Either penicillin, 250 mg four times daily orally, or erythromycin, 500 mg four times daily orally, for 14 days is effective, though erythromycin is slightly more effective in eliminating the carrier state
Azithromycin or clarithromycin may be as effective as erythromycin
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Therapeutic Procedures
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