Daily Bolus of LR: Diphtheria

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January 24, 2012 by dailybolusoflr

Diphtheria

 

·         Bacterial infection that is caused by corynebacterium diphtheriae (gram positive rod)

·         Exotoxin related symptoms- pharyngeal membrane formation and systemic symptoms

·         The membrane which forms is composed of leukocytes, fibrin, epithelial cells and bacteria and is a result of necrosis caused by the exotoxin.  It is grayish/white and filmy and then turns to a darker gray/black color with well defined borders.  The membrane is adherent to underlying tissue and bleeds if one tries to remove it.

·         Systemic symptoms are mainly cardiovascular and neurologic. 

o   CV: myocardial dysfunction, myocarditis

o   Neuro:  muscle weakness, polyneuritis affecting proximal muscle groups first but any nerves can be affected, spinal cord lesions can be found in the dorsal roots and the ventral horns

·         The most serious complications are:

o   Airway obstruction related to the edema/membrane formation

o   Cardiac conduction problems

o   CHF

o   Muscle paralysis

·         Presentation:

o   Most patients have low grade fever and URI infection signs and symptoms

o   Fever and sore throat are the most common complaints

o   Membranes are seen in over half of patients at presentation

·         Treatment:

o   Respiratory isolation

o   Diphtheriae antitoxin can be obtained from the CDC

o   IV erythromycin or IV penicillin should be given as well, but not in place of the antitoxin

o   Cardiac and airway monitoring

 

Membrane can be seen here   http://medicalpicturesinfo.com/diphtheria/

 

Ref: Rosen’s 7th ed

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