Although diphtheria is not very common but its also not very uncommon. Although there is immunization regarding diphtheria in expanded program of immunization in Pakistan but still we find cases off and on

1. Diphtheria
BRIG(R) ANWAR UL HAQ
ASSOCIATE PROFESSOR ENT
CMH LAHORE MEDICAL COLLEGE

2. INTRODUCTION
•
Diphtheria is an highly infectious and
communicable disease.
Characteristics
Involvement of the respiratory system
Local production of membrane
General symptoms caused by absorption of toxin

3. EPIDEMIOLOGICALTRIAD
Agent
( Corny bacterium)
Host Factors
( Children <5)
Envrnt factors
( Winter month)

4. Agent
• Cornybacterium diphtheria
Sources are cases and carriers
Organism will be present in the nasopharyngeal
secretions, skin lesion discharge, contaminated
fomites and infected dust
Period of infectivity is 14-28 days from the
onset of diseases

5. Host factors
•
•
Affects children of 1-5 years of age
It effects both sexes.
Environmental factors
• All seasons
• Most common in winter

6. Mode of transmission
•
•
•
Droplet nuclie
Infected cutaneous lesions
Infected object or dust, contaminated with
nasopharyngeal secretions

7. Portal of entry
Incubation period
 2-6 days
•
•
Respiratory route
skin cuts and wounds
Pharyngotonsillar diphtheria
Laryngotracheal diphtheria
Nasal diphtheria
Cutaneous diphtheria
Types of diphtheria

8. Sign/symptoms
Pharyngotonsillar diphtheria
Sore throat
Difficulty in swalloing
Low grade fever
Membrane

9. Characristics of membrane
 In early stages
Whitish membrane
Wiped off easily over pharynx or tonsil
 Later stages
 Thick
 Blue –white to grey – black
 Adherent
 Difficult to remove
 If removed it will bleeding

10. Mucosal erythema around the membrane
Edema of submandibular area
Bull neck appearance

11. Laryngo tracheal diphtheria
 It is preceded by pharyngo-tosilar
Charactristics
Hoarseness of voice
Brassy cough

12. Nasal Diphtheria
Unilateral or bilateral
Serosanguineous
Blood and serous nasal discharge
Excoriation of upper lip
Toxemia is minimal

13. Cutaneous diphtheria
May occasionally involve skin or conjunctiva.

14. Differential diagnosis
Membranous Tonsillitis
Vincent’s Angina
Infectious mononucleosis
Agranulocytosis
Leukemia
Aphthous ulcers
Traumatic ulcer
Foreign body (Nasal Diphtheria)

15. Diagnosis
Schick test
Schick test toxin .2 ml is injected in to forearm
as test arm and in to opposite arm control
arm same amount of inactivated toxin ( IM)
Positive Reaction
Test arm- with in 24-36hrs, a circumscribed red
flash of 10-15 diameter. It reaches maximum by
4thto 7thday and later on slowly fades in to
brown patch
Control arm- No change occurs

16. Prevention and control
Early detection of cases and carriers Isolation
Treatment
Diphtheria antitoxins ranging 10,000 to 80,000
units or more are administered iv or im
depending on severity of care
2.5 lakh unit penicillin QID for 5 days
250mg erythromycin QID

17. Treatment
 Carriers
 Oral erythromycin for 10 days
 Contacts
 If immunized previously with in 2 year
 No action needed
 If immunized long back ( more than 2 years)
 DT booster dose
 If not immunized at all
 Prophylactic benzathine penicillin or erythromycin + active
immunization

18. Immunization
Combined vaccine
as per national schedule
Note- Vaccine should be kept in 4-8⁰C
Use within a week from day of issue to sub centre

19. •
Antiserum
For treatment purpose
Anti sera Purpose Dose Route
Diphtheria anti
toxin
prophylactic 500-2000 unit SubCut/IM
Diphtheria anti Treatment 10,000 to IM
toxin 30,000 unit or IV
40,000 to
1,00,000 unit
( 2 Doses with
an interval of ½
to 2 hrs)

20. COMPLICATIONS
1. Respiratory Failure – Occlusion of the airway
by the membrane.
2. Myocarditis – Occurs by 2ndweek. Can lead to
CHF, arrhythmia or sudden death.
3. Neurological –
Palatal palsy
Ocular Palsy
Loss of accommodation
Polyneuritis
4. Renal Complications – Oliguria / Proteinuria

21. SUMMARY
•
•
•
•
• Diphtheria is a endemic, respiratory tract ,
communicable disease comes under six killer
disease caused by corny bacterium diphtheriae.
Commonly seen in children less than five years
and in winter season
Mainly four types . Pharyngotonsilar,
laryngotracheal, nasal and cutaneous .
Diagnosed by Schick test / Albert stain /
Culture.
Early detection and treatment is the best way of
prevention and control.