Presentation
A diphtheria culture is usually diagnostic if disease symptoms are present. [arupconsult.com]
Analysis using mGenomeSubtractor ( 7 ) indicated that 1,982 coding sequences (CDS) were present in both strains, with 318 CDS being present in C. diphtheriae bv. mitis NCTC 3529 that were not present in C. diphtheriae bv. gravis NCTC 13129. [doi.org]
Blood cultures showed a fluorescent Gram-positive, aerobic, coryneform-like bacillus presenting pyrazinamidase and CAMP reaction negative. [ncbi.nlm.nih.gov]
Immune System
- Cervical Lymphadenopathy
She also has marked cervical lymphadenopathy and edema of the neck. She is immediately admitted for monitoring, antibiotics, and antitoxin. [medbullets.com]
On examination cervical lymphadenopathy was noted along with grayish white membrane in the throat. What is your diagnosis? Clinically, this appears to be a case of pharyngeal or faucial diphtheria. [microrao.com]
Cervical edema and cervical lymphadenopathy from diphtheria infection produce a bull's neck appearance in this child. Source: Public Domain www.immunize.org/images/ca.d/ipcd1861/img0002.htm. [emedicine.medscape.com]
Entire Body System
- Fever
A 54-year-old female with a prosthetic mitral valve presented with a 3-day history of dizziness, subjective fever, and chills. Blood cultures were positive for a pleomorphic Gram-positive rod. [ncbi.nlm.nih.gov]
Snapshot A 4-year-old girl presents to the emergency room for a fever and sore throat. She recently visited Thailand for 2 months with her parents and had just flown back a couple of days ago. [medbullets.com]
- Malaise
Its symptoms include sore throat, fever, and malaise. A thick, gray-green fibrin membrane, the 'pseudomembrane', can be found at the site where infection occurs. [creative-diagnostics.com]
The symptoms of the disease are sore throat, malaise, low-grade fever and swollen neck glands. [thenativeantigencompany.com]
The illness is characterized by fever, malaise, and sore throat with a distinguishing thick pseudomembrane present over the involved mucosa. A swab from beneath the pseudomembrane is the preferred specimen for culture. [mayomedicallaboratories.com]
- Chills
A 54-year-old female with a prosthetic mitral valve presented with a 3-day history of dizziness, subjective fever, and chills. Blood cultures were positive for a pleomorphic Gram-positive rod. [ncbi.nlm.nih.gov]
Other clinical manifestations may include a sore throat, dysphagia, hoarseness, enlarged lymph nodes, difficulty breathing, nasal discharge, fever, and chills. [dentalcare.com]
Symptoms include sore throat, low-grade fever, chills, and sometimes enlarged lymph nodes in the neck. A thick coating may form in the back of the nose or throat making it hard to breathe or swallow. [vdh.virginia.gov]
It usually affects the nose and throat and causes a bad sore throat, swollen glands, fever, and chills. [fpnotebook.com]
- Congestive Heart Failure
The patient had underlying congenital heart disease and incomplete immunization. He presented with fever, epistaxis and congestive heart failure. He received high-dose penicillin therapy and diphtheria antitoxin with clinical improvement. [ncbi.nlm.nih.gov]
Systemic complications that are life-threatening may occur as a result of the action of diphtheria toxin on peripheral motor the myocardium and neurons, such as loss of motor function and congestive heart failure. [creative-diagnostics.com]
Congestive heart failure. These are the clinical signs of nasopharyngeal diphtheria infection: A sore throat. Dysphagia. Bloody nasal discharge. Pseudomembrane formation. [labpedia.net]
- Pediatric Disease
Infants become susceptible to the disease at age 6-12 months after their transplacentally derived immunity wanes. [17] Since the advent of diphtheria vaccination, cases of pediatric disease have declined dramatically. [emedicine.medscape.com]
Respiratoric
- Pertussis
Vaccine Vaccines that contain diphtheria toxoid, tetanus toxoid, and acellular pertussis help protect against diphtheria, tetanus, and pertussis, but they do not prevent all cases. [msdmanuals.com]
There are four combination vaccines available to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. [dentalcare.com]
Effects of a minimum interval immunization schedule for diphtheria and tetanus toxoids and acellular pertussis vaccination during a pertussis outbreak. Arch Pediatr Adolesc Med. 2009 May. 163(5):417-21. [QxMD MEDLINE Link]. [emedicine.medscape.com]
Today, the diphtheria toxoid vaccine, which is in most formulations combined with tetanus and pertussis antigens, is one of the oldest and safest vaccines known. [onlinelibrary.wiley.com]
Diseases / Streptococcal / Tetanus 1 4 Completed Prevention Diphtheria / Pertussis / Tetanus 1 4 Completed Prevention Diphtheria / Tetanus 1 4 Completed Treatment End Stage Renal Disease (ESRD) 1 4 Recruiting Basic Science Human Immunodeficiency Virus [drugbank.ca]
- Stridor
Clinical Presentation Incubation period – 2-4 days Respiratory tract involvement Anterior nasal disease Faucial disease – classic membranes on pharynx and tonsils, cervical adenopathy, and fever Laryngeal and tracheobronchial disease – hoarseness, dyspnea, stridor [arupconsult.com]
Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction. [msdmanuals.com]
~ Case reports Case 1 A 10-year-old female child presented to the Pediatric emergency with history of fever, respiratory distress and stridor. [ijmm.org]
She did not have stridor, respiratory distress, cardiac murmur, or organomegaly. The remainder of the examination was normal. [pediatrics.aappublications.org]
- Hoarseness
[…] soft-tissue edema Clinical Presentation Incubation period – 2-4 days Respiratory tract involvement Anterior nasal disease Faucial disease – classic membranes on pharynx and tonsils, cervical adenopathy, and fever Laryngeal and tracheobronchial disease – hoarseness [arupconsult.com]
Other clinical manifestations may include a sore throat, dysphagia, hoarseness, enlarged lymph nodes, difficulty breathing, nasal discharge, fever, and chills. [dentalcare.com]
Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction. [msdmanuals.com]
Signs and symptoms may include: A thick, gray membrane covering the throat and tonsils A sore throat and hoarseness Swollen glands (enlarged lymph nodes) in the neck Difficulty breathing or rapid breathing Nasal discharge Fever and chills Tiredness In [mayoclinic.org]
If disease is severe, hoarseness and stridor follow. Some patients exhibit a classic “bull neck” due to severe pharyngeal edema and involvement of the tonsils, submandibular lymph nodes, uvula, and anterior neck. [infectiousdiseaseadvisor.com]
- Pharyngeal Edema
Some patients exhibit a classic “bull neck” due to severe pharyngeal edema and involvement of the tonsils, submandibular lymph nodes, uvula, and anterior neck. [infectiousdiseaseadvisor.com]
Gastrointestinal
- Dysphagia
Other clinical manifestations may include a sore throat, dysphagia, hoarseness, enlarged lymph nodes, difficulty breathing, nasal discharge, fever, and chills. [dentalcare.com]
Although debridement of the epiglottis may lead to postoperative dysphagia, the goals of surgery are eradication and diagnosis of disease. [pediatrics.aappublications.org]
Pharyngeal infection After an incubation period, which averages 5 days, and a prodromal period of between 12 and 24 hours, patients develop mild sore throat, dysphagia, low-grade fever, and tachycardia. [msdmanuals.com]
Cardiovascular
- Systolic Murmur
He had a systolic murmur leading to a clinical suspicion of endocarditis. He had no specific clinical features of diphtheria. Blood cultures were taken and empiric therapy commenced with benzylpenicillin, vancomycin and gentamicin. [casereports.bmj.com]
Jaw & Teeth
- Tonsillar Exudate
She had conjunctival erythema, cracked, red lips, and bilateral tonsillar exudates. Cervical nodes were tender and not fluctuant. Plantar desquamation was present. She did not have stridor, respiratory distress, cardiac murmur, or organomegaly. [pediatrics.aappublications.org]
Diphtheria include pharyngeal pseudomembranes Pseudomembranes Raised yellow or off-white plaques up to 2 cm in diameter that form as a result of mucosal ulceration Pseudomembranous Colitis (grayish tonsillar exudates), severe pharyngitis Pharyngitis Pharyngitis [lecturio.com]
- Exudative Pharyngitis
The onset is sudden, with malaise, sore throat, exudative pharyngitis, and a low-grade fever. [bacteriologynotes.com]
Of the child cases, one had congenital cardiac disease, one had recent undergone a major dental treatment and one had an episode of non-exudative pharyngitis two weeks prior to the onset of infection. [omicsonline.org]
Skin
- Skin Ulcer
ulcers and sore throats. [ncbi.nlm.nih.gov]
Identification of close contacts, especially contacts who may have been directly exposed to oral and skin ulceral secretions from the cases. [ecdc.europa.eu]
Figure 2 Skin ulceration in a wound infected with Corynebacterium diphtheriae. [academic.oup.com]
Any skin ulcers could take two or three months to fully heal, though scarring may be permanent. Is diphtheria curable? Yes. When treated immediately, diphtheria is managed successfully with antitoxins and antibiotics. [my.clevelandclinic.org]
However, some authors shown that skin lesions are the most likely sources ( 9, 13, 14 ). In the cases presented here, skin ulceration was uncommon (1 case), but dental caries were found in >22% of cases. Dental caries could be a portal of entry. [wwwnc.cdc.gov]
Face, Head & Neck
- Neck Swelling
Examination was significant for an afebrile, ill-appearing child with prominent neck swelling and left neck redness. She had conjunctival erythema, cracked, red lips, and bilateral tonsillar exudates. Cervical nodes were tender and not fluctuant. [pediatrics.aappublications.org]
Neck swelling is usually present in severe disease. Myocarditis, polyneuritis, and airway obstruction are common complications of respiratory diphtheria. Cutaneous diphtheria presents as infected skin lesions which lack a characteristic appearance. [kitpcr.com]
Neurologic
- Peripheral Neuropathy
Less common consequences include myocarditis (about 20% of cases) and peripheral neuropathy (about 10% of cases) ( Wikipedia ). [bacteria.cz]
Other complications include cardiac dilatation and failure, mycotic aneurysm, endocarditis, rhythm disturbances, secondary bacterial pneumonia, cranial nerve dysfunction and peripheral neuropathy, total paralysis, septicemia, septic arthritis, osteomyelitis [microrao.com]
Diphtheria vaccines protect against the toxin responsible for pseudomembranes, myocardiopathy, and peripheral neuropathy and are 97% efficacious. 1, 16 Vaccines do not protect against colonization by nontoxigenic C diphtheriae. 22 Although the toxin is [pediatrics.aappublications.org]
Workup
The reliable detection of toxigenic Corynebacterium spp. is of substantial importance for both diphtheria surveillance in the public health sector and the clinical workup of a patient with diphtherialike symptoms. [ncbi.nlm.nih.gov]
Serum
- Decreased Platelet Count
Laboratory evaluation revealed elevated white blood cell count (17,8 × 10 3 /μl) with 34% of band neutrophils and 51% of granulocytes, decreased platelet count (29 × 10 3 /μl), slightly elevated liver enzymes (AST 52 U/L, ALT 41 U/L, LDH 589 U/L, alkaline [ann-clinmicrob.biomedcentral.com]
Microbiology
- Gram-Positive Rods
Blood cultures were positive for a pleomorphic Gram-positive rod. Initial phenotypic testing could only support the identification of a Corynebacterium species. [ncbi.nlm.nih.gov]
- Gram-Positive Bacteria
Abstract Many surface proteins in Gram-positive bacteria are covalently linked to the cell wall through a transpeptidation reaction catalysed by the enzyme sortase. [ncbi.nlm.nih.gov]
Gram stain also shows gram-positive bacteria. Possible References Used Back to tests [labpedia.net]
The diagnosis of C. diphtheriae includes a Gram stain procedure; results will indicate gram-positive, pleomorphic bacteria that will dye violet-blue and resemble clubs. [wikidoc.org]
The molecular switch that activates the cell wall anchoring step of pilus assembly in Gram-positive bacteria. Proc Natl Acad Sci U S A. 2008;105(37):14147–52. [bmcgenomics.biomedcentral.com]
PR Interval
- Prolonged PR Interval
A prolonged PR interval with changes in the ST-T waves were noted on her electrocardiogram. The immunization history of the child was complete with two booster doses at 1.5 years and 5 years respectively. [ijmm.org]
Treatment
The case was oriented as cellulitis and started intravenous treatment with ceftriaxone 1g for 5 days and linezolid 600mg for 3 days, after that the treatment were change to oral azithromycin for one week. [elsevier.es]
The differences in length of treatment within each group make the comparison of outcome (mortality, need for surgical intervention, disease and treatment complications) difficult. [ncbi.nlm.nih.gov]
Topics addressed are genomics of toxigenic corynebacteria, host-pathogen-interaction, detection, surveillance and treatment as well as application aspects. [link.springer.com]
Epinephrine should be kept at hand during these test doses, as well as during treatment. [infectiousdiseaseadvisor.com]
Guinea pig lethality test Treatment and immunization Treatment is achieved by suppression of bacterial growth by administration of penicillin and erythromycin antibiotics that eliminates C. diphtheriae and terminate the production of toxin. [microbeonline.com]
Prognosis
[…] die of the infection if left untreated, and 1 in 10 die, despite treatment Please find comprehensive information on Diphtheria regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]
[…] pertussis 5 doses before school-age, completed by 4-6 years of age Tdap vaccine booster vaccine at 11-12 years of age should also be given to pregnant mothers and those around them Td vaccine tetanus and diphtheria toxoid vaccine at 10-year intervals Prognosis [medbullets.com]
Diphtheria Microchapters Home Patient Information Overview Historical Perspective Classification Causes Differentiating Diphtheria from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications and Prognosis Diagnosis [wikidoc.org]
Etiology
Abstract Corynebacterium diphtheriae is the etiological agent of diphtheria, a potential fatal disease caused by a corynephage toxin. [ncbi.nlm.nih.gov]
Diphtheria and its Etiological Agents Pages 1-14 Corynebacterium diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis—General Aspects Guaraldi, Ana Luíza de Mattos (et al.) [springer.com]
Epidemiology
Sign in Original ArticleFree PreviewArchive Corynebacterium diphtheriae Skin Infections in Alabama and Louisiana — A Factor in the Epidemiology of DiphtheriaList of authors. Mark A. Belsey, M.D., M.P.H., and T.M., Michael Sinclair, M.D., M. [nejm.org]
We report a bloodstream infection caused by a nontoxigenic strain of C. diphtheriae and discuss the epidemiology, possible sources of the infection, and the implications of rapid species identification of corynebacteria. [ncbi.nlm.nih.gov]
Pathophysiology
Transmission – airborne or direct contact (respiratory secretions or skin lesion) Organism Gram-positive bacillus Not spore forming Unencapsulated Pleomorphic Produces exotoxin that causes many of the symptoms Results in asymptomatic carriage in some patients Pathophysiology [arupconsult.com]
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Corynebacterium diphtheriae is the etiological agent of diphtheria and occurs in 2 forms, respiratory and cutaneous diphtheria [mayomedicallaboratories.com]
Pathophysiology C.diphtheriae causes diphtheria disease in non-immunized human hosts via secreted toxins.[1][2] Toxigenic strains of the bacterium will secrete toxins in nasopharyngeal or skin lesions; it is common for hosts to carry C. diphtheriae in [wikidoc.org]
Prevention
Immunity derived from vaccination or active infection may not prevent patients from becoming carriers; however, most patients who are adequately treated do not become carriers. [msdmanuals.com]
Prevention Haemophilus Influenzae Type B / Neisseria Meningitidis 1 3 Completed Prevention Infections, Pneumococcal 4 3 Completed Prevention Measles; Mumps; Rubella 1 3 Completed Prevention Meningococcal Disease 1 3 Completed Prevention Mumps / Rubella [drugbank.ca]
Prevention Diphtheria is a vaccine-preventable infection. There are four combination vaccines available to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. [dentalcare.com]
PMID 1749380. ↑ 6.0 6.1 "Pinkbook | Diphtheria | Epidemiology of Vaccine Preventable Diseases | CDC". ↑ Nester, Eugene W.; et al. (2004). Microbiology: A Human Perspective (Fourth ed.). Boston: McGraw-Hill. [wikidoc.org]
April 2017 Center for Disease Control and Prevention: Diphtheria, prevention We hold good stocks of all our antigens to ensure a rapid delivery service worldwide. [thenativeantigencompany.com]