Presentation
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]
The patient reported no I.V. drug use, so it can be assumed that no risk factors for infective endocarditis were present. [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. [step1.medbullets.com]
Other manifestations include cervical lymphadenopathy, soft tissue swelling of the neck, stridor, and/or difficulty breathing as a result of partial airway obstruction. [amboss.com]
Entire Body System
- Fever
Topic Images 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. [step1.medbullets.com]
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]
- 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]
Patients initially present with fever, malaise, and sore throat. Within a few days, a grayish-white pseudomembrane develops over the tonsils, posterior pharyngeal wall, and/or larynx. [amboss.com]
Diphtheria is most commonly an infection of the upper respiratory tract and causes fever, sore throat, and malaise. [ncbi.nlm.nih.gov]
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. [mayocliniclabs.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]
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]
(characteristic) The toxin is distributed to distant organs by the circulatory system and may paralysis and congestive heart failure. C. diphtheria may also cause cutaneous diphtheria. [microbe-canvas.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
[…] in einer Fertigspritze Corynebacterium diphtheriae (2 IU/0.5ml) + Bordetella pertussis filamentous hemagglutinin antigen (formaldehyde inactivated) (8 mcg/0.5ml) + Bordetella pertussis pertactin antigen (2.5 mcg/0.5ml) + Clostridium tetani (20 IU/0.5ml [go.drugbank.com]
Diphtheria, Tetanus, and Pertussis Immunization in Children 7 Through 18 Years of Age. In: Post TW, ed. UpToDate. [amboss.com]
QID: 106293 Pertussis toxin inhibits the G-protein Gi alpha subunit via ADP ribosylation Overactivates guanylate cyclase Inactivates the 60S ribosomal subunit Inactivates elongation factor 2 M 1 E Select Answer to see Preferred Response (M1.MC.13.175) [step1.medbullets.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
Other manifestations include cervical lymphadenopathy, soft tissue swelling of the neck, stridor, and/or difficulty breathing as a result of partial airway obstruction. [amboss.com]
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]
~ 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]
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]
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]
Other symptoms may include a runny nose, cough, headache, and hoarseness. Pharyngitis, and “bull’s neck Neck The part of a human or animal body connecting the head to the rest of the body. [lecturio.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]
- 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]
Dysphagia. Bloody nasal discharge. Pseudomembrane formation. Diagnosis Clinical diagnosis depends upon culture-proven toxigenic C.diphtheriae infection of : The skin. Nose, or throat. [labpedia.net]
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
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]
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]
- Exudative Pharyngitis
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]
The onset is sudden, with malaise, sore throat, exudative pharyngitis, and a low-grade fever. [bacteriologynotes.com]
Skin
- Skin Ulcer
ulcers and sore throats. [ncbi.nlm.nih.gov]
Figure 2 Skin ulceration in a wound infected with Corynebacterium diphtheriae. [academic.oup.com]
Identification of close contacts, especially contacts who may have been directly exposed to oral and skin ulceral secretions from the cases. [ecdc.europa.eu]
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]
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]
Face, Head & Neck
- Neck Swelling
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]
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]
Neurologic
- Peripheral Neuropathy
Less common consequences include myocarditis (about 20% of cases) and peripheral neuropathy (about 10% of cases) ( Wikipedia ). [bacteria.cz]
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]
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]
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 results of comparative phylogenetic analyses confirmed that the genera Corynebacterium, Dietzia, Gordona, Mycobacterium, Nocardia, Tsukamurella, and Turicella form a monophyletic taxon within the phylum containing the high-Gcontent gram-positive bacteria [phe-culturecollections.org.uk]
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 outcome can be good if patients are carefully selected for medical or surgical treatment. [omicsonline.org]
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]
On the third day of treatment the antibiotics were changed to amikacin and ciprofloxacin according to antibiogram. [ann-clinmicrob.biomedcentral.com]
Treatment The patient should be isolated as soon as diphtheria is suspected. [amboss.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 [step1.medbullets.com]
Prognosis : If your child were to contract diphtheria and be hospitalized immediately, he would most likely recover. [thevaccinemom.com]
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
To the best of our knowledge, this is the first extensive study of the epidemiology of C. diphtheriae from India. [journals.plos.org]
The cases occurred in various parts of Poland; no epidemiologic links were identified. [wwwnc.cdc.gov]
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]
Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 61 (21), 159 - 160. https://apps.who.int/iris/handle/10665/225825 Journal Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 61 (21): 159 - 160 Language English [apps.who.int]
Pathophysiology
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 [mayocliniclabs.com]
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]
Etiology Pathogen: Corynebacterium diphtheriae Route of infection Droplet transmission Less commonly through direct or indirect contact with open lesions Infectious period: variable References:[2] Pathophysiology ABCDEFG of C. diphtheria: ADP-ribosylation [amboss.com]
Prevention
Finally, patients should be immunized to prevent re-infection. Prevention: The most effective way of prevention is immunization. Children receive a series of DPT (diphtheria-tetanus-pertussis) shots. [web.uconn.edu]
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]
/ Viral Hepatitis B 1 4 Completed Prevention Diphtheria / Pertussis / Tetanus 1 4 Completed Prevention Diphtheria / Tetanus 1 4 Completed Prevention Meningococcal 1 4 Completed Prevention Meningococcal Infections / Pneumococcal Infection 2 Manufacturers [go.drugbank.com]
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]