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Diphtheritic Neuropathy


Presentation

  • Limb muscle weakness was present in 94%. Respiratory muscles were involved in 85.4% cases and 60.4% required mechanical ventilation, while 14.6% had fatal outcome and 10.4% had hypoxic neurological injury. Boys were affected more.[ncbi.nlm.nih.gov]
  • The specific treatment (diphtheria antitoxin) was not useful in our child as the child presented 4 wk after diphtheria infection. This case report will increase the awareness of sporadic occurrence of a rare disease among fellow pediatricians.[content.iospress.com]
  • Each entry follows a 5 section structure that will cover (1) essential features of the disorder (2) physiological basis of the disorder (3) neuropsychological and other clinical presentation (4) assessment and diagnostic practices (5) evidence-based treatments[books.google.de]
  • We report an instructive case of diphtheritic polyneuropathy that provides an opportunity to review its typical presentation and management.[jnnp.bmj.com]
Cervical Lymphadenopathy
  • A “bull neck” may arise due to cervical lymphadenopathy and soft tissue swelling. Occasionally the initial site is cutaneous, vaginal or, in neonates, umbilical.[jnnp.bmj.com]
Collapse
  • Cardiac involvement, either acutely in the form of cardiovascular collapse or as an arrhythmia or more chronically in the form of congestive heart failure, is the most common threat to life in diphtheria.[histopathology-india.net]
  • The patients with DP exhibited acute laryngitis, nasopharyngitis, or tonsillitis with pseudomembranes and were defined as having severe toxic diphtheria if there was neck oedema, toxic collapse, acute renal failure, or myocarditis.[jnnp.bmj.com]
Soft Tissue Swelling
  • A “bull neck” may arise due to cervical lymphadenopathy and soft tissue swelling. Occasionally the initial site is cutaneous, vaginal or, in neonates, umbilical.[jnnp.bmj.com]
Chronic Fatigue Syndrome
  • Apply integrative treatments for a full range of diseases and conditions including autism, stroke, chronic fatigue syndrome, and various forms of cancer...see how to advise patients on health maintenance and wellness...and get valuable advice on topics[books.google.de]
Pharyngeal Edema
  • Examination of the mouth reveals pharyngeal edema, with a silver-gray leathery membrane covering the tonsils and uvula. When scrapings are done, the underlying mucosa starts to bleed. Adenopathy is prevalent.[knowledge.statpearls.com]
Nasal Voice
  • Bulbar function was expressed on a four point scale: 0 normal; 1 minor symptoms without dysphagia; 2 moderate dysphagia, nasal voice, or palatal paresis; 3 severe dysphagia requiring a nasogastric tube.[jnnp.bmj.com]
Gagging
  • Paralysis of a soft palate, disturbance of sensitivity in a throat, decrease in a gag reflex develop on 3 — the 4th week from the beginning of a disease.[en.medicalmed.de]
  • Paralysis of a soft palate, disturbance of sensitivity in a throat, decrease in a gag reflex develop in 3 — 4 weeks from the beginning of a disease.[infomeds.net]
Regurgitation
  • However, it was noted at that time that his voice had developed a nasal quality and he began to have nasal regurgitation.[jnnp.bmj.com]
  • Paralysis of the voluntary muscles of the palate may produce a peculiar nasal quality of the voice and a tendency to regurgitate fluids through the nose. Hypopharynx: Hypopharyngeal involvement may lead to aspiration pneumonia.[histopathology-india.net]
Failure to Thrive
  • Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more.[books.google.de]
Tonsillar Exudate
  • A 29-year-old Haitian man had a sore throat with a marked tonsillar exudate followed by the onset of increasingly blurred vision with swallowing difficulties and, then, a diffuse acute demyelinating neuropathy.[ncbi.nlm.nih.gov]
  • Abstract A 29-year-old Haitian man had a sore throat with a marked tonsillar exudate followed by the onset of increasingly blurred vision with swallowing difficulties and, then, a diffuse acute demyelinating neuropathy.[prohealth.com]
Retrosternal Chest Pain
  • Four weeks after the initial onset of symptoms, he experienced an episode of retrosternal chest pain lasting 30 minutes. An ECG and subsequent exercise test were normal.[jnnp.bmj.com]
Chest Pain
  • Four weeks after the initial onset of symptoms, he experienced an episode of retrosternal chest pain lasting 30 minutes. An ECG and subsequent exercise test were normal.[jnnp.bmj.com]
Blurred Vision
  • A 29-year-old Haitian man had a sore throat with a marked tonsillar exudate followed by the onset of increasingly blurred vision with swallowing difficulties and, then, a diffuse acute demyelinating neuropathy.[ncbi.nlm.nih.gov]
  • Abstract A 29-year-old Haitian man had a sore throat with a marked tonsillar exudate followed by the onset of increasingly blurred vision with swallowing difficulties and, then, a diffuse acute demyelinating neuropathy.[prohealth.com]
  • The toxin also affects myelinated parasympathetic autonomic nerves, resulting in blurred vision from impaired accommodation, abnormal pupil reactions, and vagal block.[jnnp.bmj.com]
  • She notices that she becomes fatigued easily and has intermittently blurred vision. 457. The most likely explanation for her symptoms is a. Inappropriate antidiuretic hormone b. Diabetes mellitus c. Panhypopituitarism d.[brainscape.com]
Pupillary Abnormality
  • Facial weakness and pupillary abnormalities are common. The index cases had no limb weakness.[healthdocbox.com]
Genital Lesions
  • Diphtheria is clinically defined “as an upper respiratory tract illness characterized by sore throat, low grade fever, and an adherent membrane of the tonsils, pharynx or nose or non-respiratory diphtheria; cutaneous, conjunctival, otic, and genital lesions[wwwnc.cdc.gov]
Limb Weakness
  • Of the children, 52% had palatal palsy whereas 48% had limb weakness initially. Median duration of progression of weakness was five days. Limb muscle weakness was present in 94%.[ncbi.nlm.nih.gov]
  • Neck and trunk flexion were mildly weak and there was global limb weakness (MRC grade 4). Tendon reflexes and plantar responses were absent. He had distal sensory loss for all modalities in a glove and stocking distribution.[jnnp.bmj.com]
  • The index cases had no limb weakness. There is some inconsistency in published studies as to whether cases with limb weakness should be called MFS or Miller Fisher/Guillain-Barré overlap syndrome (our preference).[healthdocbox.com]
Cognitive Deficit
  • This approach emphasizes the importance of looking at the other functional impacts of these manifestations (e.g. cognitive deficits secondary to depression, orthodopaedic ambulation issues).[books.google.de]
Absent Deep Tendon Reflex
  • It is considered more likely with higher release of exotoxin ( 6 , 7 ) The classic features of diphtheritic polyneuropathy include sensory and motor signs and symptoms, most notably acute flaccid paralysis (AFP) with reduced or absent deep tendon reflexes[wwwnc.cdc.gov]

Workup

  • Diagnostic workup consists of confirming infection and neurophysiological evidence of demyelination. Management is conservative with attention paid to respiration and the airway, which may require mechanical ventilation if significantly impaired.[medlink.com]
Gram-Positive Rods
  • Answers Teaching Points Click Your Answer Below Corynebacterium diphtheriae, a gram-positive rod is the causative organism Transmission is only by droplet Neurological and skin manifestations are commonly seen None of the above Would you like to access[knowledge.statpearls.com]

Treatment

  • Implement proven integrative treatments for various diseases thanks to an evidence-based therapeutic approach.[books.google.de]
  • At adequate treatment at 75 – 85% of patients good restoration is observed.[herbalthera.com]
  • Treatment is begun with a plasma exchange or corticosteroids.[infomeds.net]
  • She was managed with supportive treatment. The specific treatment (diphtheria antitoxin) was not useful in our child as the child presented 4 wk after diphtheria infection.[content.iospress.com]

Prognosis

  • However, especially in view of the increasing number of European outbreaks, correct differentiation from Guillain-Barré syndrome (table) and other neuropathies is important because the treatment and prognosis are different and because of the importance[jnnp.bmj.com]
  • Prognosis Recovery from peripheral neuropathy is usually slow. Depending on aetiology patient may fully, partially recovered or patient may develop chronic muscular atrophy if severely affected.[orion-group.net]
  • Havaldar, PV; Sankpal MN, Doddannavar RP. (2000). [ Expression error: Missing operand for "Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome."]. Ann Trop Paediatr. 20 (3): 209–15..[ourmed.org]
  • The prognosis is generally poor, but some patients respond to intravenous ganciclovir (2.5 mg/kg every 8 hours for 10 days, then 7.5 mg/kg daily 5 days per week).[advances-in-medicine.net]
  • Havaldar, PV; Sankpal MN, Doddannavar RP. (2000). [ Expression error: Missing operand for "Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome."]. Ann Trop Paediatr. 20 (3): 209-15..[dictionnaire.sensagent.leparisien.fr]

Etiology

  • Reasons of the Diphtheritic polyneuropathy: The etiological agent - a diphtheritic stick (Corynebacterium diphtheriae).[en.medicalmed.de]
  • Despite an extensive evaluation, in approximately half of patients, no etiology is ever found; these patients typically have a predominately sensory polyneuropathy and have been labeled as having idiopathic or cryptogenic sensory polyneuropathy (CSPN)[accesspharmacy.mhmedical.com]
  • Careful history taking with attention to family history, environmental exposure, and systemic illness, combined with neurological examination and laboratory studies can determine the etiology in most of the cases.[orion-group.net]
  • .  ETIOLOGICAL CLASSIFICATION  1.metabolic-DM,amyloidosis,porphyria  2.infections-leprosy,HIV,CMV,syphilis,  diphtheria,lymedisease  3.immune- GBS,CIDN,MMN  4.hereditary-CMT  5.Toxic-drugs,alcohol,heavymetals  6.vasculitis-PAN,CSS,cryoglobulinemia[slideshare.net]
  • Thus, PN is a group of neurological disorder with varied etiologies caused by hereditary, metabolic, toxic, and environmental causes.[annalsofian.org]

Epidemiology

  • The committee uses no specific algorithm or diagnostic criteria for every case but comes to a consensus on the most likely diagnosis on the basis of clinical, laboratory, and epidemiologic data.[wwwnc.cdc.gov]
  • Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 1989;38:1456-61. 21. Pickup J, Wilham G. Epidemiology of diabetes. In: Guikshank K, editor. Textbook of Diabetes.[annalsofian.org]
  • Epidemiology Diphtheria is a serious disease, with fatality rates between 5% and 10%.[ourmed.org]
Sex distribution
Age distribution

Pathophysiology

  • Clinical presentation of the neuropathies depends upon the associated pathophysiologic mechanisms and the anatomical location of the nerve damage.[search.credoreference.com]
  • […] about 65% patients returned to occupation. [109] Alcoholic neuropathy Polyneuropathy has been reported to be present in 13%–66% of chronic alcoholics. [110] The relative risk of polyneuropathy in chronic alcoholics is estimated at 3.9 times. [111] The pathophysiology[annalsofian.org]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.de]
  • Khera) Cite This Article Abstract Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae .[wwwnc.cdc.gov]
  • Our data suggest that antitoxin administration on days 0–2 prevents death although cases of severe neuropathy still occur.[jnnp.bmj.com]
  • Centers for Disease Control and Prevention Diphtheria (Medical Encyclopedia) [ Read More ][icdlist.com]

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