Diphtheria ( Clinical manifestations ,Complications ,Treatment)

Clinical manifestations

Tonsillar and pharyngeal

A white membrane extends from tonsils to palate as a spider web, then this adherent membrane covers the tonsils, pharynx, larynx and trachea.

Cervical adenitis and bull neck from brawny pitting edema of soft tissue which is warm and tender.

Complications

1- Laryngeal affection leads to respiratory obstruction.

2- In the second week of the disease toxic myocarditis occurs.

3- Neurologic complications:  soft palate paralysis occurs in the first week, with nasal tone of voice and nasal regurgitation. Ocular paralysis and phrenic nerve paralysis occur in the third   week and peripheral nerve limb paralysis occurs in the fifth week.

Treatment

1- Antitoxin

· In mild cases is 40,000 U.

· In moderate severity is 80,000 U.

· In cases with severe pharyngeal or laryngeal or brawny edema is 120,000 U.

2- Antibiotic therapy: with one of the following drugs for 14 days: 

· Aqueous crystalline penicillin G. IM or IV (100,000-150,000U/kg/24hr divided in 4 doses).

· Procaine penicillin (25,000-50,000U/kg/24hr divided in 2 doses) IM.

· Erythromycin orally or IV (40-50 mg/kg/24hr, maximum, 2gm/24hr).

see the pictures

A white membrane of diphtheria

Bull neck

Bull neck