Pediatrics 10: Diphtheria Portal
PEDS: Because this entire portal pertains only to pediatric patients, the convention of underlining has been omitted.
Diptheria is caused by Corynebacterium diphtheriae. Clinical manifestations are primarily related to the toxin released by the bacteria. Initial signs and symptoms include the diphtheria membrane, which may involve any part of the upper airway.
Airway compromise may occur with the membrane involving the tonsillar pharyngeal or laryngeal region, leading to acute and even fatal airway obstruction.
Myocarditis is common with diphtheria and manifests as heart block or CHF. Neurologic complications include motor paralysis, particularly of the soft palate and pharyngeal muscles, resulting in difficulty handling secretions. Severe cases of diphtheria may result in respiratory and circulatory collapse.
Treatment
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Laryngeal diphtheria may result in airway obstruction requiring tracheostomy.
Patients with significant myocarditis may require bed rest. Serial ECGs are important.
Pay careful attention to hydration.
Anti-toxin is necessary in sufficient doses to neutralize all the free toxins.
Aqueous procaine penicillin G or erythromycin is appropriate to eradicate the organism so the diphtheria toxin is no longer produced.
β-hemolytic Streptococcus complicates 30% of diphtheria cases. Penicillin or erythromycin is effective to eradicate Streptococcus.