Summary
Definition
History and exam
Key diagnostic factors
- typical age group (<15 years or >25 years)
- exposure to infected individual
- travel from epidemic or endemic regions
- unvaccinated/incompletely vaccinated individuals
- sore throat
- dysphagia or dysphonia
- dyspnea
- croupy cough
- pseudomembrane formation
- swelling of the neck
- skin lesions
- respiratory compromise
Other diagnostic factors
- fever
- stridor
Risk factors
- unvaccinated individuals
- inadequately vaccinated individuals
- exposure to an infected individual
- travel from endemic areas
- skin breakdown
- poor hygiene, overcrowding, and poverty
Diagnostic tests
1st tests to order
- bacteriologic culture, microscopy and sensitivities
Tests to consider
- Elek test for toxigenicity
- polymerase chain reaction (PCR)
- diphtheria antibodies
Treatment algorithm
asymptomatic close contacts of respiratory and cutaneous cases
respiratory diphtheria
cutaneous diphtheria
asymptomatic carriers
Contributors
Authors
Derek Sloan, FRCP, PhD
Reader & Consultant Physician in Infectious Diseases
University of St Andrews & NHS Fife
Scotland
Infectious Diseases Referent
UK-Med
UK
Disclosures
DS declares that he has no competing interests.
Acknowledgements
Dr Derek Sloan would like to gratefully acknowledge Dr Walid Abuhammour, Dr Sarmad Farook Yahya Alhamdani, and Dr Nida Yousef, previous contributors to this topic.
Disclosures
WA, SFYA, and NY declare that they have no competing interests.
Peer reviewers
William A. Petri, Jr, MD, PhD, FACP
Chief and Professor of Medicine
Division of Infectious Diseases and International Health
University of Virginia Health System
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Linda S. Nield, MD
Associate Professor of Pediatrics
West Virginia University School Of Medicine
Morgantown
WV
Disclosures
LSN declares that she has no competing interests.
References
Key articles
Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. Chapter 1: diphtheria. Dec 2022 [internet publication].Full text
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases: diphtheria. May 2023 [internet publication].Full text
UK Health Security Agency. Public health control and management of diphtheria in England: 2023 guidelines. Nov 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Streptococcus pyogenes pharyngitis
- Acute epiglottitis
- Infectious mononucleosis
More DifferentialsGuidelines
- Infection control in healthcare personnel: epidemiology and control of selected infections transmitted among healthcare personnel and patients
- Clinical management of diphtheria
More GuidelinesPatient information
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)
More Patient informationLog in or subscribe to access all of BMJ Best Practice
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