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Diphtheria

Last reviewed: 30 Sep 2024
Last updated: 01 Sep 2023

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
Full details

Other diagnostic factors

  • fever
  • stridor
Full details

Risk factors

  • unvaccinated individuals
  • inadequately vaccinated individuals
  • exposure to an infected individual
  • travel from endemic areas
  • skin breakdown
  • poor hygiene, overcrowding, and poverty
Full details

Diagnostic tests

1st tests to order

  • bacteriologic culture and microscopy
Full details

Tests to consider

  • Elek test for toxigenicity
  • polymerase chain reaction (PCR)
  • diphtheria antibodies
Full details

Treatment algorithm

INITIAL

close contacts of respiratory and cutaneous cases

ACUTE

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.

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