Faucial diphtheria

Faucial diphtheria:

is caused by corynebacterium diphtheria. This is a very rare condition these days considering the effectiveness of the universally administered vaccinations under the immunization schedule. The disease is characterized by membranous exudate at the site of infection. This is followed by distant toxic effects.

Age of occurrence:

Occurs in the age group between 2 and 10 years. Below 2 years the passive immunity provided by the mother is still persistent. After the age of 10 the child gains immunity from exposure to community infections or immunization.

Pathogenesis:

Organisms multiply in the throat, producing toxins. The necrosis of mucosa along with collection of polymorphs and fibrin leads to false membrane formation. This is a pseudomembrane because it contains layers of necrotic mucosa, while a true membrane will be found superimposed on intact mucosa.

Incubation period: ranges from 2 - 10 days

Clinical features:

1. The child is abnormally quiet and refuses to eat

2. Malaise and headache

3. Toxemia could be present

4. Pulse rate increased out of proportion to fever

5. Presence of massive cervical lymphadenopathy (Bull's neck)

6. Toxic myocarditis is common

Investigations:

1. Throat swab reveals the organisms

2.Schick test - positive

Treatment:

1. Antibiotics - Penicillin group

2. Antidiphtheretic serum to neutralize the toxin. This is administered as follows: Mild case 20,000 units, moderate to severe cases 40,000 to 80,000 units. Half of this dose is administered intravenously and the other half intramuscularly. Of course test dose should be administered.

3. If airway is compromised tracheostomy should be done

3. Complete isolation - 2 weeks