Diphtheria

What it is

Diphtheria is a serious infection caused by Corynebacterium diphtheria, and it is not common now. It is one of the bacterial causes of acute pharyngitis, alongside group A streptococcus.

How it presents

The picture is a toxic appearance, more than just simple tonsillitis:

• Symptoms of URTI, hoarseness, dysphagia, dyspnea, respiratory stridor, wheezing and cough.
• A white nasal membrane.
• Cervical adenopathy and swollen mucosa, which imparts a bull's neck.
• Low grade fever and tender enlarged cervical lymph nodes.

The membrane itself is grey and difficult to remove, and it sits on the tonsils and the uvula. A pseudomembrane can occur in any portion of the respiratory tract, and it can cause airway obstruction and suffocation.

Cutaneous diphtheria gives indolent non-healing ulcers covered with a gray membrane.

How it is diagnosed

Throat and nose swabs are cultured in tellurite or Leoffler's media. Gram staining shows club-shaped, non encapsulated, non motile bacilli found in clusters, and the Albert stain gives a Chinese letter appearance.

The differential diagnosis of a membrane over the tonsil is membranous tonsillitis, diphtheria and infectious mononucleosis.