TAILIEUCHUNG - Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 3)

Clinical Manifestations Respiratory Diphtheria The clinical diagnosis of diphtheria is based on the constellation of sore throat; adherent tonsillar, pharyngeal, or nasal pseudomembranous lesions; and low-grade fever. In addition, diagnosis requires the isolation of C. diphtheriae or the histopathologic isolation of compatible gram-positive organisms. The Centers for Disease Control and Prevention (CDC) recognizes confirmed respiratory diphtheria (laboratory proven or epidemiologically linked to a culture-confirmed case) and probable respiratory diphtheria (clinically compatible but not laboratory proven or epidemiologically linked). Carriers are defined as individuals who have positive cultures for C. diphtheriae and either are asymptomatic or have symptoms but lack pseudomembranes | Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species Part 3 Clinical Manifestations Respiratory Diphtheria The clinical diagnosis of diphtheria is based on the constellation of sore throat adherent tonsillar pharyngeal or nasal pseudomembranous lesions and low-grade fever. In addition diagnosis requires the isolation of C. diphtheriae or the histopathologic isolation of compatible gram-positive organisms. The Centers for Disease Control and Prevention CDC recognizes confirmed respiratory diphtheria laboratory proven or epidemiologically linked to a culture-confirmed case and probable respiratory diphtheria clinically compatible but not laboratory proven or epidemiologically linked . Carriers are defined as individuals who have positive cultures for C. diphtheriae and either are asymptomatic or have symptoms but lack pseudomembranes. Most patients seek medical care for initial manifestations of sore throat and fever. Occasionally weakness dysphagia headache and voice change are the initial manifestations. Neck edema and difficulty breathing are seen in more advanced cases and carry a poor prognosis. The systemic manifestations of diphtheria stem from the effects of diphtheria toxin and include weakness as a result of neurotoxicity and cardiac arrhythmias or congestive heart failure due to myocarditis. The pseudomembranous lesion is most often located in the tonsillopharyngeal region. Less commonly the lesions are detected in the larynx nares and trachea or bronchial passages. Large pseudomembranes are associated with severe disease and a poor prognosis. A few patients develop massive swelling of the tonsils and present with bull-neck diphtheria which results from massive edema of the submandibular and paratracheal region and is further characterized by foul breath thick speech and stridorous breathing. The diphtheritic pseudomembrane is gray or whitish and sharply demarcated. Unlike the exudative lesion associated with .

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