TAILIEUCHUNG - Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 4)

Diagnosis The diagnosis of diphtheria is based on clinical signs and symptoms plus laboratory confirmation. Respiratory diphtheria should be considered in patients with sore throat, pharyngeal exudates, and fever. Other symptoms may include hoarseness, stridor, or palatal paralysis. The presence of a pseudomembrane should prompt consideration of diphtheria. Once a clinical diagnosis of diphtheria is made, diphtheria antitoxin should be administered as soon as possible. Laboratory diagnosis is based either on cultivation of C. diphtheriae or toxigenic C. ulcerans from the site of infection or on the demonstration of local lesions with characteristic histopathology. . | Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species Part 4 Diagnosis The diagnosis of diphtheria is based on clinical signs and symptoms plus laboratory confirmation. Respiratory diphtheria should be considered in patients with sore throat pharyngeal exudates and fever. Other symptoms may include hoarseness stridor or palatal paralysis. The presence of a pseudomembrane should prompt consideration of diphtheria. Once a clinical diagnosis of diphtheria is made diphtheria antitoxin should be administered as soon as possible. Laboratory diagnosis is based either on cultivation of C. diphtheriae or toxigenic C. ulcerans from the site of infection or on the demonstration of local lesions with characteristic histopathology. C. pseudodiphtheriticum a nontoxigenic organism is a common component of the normal throat flora and does not pose a significant risk. Throat samples should be submitted to the laboratory for culture with the notation that diphtheria is being considered. This information should prompt cultivation on special selective medium and subsequent biochemical testing to differentiate C. diphtheriae from other nasopharyngeal commensal corynebacteria. All laboratory isolates of C. diphtheriae including nontoxigenic strains should be submitted to the CDC. A diagnosis of cutaneous diphtheria requires laboratory confirmation since the lesions are not characteristic and are clinically indistinguishable from other dermatoses. Diphtheritic ulcers occasionally but not consistently have a punched-out appearance Fig. 131-2 . Patients in whom cutaneous diphtheria is identified should have the nasopharynx cultured for C. diphtheriae. The laboratory media for cutaneous diphtheria are the same as those used for respiratory diphtheria Loffler s or Tinsdale s selective medium in addition to nonselective medium such as blood agar. As has been mentioned respiratory diphtheria remains a notifiable disease in the United States whereas cutaneous

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