Diphtheria (Greek διφθέρα (diphthera) “pair of leather scrolls”) is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium.[1][2] It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.[3] A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis (about 20% of cases) [4] and peripheral neuropathy (about 10% of cases).[5]

Diptheria

The Styloid Process is a pointed piece of bone that extends down from the skull, just below the ear. It serves as an anchor point for ligaments and muscles associated with the tongue and larynx.

The stylohyoid ligament, stylomandibular ligament, styloglossus muscle, stylohyoid muscle and stylopharyngeus muscle are attached to the styloid process.  (3 muscles innervated by 3 cranial nerves attach to the styloid process—–stylohyoid – C.N. VII, stylopharyngeus – C.N. IX, and styloglossus – C.N. XII)

A small percentage of the population suffers from a condition called Eagle Syndrome which causes an elongation of the styloid process and stylohyoid ligament calcification. When someone with Eagle Syndrome swallows, the tissue of the throat rubs against the styloid process, resulting in glossopharyngeal nerve pain. Eagle Syndrome was first described by Watt Weems Eagle, an otorhinolaryngologist, in 1937.

GABHS has a number of known problematic sequelae that are the primary reason we look for it.  Although rare, ARF (Acute Rhematic Fever) or Rheumatic Heart Disease is our primary concern.  It is a sterile Type II autoimmune attack on the heart valves, myocardium, and joints resulting from the protracted high anti strep circulating antibodies.  It is my understanding that if you treat Strep within 9 days you avoid this possibility.  Apparently you need to treat about 40,000 cases of strep throat to avoid one such case.  With the incidence of a severe allergic reaction to PCN being 1/12,000 so clinical judgement is paramount.  The most winning strategy is to just use the “rapid test” as the decision maker.  Using this strategy, in the US, we could prevent 85 cases of rheumatic heart disease annually at the cost of $727,000 per case prevented.  You are actually more likely to contract Lemeirre’s Syndrome from Fusobacterium with a GABHS infection than Rheumatic Heart Disease.