DIPTHERIA “MALIGNANT PHARYNGITIS”, GARROTILLO “STRANGLER”,
CORYNEBACTERIUM DIPTHERIAE—KLEBS LOEFLER BACILLUS—A G+PLEOMORPHIC AEROBIC BACILLUS ARMED WITH A LYSOGENIC BACTERIOPHAGE TOXIN (EF-2 PHAGE TOXIN)
NEURO AND CARDIOTOXIC
PHARYNGITIS—A DIRTY GREY PHARYNGEAL MEMBRANE—-A LOCAL PHLEGMASIA—-RARE IN THESE DAYS WITH IMMUNIZATIONS
CAN LEAD TO EPISTAXIS, HEMOPTYSIS, AND “BULL NECK”—-REACTIVE CERVICAL LAD
OFTEN INSP STRIDOR
USED TO BE THE #1 REASON FOR A PEDIATRIC TRACH—–DID NOT WANT TO INTUBATE THEM AS THE MEMBRANE AND BLOOD MIGHT BE ASPIRATED
NEURO—PALATAL, OCULAR, AND DIPHRAGMATIC PARESES—RESEMBLE GBS
CARDIO—DYSRHYTHMIAS AND CONDUCTION DEFECTS
MAY STILL BE A DIAGNOSTIC CONSIDERATION IN POPULATIONS (AMISH OR IMMIGRANTS) WHERE VACCINATIONS ARE NOT ADHERED TO
Dx: ELEK METHOD—-DETECTION OF TOXIN FROM THROAT SWAB
ISOLATION OF G+ BACILLI WITH METACHROMATIC GRANULES
Rx: SECURE AIRWAY—-TRACH MAY BE INDICATED—INTUBATION MAY CAUSE ASPIRATION OF PSEUDOMEMBRANE—-ISOLATION OF PT, 10-60,000 UNITS OF ANTI-TOXIN GIVEN ASAP (WITHIN 48 HOURS—MUST NOT WAIT FOR CONFIRMATION OF THE Dx)—-FOLLOWING DILUTED INTRADERMAL SKIN TEST (TO R/O SEVERE REACTIVITY)
BIG DOSES OF IV PCN G OR ERYTHROMYCIN
P.O. ERYTHROMYCIN FOR ALL CONTACTS