Diphtheria: Symptoms, Complications, and Airway Emergency

Diphtheria is an acute bacterial infection caused by toxigenic Corynebacterium diphtheriae. The hallmark is a thick, gray pseudomembrane in the throat.

Classic Presentation

• Pseudomembrane: Adherent, gray-white membrane covering tonsils, pharynx, larynx, or nares. Bleeds if forcibly removed.
• Airway obstruction: Membrane can extend to trachea, causing stridor, respiratory distress, suffocation.
• Systemic symptoms: Fever, sore throat, hoarseness, swollen cervical lymph nodes ("bull neck"), malaise.

Systemic Complications (from diphtheria toxin)

• Myocarditis: Arrhythmias, heart failure (1–2 weeks after onset).
• Neuropathy: Palatal paralysis, cranial nerve palsies, peripheral neuropathy (weeks later).
• Renal tubular necrosis.

Urgent Management

1. Airway security: Intubation or tracheostomy if obstruction imminent.
2. Diphtheria antitoxin (DAT): Neutralizes circulating toxin; give ASAP (dose based on severity).
3. Antibiotics: Erythromycin or penicillin (eliminates carriage, stops toxin production).
4. Isolation: Respiratory droplet precautions until 2 negative cultures 24h apart.

Prevention

Universal vaccination with DTaP/Tdap (diphtheria toxoid). Boosters every 10 years. High coverage maintains herd immunity.

Diphtheria is a medical emergency. Suspected cases need immediate hospitalization and antitoxin.