THROAT - Faucial diphtheria

What is Faucial diphtheria?

Synonym : Diphtheritic pharyngitis
Diphtheria is an infection caused by Corynebacterium diphtheria, a gram positive bacillus.
The incidence of this disease has drastically reduced after the immunization programme.

What are the causes of  Faucial diphtheria?

  1. Age : Young children from age 2 to 5 years
  2. Air borne spread
  3. Laryngeal diphtheria usually follows pharyngeal infection

         
Causative organism : Corynebacterium diphtheria.
This organism has 3 strains
1.  Corynebacterium diphtheria gravis
2. Corynebacterium diphtheria intermedius
3. Corynebacterium diphtheria mitis

Coynebacterium diphtheria gravis is the most fulminant pathogen causing epidemics with high mortality.

What are the clinical features of faucial diphtheria?

I. General:
1. Sore throat
2. Malaise
3. Pyrexia

II. Oral cavity:
I. Lesion is seen over the tonsil with necrosis.
2.A characteristic greyish green membrane is formed on the tonsil posterior pharyngeal wall and soft palate. 'This membrane contains rich fibrinous exudate and large number of bacteria.

3. This membrane bleeds on touch and thickens with time.
4. Bilateral tender cervical lymphadenopathy often present.
5. Neck cellulitis may be present giving the appearance of "Bull Neck".

III. Larynx:
1. Infection from the pharynx easily spreads into the larynx causing rapid airway obstruction
2. Inspiratory stridor
3. Barking cough
4. Recession of anterior chest wall

IV. Neurological symptoms:
They appear 3 to 6 weeks after the onset of diphtheria.The signs
are :
1. Paralysis of the
a. Soft palate
b . Diaphragm
c. Ocular muscles
2. Occasionally, 'Guillain- Barre Syndrome'
Death is due to toxemia producing cardiac complications.

What is the treatment of Faucial diphtheria?

Diagnosis of diphtheria is made clinically.
1.       Neutralization of the exotoxin with equine antitoxin (20000-1200000      units)
2.       Benzyl penicillin 600-1200 mg every 6 hourly is given along with the       antitoxin
3.       Isolation of the patient
4.       Endotracheal intubation or tracheostomy may be necessary in severe       cases of diphtheritic laryngitis
5.       Immunization of all persons coming in contact with the patient




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