Diphtheria (cont.)

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How is diphtheria diagnosed?

The diagnosis of diphtheria is confirmed by isolation of the bacterium Corynebacterium diphtheriae. Diagnostic tests to isolate the bacterium involve obtaining cultures from the nose and throat in any individual suspected of having diphtheria, as well as their close contacts. Diagnostic tests to isolate the bacterium involve obtaining cultures from swabs of the nose and throat in any individual suspected of having diphtheria, as well as their close contacts. If cutaneous diphtheria is suspected, samples from the skin can be obtained and sent to specialized laboratories. Suspected or confirmed cases of respiratory diphtheria should be reported to the United States Centers for Disease Control and Prevention (CDC) and to your state health department.

It is also important to determine whether or not the isolate from an infected person is capable of producing diphtheria toxin, and this can be accomplished as well by testing in specialized laboratories. Finally, determining the patient's antibody levels to diphtheria toxin can also be helpful for evaluating the probability of the diagnosis of diphtheria and the potential for severe illness.

Other tests, such as ECG, imaging studies, and blood work can also help assess the extent of involvement of the disease.

What is the treatment for diphtheria?

If diphtheria is suspected in a patient, prompt treatment should be undertaken even before confirmatory lab results are available. Patients should also be placed in isolation to prevent further transmission of the disease.

Diphtheria antitoxin is the mainstay of therapy. It neutralizes circulating diphtheria toxin and reduces the progression of the disease. The effectiveness of diphtheria antitoxin is greatest if it is administered early in the course of the disease. The CDC can assist in obtaining the diphtheria antitoxin. Antitoxin is not recommended for asymptomatic carriers and it is usually of no value in localized cutaneous diphtheria.

Antibiotics should also be administered as soon as possible to patients with suspected diphtheria. Antibiotics help eradicate the bacteria, thereby stopping toxin production, and they also help to prevent transmission of diphtheria to close contacts. Penicillin and erythromycin are the recommended antibiotics. Asymptomatic carriers, as well as all close contacts potentially exposed to diphtheria, also require antibiotic treatment. Affected individuals are usually not contagious after 48 hours of antibiotic administration.

Supportive measures, such as inserting a breathing tube (intubation), may be necessary if the patient cannot breathe on their own or if there is the potential for airway obstruction. Potential cardiac and neurologic complications also need to be closely followed and addressed in consultation with the proper specialist.

Medically Reviewed by a Doctor on 11/26/2013

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