Diphtheria: Relic or relevant

Abstract

Diphtheria is an acute localized infection of the throat associated with systemic manifestations caused by the toxin producing Corynebacterium diphtheriae. Diphtheria continues to remain a serious public health problem in children largely related to lack of effective immunisation. The grey, brown, and dirty pseudo membrane is pathognomonic of this disease. The exotoxin produced by the pathogen is responsible for systemic effects. Severity of infection is determined by site of infection, immunization status of the patient, and extent of systemic involvement. Airway obstruction , myocarditis, acute kidney injury, thrombocytopenia and neuropathy are some of the serious complications associated with this disease. Of these, myocarditis is the most dreaded complication and carries a very high mortality. Diphtheria is a clinical diagnosis and specifi c antitoxin is the mainstay of therapy and should be administered as early as possible. Antibiotics are used to eradicate residual organisms, stop toxin production and decrease infectivity. The indications for PICU transfer include severe pharyngo tonsillar disease, delayed presentation to hospital (> 5 days), delayed antitoxin therapy, signs of airway obstruction and/ormyocarditis. Extremes of ages, severe disease, unimmu-nized children, myocarditis and delayed administration of antitoxin are all poor prognostic factors.