Making a diagnosis
Before starting treatment, a detailed clinical diagnosis must be formulated. To do this, the physician determines the localization of the pathological process based on clinical and instrumental data and confirms it bacteriologically (swabs from the naso-oropharynx, and if necessary, from the wound surface or genitals).
The severity of the disease is also assessed. It depends on:
- The extent of the process.
- The presence of signs of toxic diphtheria (at the site of entry).
- The presence of early complications (in oropharyngeal involvement).
- Symptoms of laryngeal stenosis and respiratory failure (in respiratory tract involvement).
Management tactics and hospitalization
Key rule: all patients diagnosed with "Diphtheria" are subject to hospitalization, regardless of where the process is localized, how extensive it is, or how it manifests.
Patients are admitted to the intensive care unit (ICU) of an infectious diseases hospital if the following are present:
- Early severe complications of toxic oropharyngeal diphtheria.
- Laryngeal stenosis.
- Respiratory failure (in respiratory diphtheria).
Principles of therapy
Treatment of diphtheria includes specific and non-specific methods:
- Specific therapy: administration of diphtheria antitoxin (DAT) in the initial period and at the peak of the disease (until the membranes are rejected). The dose and frequency of administration are strictly individual and depend on the clinical picture.
- Non-specific detoxification therapy: performed in parallel with the administration of DAT.
- Anti-shock therapy: prescribed as needed (e.g., in the development of infectious-toxic shock).
- General principles: antibacterial, desensitizing, and symptomatic therapy. Patients are prescribed bed rest and a special diet.
Discharge criteria and vaccination
A patient can be discharged from the hospital only after complete clinical and bacteriological recovery.
Discharge criteria:
- Rejection of fibrinous membranes and epithelialization of the eroded surface.
- Absence of signs of peripheral nerve, myocardial, renal, or other specific/non-specific complications.
- Obtaining two negative results of bacteriological examination (complete bacteriological clearance).
If the patient retains late, residual, or iatrogenic complications, they may be transferred to a specialized department (e.g., cardiology), but only after complete bacteriological clearance.
Vaccination of convalescents: Indicated for those who have suffered moderate and severe forms of diphtheria. It is carried out using AD-M or ADS-M toxoid. Primary vaccination is prescribed 6 months after recovery, and re-vaccination 6–9 months thereafter.
Briefly: answers to topical questions
Which groups of antibacterial drugs are the drugs of choice for etiotropic therapy of diphtheria?
The cited sources confirm that antibacterial therapy is prescribed for diphtheria. It is also indicated that macrolides in high concentrations have a bactericidal effect against the diphtheria pathogen and are the drugs of choice in case of penicillin allergy. The groups of antibacterial drugs of choice specifically for etiotropic therapy of diphtheria are not listed in the sources.
What specific complications affecting the nervous system, myocardium, and kidneys are characteristic of diphtheria?
Specific complications include:
- Nervous system — demyelination of fibers (first cranial, then others), leading to flaccid paresis and paralysis of skeletal muscles, as well as autonomic innervation disorders (predominantly cardiovascular).
- Myocardium — early and late myocarditis. Damage to cardiomyocytes leads to impaired membrane de- and repolarization processes, decreased myocardial conductivity and contractility.
- Kidneys — tubular epithelial necrosis, leading to necrotic (toxic) nephrosis and acute renal failure (ARF).
What is the correct technique for taking material (swabs) for bacteriological examination for Corynebacterium diphtheriae?
The material for bacteriological examination is discharge from the naso-oropharyngeal mucosa, tonsils, as well as the wound surface or genitals if necessary. Sampling is performed as a swab followed by inoculation onto a blood tellurite-containing medium.
DAT — Diphtheria Antitoxin: Helps Before Clearance.
Class and exam questions
Can diphtheria be treated at home in mild cases?
No. The absolute indication is the hospitalization of all patients with a diagnosis of "Diphtheria" regardless of severity.
Until what point is diphtheria antitoxin (DAT) administered?
DAT is the basis of treatment in the initial period and at the peak of the disease — until the fibrinous membranes are rejected.
What are the criteria for discharging a patient?
Clinical recovery is required (rejection of membranes, epithelialization, absence of complications) and two negative results of diphtheria bacteriological cultures.
Is vaccination necessary after having diphtheria?
Yes, after moderate and severe forms. Vaccination is carried out 6 months after recovery (AD-M or ADS-M).
What else to study on this topic
- Clinical presentation of toxic oropharyngeal diphtheria
- Laryngeal stenosis: stages and clinical features
- Differential diagnosis of diphtheria and tonsillitis
- Early and late complications of diphtheria
- Features of bacteriological examination for Corynebacterium diphtheriae
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