Organism Corynebacterium diphtheriae and rarely C. ulcerans.

Clinical features Diphtheria produces both local and systemic effects. The organism can infect the tonsils, pharynx, larynx, nose or skin, forming a pale grey membrane and local inflammation. Symptoms are fever, sore throat and enlarged cervical lymph nodes in the pharyngeal form, blood-stained discharge in the nasal form and skin ulcers in the cutaneous form. The inflammatory reaction produced in the respiratory tract can lead to swelling of the neck and respiratory obstruction. From the primary site, exotoxin is produced, which can cause myocarditis or neuropathy, especially cranial nerve palsies.

Diagnosis Throat, nose or skin swab of the exudate. A culture of the organism should be sent to a reference laboratory if possible.

Transmission Diphtheria can be transmitted by:

• airborne transmission of droplets;

• direct contact with lesions and exudates;

• indirect through articles soiled with discharges;

• ingestion of contaminated milk.

In an unimmunized population, there is a high incidence of carriers and a low incidence of cases in a ratio of approximately 19:1. Between 6% and 40% of children are infected every year so that by 5 years, some 75% have been infected and by 15 years, nearly all the children are infected. This means that by 15 years of age, the majority of children have developed immunity either by a sub-clinical infection or one in which clinical symptoms were revealed.

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