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Laryngeal Diphtheria

Mostly, it is secondary to faucial diphtheria affecting children below 10 years of age. Incidence of diphtheria in general is declining de to wide-spread use of immunization.
Effects of laryngeal diphtheria are due to:
  1. Formation of a tough pseudomembrane over the lar­ynx and trachea which may completely obstruct the airway.
  2. Exotoxin liberated by bacteria leading to myocardi­tis and various neurological complications.
Clinical Features
  1. General symptoms. Onset is insidious with low grade fever (100-101°F), sore throat and malaise but patient is very toxaemic with tachycardia and thready pulse.
  2. Laryngeal symptoms. Hoarse voice, croupy cough, inspi­ratory stridor, increasing dyspnoea with marked upper airway obstruction.
  3. Membrane. Greyish white membrane is seen on the tonsil, pharynx and soft palate. It is adherent and its removal leaves a bleeding surface. Similar membrane is seen over the larynx and trachea.
  4. Cervical lymphadenopathy. Characteristic “bull-neck” may be seen.
Laryngeal diphtheria is mostly secondary to faucial diph­theria. Diagnosis is always clinical but confirmed by smear and culture of corynebacterium diphtheriae. Treatment is started on clinical suspicion.
  1. Diphtheria antitoxin. It neutralises free toxin circulating in the blood.
  2. Antibacterials. Benzylpenicillin, Erythromycin can be given to those who are allergic to penicillin.
  3. Maintenance of airway. Tracheostomy may become essential. Direct laryngoscopy, removal of diph­theritic membrane and intubation can be done. Intubation relieves respiratory obstruction and can make subsequent tracheostomy easy.
  4. Complete bed rest. Complete bed rest for 2-4 weeks is essential to guard against effects of myocarditis.
  1. Asphyxia and death due to airway obstruction.
  2. Toxic myocarditis and circulatory failure.
  3. Palatal paralysis with nasal regurgitation.
  4. Laryngeal and pharyngeal paralysis.
Note: A lot of MCQ books suggest that most common cause of death due to diptheria is larynx diptheria causing obstruction by membrane. This is not true.  Toxemia is the most common cause of death in diptheria.

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