0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

TREATMENT

■ IV antibiotics (cephalosporins)
■ ICU admission
■ ENT/surgical consult for I + D after intubation
■ Consider steroids and humidified O 2.

Diphtheria Laryngitis

ETIOLOGY

■ Corynebacterium diphtheriae (Gram-positiverod)
■ Local invasion with tissue necrosis
■ Exotoxin production causing systemic findings
■ Previously caused epidemics primarily among young children, now seen
rarely in the United States
■ Older adults at risk

SYMPTOMS/EXAM

■ Grayish pseudomembrane (see Figure 14.22)
■ Bull neck: Lymphadenopathy, edema, stridor
■ Tachycardia
■ Malaise
■ Headache
■ Immunizations not up to date

TREATMENT

■ Antitoxin (horse): To neutralize the exotoxin
■ Antibiotics: Penicillin or erythromycin
■ Isolation

Pathogenic Gram-positive

bacteria:

Staphylococcussp.

Streptococcussp.

Actinobacteriumsp.

Bacillus anthracis, B. cereus

Clostridium botulinum,

C. difficile, C. perfringens,

C. tetani

Coynebacterium diphtheria

Listeriasp.

FIGURE 14.22. Pharyngeal pseudomembrane in patient with diphtheria laryngitis.

(Reproduced, with permission, from Whiting JL, Chow AW. Life-threatening infections of the
mouth and throat. J. Crit Illness2:36:1987.)