0071643192.pdf

TREATMENT

■ Supportive therapy

■ Close observation of respiratory function with forced expiratory volume

(FEV 1 ) monitoring

■ Prophylactic intubation or ventilatory support if

■ Decreased FEV 1 below 100% predicted

■ CO 2 retention

Diphtheria

A toxin-mediated multisystem illness caused by Corynebacterium diphtheriae

PATHOPHYSIOLOGY

■ Respiratory or skin (tropical climates or poor hygiene) infection with C.

diphtheriae→exotoxin release →

■ Local membrane formation.

■ Peripheral neuropathy →neurologic symptoms.

SYMPTOMS/EXAM

■ Respiratory infection

■ Symptoms indistinguishable from pharyngitis, tonsillitis

■ Adherent, grayish-white to grayish-black membrane visible at site of

infection

■ Sharply demarcated borders

■ Skin infection

■ Clinically similar to chronic skin ulcers/wounds

■ Grayish membrane present

COMPLICATIONS

■ Airway obstruction from membrane formation

■ Neurologic

■ Weakness →paralysis (often starts with paralysis of the soft palate).

■ Dysphagia and dysarthria

■ Myocarditis

■ Nephritis

DIAGNOSIS

■ Suspect and treat based on clinical examination.

■ Culture is confirmative.

TREATMENT

■ Diptheria antitoxin.

■ Antibiotics (penicillin or erythromycin).

■ Supportive care.

Diabetic Distal Symmetric Polyneuropathy

The most common type of peripheral neuropathy. It is a gradually progressive

disease process (years) due to microvascular injury to the nerve.

NEUROLOGY

Diphtheria:

Exudative pharyngitis with

progressive weakness.

Treat with diptheria antitoxin.