![]() Fatal respiratory diphtheria in a US traveler to Haiti-Pennsylvania, 2003. This booster is particularly important for travelers who will live or work with local populations in countries where diphtheria is endemic. After a primary series and childhood and adolescent boosters, booster doses with a diphtheria toxoid–containing vaccine at 10-year intervals given either as Td (tetanus-diphtheria) or Tdap (tetanus-diphtheria-acellular pertussis if not previously given) should be given to all adults. PREVENTIONĪll travelers should be up-to-date with diphtheria toxoid vaccine before departure. Antimicrobial prophylaxis (erythromycin or penicillin) is recommended for close contacts of patients. Supportive care (airway, cardiac monitoring) is required. In addition to DAT, an antibiotic (erythromycin or penicillin) should be used to eliminate the causative organisms, stop exotoxin production, and reduce communicability. In the United States, DAT is available to physicians under an investigational new drug protocol by contacting their state health departments and then CDC at 77. ![]() Equine diphtheria antitoxin (DAT) is the mainstay of treatment and can be administered without waiting for laboratory confirmation. Patients with respiratory diphtheria require hospitalization to monitor response to treatment and manage complications. Diphtheria is a nationally notifiable disease. diphtheriae from culture of nasal or throat swabs or membrane tissue and testing for toxin production by the Elek test. DIAGNOSISĪ presumptive diagnosis is usually based on clinical features. Fatal airway obstruction can result if the pseudomembrane extends into the larynx or trachea or if a piece of it becomes dislodged. The pseudomembrane is firm, fleshy, grey, and adherent it typically will bleed after attempts to remove or dislodge it. The hallmark of respiratory diphtheria is a pseudomembrane that appears within 2–3 days of illness over the mucous lining of the tonsils, pharynx, larynx, or nares and that can extend into the trachea. ![]() Respiratory diphtheria has a gradual onset and is characterized by a mild fever (rarely >101☏ ), sore throat, difficulty swallowing, malaise, loss of appetite, and if the larynx is involved, hoarseness. Nasal diphtheria can be asymptomatic or mild, with a blood-tinged discharge. Affected anatomic sites include the mucous membranes of the upper respiratory tract (nose, pharynx, tonsils, larynx, and trachea ), skin (cutaneous diphtheria), or rarely, mucous membranes at other sites (eye, ear, vulva). The incubation period is 2–5 days (range, 1–10 days). Respiratory and cutaneous diphtheria have been reported in travelers, though rarely. Cutaneous diphtheria is common in tropical countries. Since 2016, respiratory diphtheria outbreaks have occurred in Indonesia, Bangladesh, Myanmar, Vietnam, Venezuela, Haiti, South Africa, and Yemen. EPIDEMIOLOGYĮndemic in many countries in Asia, the South Pacific, the Middle East, Eastern Europe and in Haiti and the Dominican Republic. Cutaneous diphtheria can be transmitted by contact with discharge from skin lesions. Person-to-person through oral or respiratory droplets, close physical contact, and rarely, by fomites. Toxigenic strains of Corynebacterium diphtheriae biotype mitis, gravis, intermedius, or belfanti.
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