* Toxic infection caused by Corynebacterium diphtheriae (Klebs-Löffler bacillus).
Gram positive bacillus; the packet group matches (or pins or Alphabet Letter) is suggestive.
* The strains carrying the gene Tox (transmitted by a bacteriophage) produce a toxin.
Cell damage are related to nuclease action of the toxin.
* The pharyngitis are very contagious (direct air transmission).
* Malignant diphtheria: often secondary to angina but occurs when the local signs of angina and fever disappeared.
– Early Marfan Syndrome: 7d after initiation of angina;begins with vomiting and paralysis of the veil (nasal reflux).
The key symptom is myocarditis.
The risk of cardiac arrest persists 8 weeks.
– Late Syndrome Genet & Mézard (35th day); begins with a paralysis of accommodation, paresis of sailing, followed by an ascending polyneuropathy with respiratory illness that requires assisted ventilation.
Paralysis regresses without sequelae from the 52nd day.
– Laryngeal diphtheria (croup) and faint voice hoarse cough and dyspnea with laryngeal inspiratory bradypnea, draw and wheezing.
* NSF: neutrophilia.
* Culture (mid Löffler) and testing Elek (appearance of the toxin) confirms the diagnosis.
* Emergency treatment => serum therapy (anti-toxic serum).
Penicillin G is the reference antibiotic (spectacular action on false membranes).
Isolation is required.
Croup -> corticosteroids.
The relay of serum therapy is provided by the anatoxithérapique vaccine (J1, J3, J15).
* Prophylaxis of contacts: subjects unvaccinated contacts must be protected by a serum therapy emergency while a first toxoid injection is performed.
Healthy carriers should be screened and treated (penicillin, macrolide).
