Diphtheria

Abstract

A 3-year-old, unimmunized boy is seen at a hospital clinic in Cartagena, Colombia, with fever, sore throat, and progressive neck swelling that began 2 days earlier. The boy and his family had fled the geopolitical and humanitarian crisis in their home country of Venezuela. The boy had never before seen a doctor and had never been given any immunizations. On physical examination, he appears malnourished. He is breathing comfortably at rest, but when he becomes agitated, inspiratory stridor is noted. He has nasal congestion, with dried blood on both nostrils. A thick greyish-white exudate is present on the posterior pharynx. Bilateral cervical lymphadenopathy is present, and the neck appears to be swollen. The remainder of his exam is unremarkable.

A clinical diagnosis of diphtheria is made. The boy is hospitalized so that he can be monitored closely for signs of impending airway obstruction. A single dose of intravenous equine-derived diphtheria antitoxin is administered, and then treatment with aqueous penicillin G is initiated. Postexposure antibiotic prophylaxis is provided to all members of his family. The boy improves slowly while completing a 14-day course of antibiotics without developing signs of myocarditis or neuropathy. Prior to hospital discharge, a dose of diphtheria toxoid-containing vaccine is administered. A return appointment was scheduled with the outpatient clinic 1 week later, but the child was lost to follow-up.