Diphtheria is an acute bacterial infection that usually affects nose, tonsils, throat and skin, causes fever, sore throat, and malaise. A thick, gray fibrin membrane, the pseudomembrane, often forms over the site(s) of infection, as a result of the combined effects of bacterial growth, toxin production, necrosis of underlying tissue, and the host immune response. Homoeopathic remedies can successfully treat diphtheria and prevent its complications.
Diphtheria is an acute pharyngeal or cutaneous infection caused mainly by toxigenic strains of Corynebacterium diphtheria. Usually infect the nasopharynx or skin.
- Pseudomembranous pharyngitis
- Nonspecific skin infections
Followed by myocardial and neural tissue damage secondary to the exotoxin. An asymptomatic carrier state also exists. Diagnosis is clinical and confirmed by culture.
Epidemiology and transmission
Humans are the only known reservoir for Corynebacterium diphtheria. The organism is spread by
- Respiratory droplets
- Contact with nasopharyngeal secretions
- Contact with infected skin lesions
Signs and symptoms
After an incubation period of 5 days, and a prodromal period between 12 and 24 h, patients develop
- mild sore throat,
- low-grade fever,
- malaise and
Nausea, emesis, chills, headache, and fever are more common among children.
If a toxigenic strain is involved,
- The characteristic membrane appears in the tonsillar area.
- It may initially appear as a white, glossy exudate but typically becomes dirty gray, tough, fibrinous, and adherent so that removal causes bleeding.
- Local edema leads to visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea.
- If a large amount of toxin is absorbed, severe prostration, pallor, tachycardia, stupor, and coma may occur; toxemia may cause death within 6 to 10 days.
- Mild disease with a serosanguineous or purulent discharge and irritation of the external nares and upper lip occurs in patients who have only nasal diphtheria
- This is a variable dermatosis most often characterized by punched-out, non healing or enlarging skin ulcers, lesions with necrotic sloughing or pseudo membrane formation . The lesions rarely exceed 5 cm.
- The diagnosis requires cultivation of Corynebacterium diphtheria from lesions, which most commonly occur on the extremities.
Other Clinical Manifestations
Corynebacterium diphtheria causes rare cases of endocarditis and septic arthritis, most often in patients with preexisting risk factors such as cardiac valvular disease, injection drug use, or cirrhosis
The main complications of diphtheria are cardiac and neurologic.
- Myocarditisis usually evident by the 10th to 14th day.
- Nervous system toxicity:
- The toxin causes a demyelinating polyneuropathy that affects cranial and peripheral nerves. Peripheral neuropathy appears during the 3rd to 6th wk.
- The toxic effects usually begin during the 1st wk of illness with loss of ocular accommodation and bulbar palsy, causing dysphagia and nasal regurgitation.
- The diaphragm may become paralyzed, sometimes causing respiratory failure.
- Resolution occurs over many weeks.
Overall mortality is 3%; it is higher in those with any of the following:
- Delayed presentation
- Acute renal failure
- Age < 15 yr or > 40 yr
Gram stain and culture:
Gram stain of the membrane may reveal gram-positive bacilli with meta chromatic (beaded) staining in typical Chinese-character configuration. Material for culture should be obtained from below the membrane.
PCR testing for the diphtheria toxin gene can be done.
Swab or biopsy specimens should be cultured. Patients with cutaneous diphtheria may be co-infected with group A streptococci or Staphylococcus aureus.
ECG should be done to look for ST-T wave changes, QTc prolongation, and/or 1st-degree heart block related to myocarditis, which often becomes evident as the respiratory symptoms resolve.
- Patients in whom diphtheria is suspected should be hospitalized in respiratory isolation rooms, with close monitoring of cardiac and respiratory function.
- A cardiac workup is recommended to assess the possibility of myocarditis.
- In patients with extensive pseudomembranes, possibility that tracheostomy or intubation will be required.
- Amyl nitrosum: Catarrh and dysphagia (sequelae of a recent attack of diphteria) entirely relieved during the action of the drug, but returned after its effects had passed off.
- Apis Mel– remarkable remedy for diphtheria, first stage of diphtheria; may be given as a preventive, diphtheria insidiously progressing, small amount of pain accompanying intense and extensive inflammation; oedema of throat, uvula edematous and enlarged. Thirstlessness; breathing difficult from oedema of glottis; tonsils especially right sided, studded with deep, gray, angry-looking ulcerations.
- Arsenicum—Great anguish, extreme restlessness and fear of death. Fetid breath and viscid, foul discharge from the nostrils. Constant desire for cold drinks but can take only little. Great prostration, all worse about midnight.
- Belladonna: In forming stage. Great dryness of fauces; tonsil bright red and swollen. Very restless, feels drowsy, yet cannot sleep Congestion to head, with throbbing of carotids; eyes injected; delirium.
- Bromium – has done some wonderful work in diphtheria. The membrane first forms in the bronchi, trachea or larynx running upward .Complaints on the left side of the body. Membranous croup: great rattling of mucus but no expectoration. There seems to be great danger of suffocation from accumulation of mucus in the larynx.
- Capsicum annum: The throat it is of a deep red, purplish, color; dry, except in spots which are ulcerated. Use a good strong pepper tea for a gargle and give the 6th.
- Chin ars: It has acted just as favorably in malignant diphtheria.
- Crotolus Horridus– Malignant diphtheria or scarlatina; œdema or gangrene of the fauces or tonsils; pain worse from empty swallowing; if vomiting or diarrhœa come on blood oozes from nose and mouth, persistent hemorrhage; difficult swallowing, great thirst; excessive prostration; pulse small and weak.
- Diphtherinum: Diphtheritic membrane, thick, dark gray or brownish black; temperature low or sub-normal; pulse weak and rapid; extremities cold and marked debility; patient lies in a semi-stupid condition; eyes dull, besotted . Swallows without pain but, fluids are vomited or returned by the nose. Epistaxis or profound prostration from very onset of attack. Laryngeal diphtheria. Post-diphtheritic paralysis.
- Echinacea It gives greatest promise as a powerful antiseptic, both locally and internally, and will prove useful in diphtheria .Echinacea is the remedy for blood poisoning. It is indicated where there is a tendency to gangrenous state, with sloughing in the soft tissues. Its immediate effect upon fevers caused by the continual absorption of septic material, as in diphtheria, shows that its destructive influence begins upon the pernicious germs as soon as administered.
- Gelsemium – indicated in cases of diphtheric paralysis of pharynx.
- Kali bich: In diphtheria; many cases have been cured when there were profound prostration, lack of any acute, painful sensation, profuse perspiration, weak, soft pulse, some infiltration of cellular tissue and the tough tenacious exudation.
- Kali Mur– Diphtheria is accompanied with great prostration and there is characteristic glandular enlargement of the uvula and entire soft palate.
- Lac can– it changes sides starting on one side, frequently the left; the soreness and swelling suddenly shifts to the opposite side only to return in a few hours to the starting point. The membrane is yellow, grayish, curdy. If ulcer are formed, they like silver glass; paralysis of the throat so that the fluids return by the nose when drinking.
- Lachesis– the discharge from the nose is acrid, membranes of the throat are dark red or bluish. Swallowing of the saliva is painful.
- Lycopodium– Diphtheritic deposits on the right side of the throat and spreading to left side;Fauces brownish-red, or descends from the nose, desire for warm drinks which are grateful to the throat; tonsils, tongue, and fauces swollen, with spasm of swallowing.
- Merc bin iodatus– diphtheric and glandular affections of left side; fauces dark red; solids or liquids painful when swallowing; exudation slight; easily detached; cases attending epidemic scarlet fever, ulcers, on fauces or tonsils; glands enlarged; greenish tough lumps from pharynx or posterior nares.
- Merc cynatus– is of great value in that much dreaded disease
- malignant diphtheria, with intense redness of fauces and great difficulty of swallowing, diphtheria of the larynx and nose, pseudo-membranous formation extends all over fauces and down the throat putrid, gangrenous diphtheria, with phagedenic ulceration
- membranous croup, great weakness; extreme prostration, epistaxis in association with diphtheria .
- Merc proto-iodatus– diphtheric and throat affections where the cervical and parotid glands are enormously swollen; membrane begins on or is worse on right side; aggravation by warm drinks, and empty swallowing.
- Mercurius – diphtheria: tonsils inflamed, uvula swollen, elongated, constant desire to swallow; membrane thick, gray, shared like- borders adherent or free.
- Natrum muriaticum: For weak paralytic condition following fever and diphtheria. For conditions simulating diphtheria .
- Nitric acid– remarkable remedy for nasal diphtheria; offensive and watery discharge from nose; excoriates parts when touches; fauces and glands swollen; foetor oris; great prostration; difficult and pain full deglutition; white deposits in nares. “It has cured diphtheria where the splinter sensation was present,” and the other symptoms agreed.
- Phosphorus : Suddenness is a feature of Phos. Sudden prostration occur in diphteria, or any disease in which the system has sustained a profound shock
- Phytolacca: throat as if it were large empty cavern; feeling as if a hot ball were lodged in fauces, and sensation as after swallowing choke-pears; pains in head, back and limbs, great prostration and restlessness; soft palate and fauces highly inflamed and swollen, sore and sensitive.Fauces and tonsils highly inflamed and covered with darkcoloured pseudo-membrane. Excessive fetor of breath. Deglutition almost impossible. Great prostration. When rising up in bed, gets faint and dizzy.
- Sulphur : Local application of Sulphur to the throat has cured diphtheria.
- Tarantula cubensis: For malignant diphteria.
URINARY SYSTEM – Kidneys – Inflammation – from – scarlet fever, diphtheria
Apis , Ars. Canth Hell. 1 Hep. Merc-c. Rhus-t. Ter.
NERVOUS SYSTEM – Adynamia – From – diphtheria, stupor, cold limbs, low temperature, pulse rapid, weak
NERVOUS SYSTEM – Nerves, neuritis – Diphtheritic
GENERALITIES – Prophylactics – Diphtheria
Blood – SEPTICEMIA, blood poisoning – diphtheria, in
Constitutions – WEAK, constitutions – diphtheria, in
Diseases – CONVALESCENCE, ailments, during or since – diphtheria, after
Diseases – DIPHTHERIA, infection
APIS, ARS., BROM., KALI-BI.,KALI-CHL.,LAC-C.,LACH., LYC.,PHOS.,PHYT.,RHUS-T.
Diseases – PARAPLEGIA – diphtheria, after
Fevers – DIPHTHERIA, infection
ARS.,BROM., KALI-BI.,KALI-CHL., LAC-C.,LACH.,LYC., PHOS.,PHYT. ,RHUS-T.
Generals – WEAKNESS, sensation of being – diphtheria, in
LACH., MERC-CY., PHYT.
Glands – SWELLING, of glands – diphtheria, in
Glands – SWELLING, of glands – lymphatic, swelling – diphtheria
Heart – ENDOCARDITIS – diphtheria after
Kidneys – BRIGHT’S disease – diphtheria
Apis Merc-c. phyt.
Kidneys – NEPHRITIS, infection – diphtheria, from
Larynx – VOICE, general – hoarseness, voice – diphtheria, after
Nose – DIPHTHERIA, in
Am-c. Hydr. Kali-bi. Lyc. Petr.
Nose – NOSEBLEEDS, epistaxis – diphtheria, in
Carb-v. Chin. Crot-h. Hydr. Ign. Kali-chl. Lach. Merc-cy. Nit-ac
Throat – DIPHTHERIA, infection
APIS., ARS., KALI-BI., KALI-CHL., LAC-C., LACH., LYC., PHOS., PHYT., RHUS-T.
Throat – MEMBRANE, fauces, exudation
Throat – PARALYSIS – paralysis, pharynx – post diphtheritic
ARS., LAC-C., LACH., NAJA., SEC.
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