Here you see certain signs and symptoms when we assess the throat and the nose of a patient.
Now, on the top left, you'll see the throat is pretty mild.
You do see some exudative tonsils.
And this is what a throat can look like with strep throat
or mononucleosis or even in some patients with thrush.
So you really wanna have diphtheria on your differential.
I have seen patients with throats that look similar to the one on the top left.
And I've attempted to scrape away at this and it does scrape away, so it's not been diphtheria.
But you always wanna keep that on your differential.
The next picture over, you can see there's almost a complete obstruction by the pseudomembrane.
You can see down that it's progressed on the top right picture down toward the trachea and the voice box.
And you could see on the bottom picture that they're spread into the nose and all over the nasal turbinates.
Signs and symptoms. Your patients can have fever, chills and fatigue.
They're going to have a sore throat. They may have hoarseness.
And remember, this involves the bacteria settling on to the larynx.
The patient can cough and they're gonna have difficult and painful swallowing.
The patient can also develop difficulty breathing, and this is due to the pseudomembrane
and the localized inflammation.
The patient will have lymphadenopathy and this is pronounced.
You're gonna do a full lymph exam.
When you look in the throat or in the nose, you're gonna see this gray pseudomembrane.
The patient may have signs and symptoms of Croup.
And remember, this is just a tightened airway.
They may have a barking cough and stridor due to their decreased airway size.
This can also present on the skin.
And the patient can have skin ulcers that are gonna be covered by a gray membrane.
Here you can see on exam. You wanna obtain a complete medical history of your patient
and this is really important to ask about their vaccination status.
Have they received their DT, their DTaP, their TD, or their TDaP vaccines?
And when did they receive these? Because we know that this protection will wane.
On physical exam, you're going to assess your patient's vital signs.
You're also going to do a full head, eyes, ears, nose and throat exam.
You're gonna do a cardiac exam.
Do a respiratory exam and examine their skin.
Here, we see a lesion on a patient with diphtheria.
So there are ways to diagnose this clinically and via lab criteria.
Regarding the clinical criteria, you're gonna look for a patient
with an upper respiratory tract illness and having a sore throat.
But remember, this is a lot of other things too.
Your patient may have a cold. They may have strep throat.
They may have other viral causes of sore throat. They may have mono.
So this is just step one. Your patients can also have a low-grade fever.
A high fever is rare with diphtheria. This is the key. This is the difference on exam.
You look in the throat and you're gonna see an adherent, dense gray pseudomembrane,
and this is atypical, covering the posterior aspect of the pharynx.
We don't see this in any of the common conditions. We only see this with diphtheria.
So, lab criteria. You can isolate the bacteria from a gram stain or a throat culture.
But remember, a gram stain, you can get this information pretty quickly.
But a throat culture is going to take 48 to 72 hours.
You can also do a wound culture from a patient's skin on their ulcer.