obsolete nasopharyngeal diphtheria

Nasopharyngeal Diphtheria: A Rare and Obsolete Condition

Nasopharyngeal diphtheria is a rare and obsolete form of diphtheria that affects the nasal passages and upper airways. It is caused by the bacterium Corynebacterium diphtheriae, which produces a toxin that can cause inflammation and damage to the mucous membranes.

Symptoms

The symptoms of nasopharyngeal diphtheria typically include:

• Unilateral or bilateral serosanguinous discharge from the nose
• Excoriations (abrasions) on the upper lip
• Sore throat and difficulty swallowing

These symptoms are often accompanied by a high fever, which can range from 102°F to 104°F.

Causes

Nasopharyngeal diphtheria is caused by the bacterium Corynebacterium diphtheriae, which is highly contagious. The bacteria can be spread through respiratory droplets, contaminated food and water, or direct contact with an infected person.

Prevention

Fortunately, nasopharyngeal diphtheria is a rare condition in high-income countries due to widespread vaccination against diphtheria. However, it remains endemic in many low- and middle-income countries where vaccine coverage may be limited.

References

• [2] Clinical descriptions of diphtheria appeared in Hippocratic writings, but the illness was not clearly differentiated from other upper respiratory disease until clinician-pathologist Pierre Bretonneau first described its unique clinical characteristics.
• [4] The prevalence of toxigenic diphtheria syndromes has dropped since the introduction of the diphtheria toxoid vaccine, widely implemented in the United States in the 1940s.

Symptoms of Anterior Nasal Diphtheria

Anterior nasal diphtheria, also known as nasopharyngeal diphtheria, is a rare form of the disease. The symptoms can be mild and similar to those of the common cold.

• Mild or chronic unilateral mucopurulent to serosanguinous nasal discharge: This is one of the earliest signs of anterior nasal diphtheria (1).
• Excoriations: These are skin irritations that can occur due to the infection (4).
• Malaise, sore throat, anorexia, and low-grade fever: These symptoms can be present in the early stages of the disease (2).

Comparison with Common Cold

The onset of anterior nasal diphtheria is often indistinguishable from that of the common cold. The symptoms may appear as mild or chronic unilateral mucopurulent to serosanguinous nasal discharge, making it difficult to diagnose (3).

Note: Anterior nasal diphtheria is a rare form of the disease and its symptoms can be similar to those of other conditions.

References: [1] - Symptoms include fever, hoarseness, and a barking cough. The membrane can lead to airway obstruction, coma, and death. Anterior Nasal Diphtheria. [2] - Onset is gradual and early symptoms include: malaise, sore throat, anorexia, and low-grade fever. [3] - The onset of anterior nasal diphtheria is indistinguishable from that of the common cold and is usually characterized by a mucopurulent nasal discharge ( ... [4] - Anterior nasal diphtheria may appear as mild or chronic unilateral mucopurulent to serosanguinous nasal discharge and excoriations. Onset of symptoms often ...

Based on the provided context, it appears that there are several diagnostic tests for nasopharyngeal diphtheria, but some of them have become obsolete.

The Schick test, which was once used to diagnose diphtheria, is now considered obsolete [6]. This test involved injecting intradermal diphtheria toxin and observing the reaction. However, with advancements in technology, this test is no longer recommended for diagnosis.

On the other hand, the Elek test, also known as the immunodiffusion technique for virulence, is still considered a reliable method for confirming diphtheria [2]. This test involves detecting the presence of diphtheria toxin and is often used in conjunction with bacteriological culture and toxigenicity testing.

In addition to these tests, rapid diagnosis can be achieved through IFA staining of a 4-hour culture or PCR (Polymerase Chain Reaction) testing [9].

It's worth noting that laboratory diagnosis of diphtheria typically involves a combination of clinical presentation, history, and laboratory testing. A clinical suspicion of diphtheria should be raised by a presentation consistent with the disease, and bacteriological culture and toxigenicity testing are essential for confirming the diagnosis [7][8].

References: [2] - The Elek test is recommended as the “gold standard” in diphtheria diagnostics. [6] - The Schick test is considered obsolete now. [7] - Diagnosis is usually based on history, clinical presentation and laboratory testing. [8] - Bacteriological culture and toxigenicity testing of the resulting isolate are essential for confirming diphtheria. [9] - Rapid diagnosis is possible if the lab has IFA staining of a 4-hour culture.

Treatment of Obsolete Nasopharyngeal Diphtheria

Nasopharyngeal diphtheria, also known as anterior nasal diphtheria, is a rare form of the disease that affects the mucous membranes of the nose. The treatment for this condition has evolved over time.

• Historical Treatment: In the past, diphtheria antitoxin (DAT) was used to treat nasopharyngeal diphtheria. However, with the advancement in medical science and the availability of more effective treatments, the use of DAT has become obsolete.
• Current Treatment: The current treatment for nasopharyngeal diphtheria focuses on supportive care, which includes:
  • Antibiotics to manage secondary bacterial infections
  • Symptomatic relief measures such as nasal decongestants and saline irrigations
  • Rest and hydration to help the body recover from the infection

It's essential to note that nasopharyngeal diphtheria is a rare condition, and most cases are self-limiting. However, if you suspect someone has this condition,

The differential diagnosis for obsolete nasopharyngeal diphtheria, also known as anterior nasal diphtheria, includes several conditions that can cause similar symptoms. These include:

• Other Corynebacterium species: These bacteria can cause infections in the respiratory tract and may present with symptoms similar to those of nasopharyngeal diphtheria.
• Streptococcal pharyngitis: This bacterial infection can cause inflammation of the throat and may be mistaken for nasopharyngeal diphtheria.
• Viral tonsillopharyngitis: Certain viral infections, such as the common cold or flu, can cause symptoms similar to those of nasopharyngeal diphtheria.
• Vincent's angina: This is a rare but serious bacterial infection that can cause inflammation of the throat and may be mistaken for nasopharyngeal diphtheria.

It's worth noting that the distinctive feature of nasopharyngeal diphtheria is the presence of a pseudomembrane, although this may be missing or patchy in some patients with early disease. However, this symptom can also be present in other conditions, making differential diagnosis challenging.

According to [11], anterior nasal diphtheria as the only manifestation is uncommon (about 2% of cases), and the differential diagnosis of respiratory diphtheria includes infection with other pathogens that can cause similar symptoms.

In addition, [15] states that the distinctive feature of diphtheria is the pseudomembrane, although this may be missing or patchy in some patients with early diphtheria. This suggests that a thorough examination and laboratory tests are necessary to confirm the diagnosis of nasopharyngeal diphtheria.

References: [11] - The differential diagnosis includes infection with other pathogens that can cause similar symptoms including: other Corynebacterium species, [12] - C diphtheria is responsible for both endemic and epidemic diseases, and it was first described in the 5th century BC by Hippocrates.