Case 5

Question 1

36-year-ild patient S. visited an internal medicine physician on April, 16 with complaints of sore throat when swallowing, fever up to 38.6 C, and moderate headache. Anamnestic data: the patient fell ill on April, 14, when the throat became sore, with an increase in the intensity over time. In the morning of April 15, when examining the oropharynx with the help of a mirror, the patient saw plaque on the tonsils. Rinsing with sodium chloride solution did not bring any improvement. In the morning of April, 16, the patient discovered swelling under the lower jaw on the right and went to a doctor. The doctor noted the patient’s condition of moderate severity, pallor of the face, pasty edema of the neck till its middle (the skin above the surface of the edema of the usual color), and enlarged and slightly tender submandibular lymph nodes on the right. Examination of the oropharynx revealed purplish-cyanotic coloration of the mucous membrane and severe swelling of the right tonsil, completely coated with dirty grey plaque, spreading to the soft palate, uvula, and right arch. With an attempt to remove the plaque with a spatula, the mucous membrane started bleeding. The patient did not have difficulty breathing, the voice was normal. Tachycardia was noted (100 beats per minute), blood pressure was 170 / 90 mm Hg. Task 1. State a clinical diagnosis.

Answer 1

toxic pharyngeal diphtheria, grade I, moderate severity.

Question 2

Provide a pathogenetic rationale for the clinical syndrome complex.
List the types and classification of diphtheria.

Answer 2

Diphtheria is caused by the bacteria Corynebacterium diphtheriae, which produces a toxin that can cause damage to the respiratory tract and other organs. The toxin prevents protein synthesis ie preventing communication between messenger RNA and transfer RNA and this will stop addition of amino acids. This can lead to the formation of a pseudomembrane in the throat, which can cause airway obstruction and difficulty breathing. In severe cases, the toxin can also affect the skin( chronic non healing ulcer), heart, kidneys, and nervous system., bacteriemia endocarditis, arthritis etc

Question 3

3. Make a differential diagnosis algorithm.

Answer 3

Differential diagnosis algorithm: Differential diagnosis should include other causes of sore throat and tonsillar exudate, such as streptococcal pharyngitis, acute tonsillitis, infectious mononucleosis, and oral candidiasis. Imaging studies, such as CT scan or ultrasound, may be necessary to confirm the presence of a pseudomembrane. Laboratory testing, such as PCR or bacterial culture, can confirm the presence of Corynebacterium diphtheriae.

Question 4

4. What are the principles of etiotropic therapy for this disease?

Answer 4

3. Principles of etiotropic therapy: The patient should be treated with

Diphtheria antitoxin DAT: dosage 80,000 to 120, 000 units
which can neutralize the diphtheria toxin and prevent further damage.

Antibiotics, such as penicillin 300,000 units at 12hrs
or erythromycin 500mg should also be administered to target the bacterial infection. Supportive care, such as oxygen therapy and mechanical ventilation, may be necessary for patients with severe airway obstruction. In addition, vaccination (DTap or Tdap) against diphtheria should be provided to prevent further spread of the disease. Close contacts of the patient should

Question 5

List and explain forms of Diphtheria and the grades

Answer 5

Localized form
Extended form
Toxic form