**Diphtheria Checklist**

**It will be useful to review the list of symptoms and signs and other
factors that may be considered when determining probability (high or
low) of diphtheria and need for diphtheria antitoxin.**

  ------------ ------------------------------------------------------ --------
               Symptom or event                                       Yes/No

  Suspect case Pharyngitis or nasopharyngitis or tonsillitis or       
               laryngitis or combination , absent or low-grade fever  
               ([\<]{.underline}103°F)                                

               Grayish adherent pseudo-membrane present               

               Membrane bleeds, if manipulated or dislodged           

                                                                      

  Probable     Suspect case above + 1 or more of the following        
  case                                                                

               \- Stridor or change in voice                          

               \- Bull-neck (cervical edema)                          

               \- Toxic circulatory collapse                          

               \- Acute renal insufficiency                           

               \- Sub-mucosal or sub-cutaneous petechial hemorrhage   

               \- Myocarditis                                         

               \- Death                                               

                                                                      

               Recently returned (\<2 weeks) from travel to area with 
               endemic diphtheria?                                    

               Recent contact (\<2 weeks) with confirmed diphtheria   
               case or carrier?                                       

               Recent contact (\<2 weeks) with visitor from area with 
               endemic diphtheria?                                    

               Recent contact with dairy or farm animals? Domestic    
               pets?                                                  

               Immunization status: Up-to-date - any DTaP/DT/Tdap/Td  
               shot within past 10 years?                             

                                                                      

  Laboratory   Culture of *C. diphtheriae or C. ulcerans* AND         
  Confirmed                                                           
  case                                                                

               \- Positive Elek Test OR                               

               \- PCR for *tox* gene (Positive for subunit A and B)   
               OR                                                     

               \- 4-fold rise in serum anti-diphtheria IgG antibody   
               levels between acute and convalescent stage of         
               illness.                                               

                                                                      
  ------------ ------------------------------------------------------ --------

**What other disease agents may be considered in the differential
diagnosis of respiratory diphtheria?**

Respiratory diphtheria is an uncommon disease in the US. Respiratory
diphtheria may be caused by toxigenic strains of *Corynebacteriul
diphtheriae*, uncommonly *C. ulcerans*, *C. pseudodiphthericum*.
Non-toxigenic strains of C. diphtheria may also be associated with
respiratory diphtheria.

Other disease agents which result in membranous pharyngitis include:

1.  Group A β-hemolytic *Streptococcus*

2.  *Staphylococcus aureus*

3.  *Arcanobacter hemolyticum*

4.  *Candida albicans*

5.  *Borellia vincenti (*Vincent's angina)

6.  *H. influenzae (acute epiglottitis*

7.  Viruses -- EBV (Infectious mononucleosis), adenovirus, *Herpes
    simplex*,

8.  Other agents - *Toxoplasma*

Use of some anti-neoplastic agents may also result in formation of a
pharyngeal membrane e.g., methotrexate.