Diphtheria Clinical Features Respiratory diphtheria presents as a sore throat with low-grade fever and an adherent membrane of the tonsils, pharynx, or nose. Neck swelling is usually present in severe disease. Cutaneous diphtheria presents as infected skin lesions which lack a characteristic appearance. Etiologic Agent Toxin-producing strains of Corynebacterium diphtheriae.
Diphtheria remains endemic in developing countries.
Complications and deaths are much less frequent in cutaneous diphtheria. Cutaneous lesions are important in transmission. In the pre-vaccine era, children were at highest risk for respiratory diphtheria. Recently, diphtheria has primarily affected adults in the sporadic cases reported in the U.S. and in the large outbreaks in Russia and New Independent States of the Former Soviet Union. An asymptomatic carrier state exists even among immune individuals.