The presence of a thick grayish white adherent pseudomembrane, adenopathy and cervical swelling, and low grade fever should certainly provoke a high index of suspicion of diptheria, especially in a child who has not received pediatric immunization. The diagnosis of diptheria is primarily made presumptively on clinical grounds and confirmed by the recovery of toxigenic Corynebacterium diphtheriae by the laboratory.
Respiratory diphtheria is rare in the United States.
With this low incidence, the likelihood that a patient with membranous pharyngitis has res-piratory diphtheria is low. The diagnosis and clinical management of exudative pharyngitis with a pseudomembrane in a country where diphtheria is extremely rare represent a dilemma for the practitioner. In weighing the benefits and risks of diphtheria antitoxin treatment, it is prudent to err on the side of using antitoxin. American Academy of Pediatrics. Virtual elimination of respiratory diphtheria in the United States.