Indian Pediatrics 2002; 39:311-312  

A Case of Cutaneous and Pharyngeal Diphtheria

Diphtheria continues to be a resurgent infection in spite of mass immunization in many developing countries, resulting in significant morbidity and mortality(1).

We report a case of pharyngeal and cutaneous diphtheria in a 15-year-old boy. The patient presented with a history of fever, sore throat, nasal obstruction, and difficulty in breathing since 5 days and ulcer on the median side of right foot since 4 weeks. On examination, the tonsils were enlarged. The posterior pharyngeal wall and epiglottis were covered with gray white membrane, which bled on touch. Neck movements were restricted and lymph nodes in the posterior triangle and deep cervical nodes were palpable. The foot ulcer was also covered with a brownish membrane and inguinal nodes were palpable. The membranes from the throat and ulcer were sent for Albert’s staining, culture and sensitivity.

Albert’s stain of membranes from throat and ulcer revealed green slender bacilli with metachromatic granules arranged in cuneiform pattern.

Culture on blood agar, Loeffler’s serum slope, and tellurite blood agar grew Corynebacterium diphtheriae, which was confirmed biochemically as Corynebacterium diphtheriae var mitis. Both isolates were found to be producing toxin when tested by Elek’s gel precipitation test. Both the isolates had similar sensitivity pattern being sensitive to ampicillin, pencillin, ciprofloxacin, ceftri-axone, and amoxyclav and resistant to erythromycin and cefaperazone.

Patient had an uneventful recovery after being treated with single dose of 1,00,000 units antidiphtheritic serum (ADS), injection crystalline penicillin 10 lakh units 6 hourly and gentamicin 80 mg 12 hourly for 10 days.

Due to mass immunization programs, the reported annual incidence of diphtheria in India was 2725 in 1999(3). Though many centers in our country report pharyngeal diphtheria(3), the incidence of both pharyngeal and cutaneous diphtheria in an older child is indeed a rare occurrence in our country. Therefore, the increased incidence of diphtheria in older children only emphasizes the need to improve and strengthen the childhood immunization program coverage.

Shalini Shenoy,
Prashanth H.V.,
Godwin Wilson,
Department of Microbiology,
Kasturba Medical College,
Light House Hill Road,
Mangalore 575 001, India.
E-mail: [email protected]

1. Havaldar PV. Diphtheria in the Eighties: Experience in a South Indian district hospital. J Indian Med Assoc 1992; 90: 155-156.

2. Annual Report 1999-2000. Ministry of Health and Family Welfare, Government of India, New Delhi.

3. Singhal T, Lodha R, Kapil A, Jain Y, Kabra SK. Diphtheria down but not out. Indian Pediatr 2000; 37: 728-736.