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Specific Infections in Children
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Neal Russell, Sarah May Johnson, Andrew Chapman, Christian Harkensee, Sylvia Garry, Bhanu Williams
Diphtheria is a potentially fatal respiratory tract infection with high mortality, even when treated. It typically presents with an acutely unwell ‘toxic’ child. Corynebacterium diphtheriae is droplet spread and the associated endotoxin 62-kd polypeptide causes tissue necrosis. Cutaneous diphtheria occurs with non-toxigenic strains. The incubation period is 2–5 days.
Infections and infestations of nail unit
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Vineet Relhan, Vikrant Choubey
With the advent of immunization, cutaneous diphtheria is rarely encountered these days. However, cases have been reported in travelers to endemic areas.18 Typically, the disease begins as a pustule and then evolves into an ulcer varying in size from 0.5 cm to a few centimeters in diameter that is covered with a pseudo-membrane that bleeds on removal and has erythematous edges. Within 1–3 weeks, the false membrane turns into a blackish scab and rapidly falls off, leaving behind a residual ulcer that gradually heals with an atrophic scar. Cutaneous diphtheria most often appears on areas afflicted by preexisting dermatological conditions such as traumatic wounds, burns, insect bites, and infection. The commonly involved sites are lower and upper limbs. Differential diagnosis includes impetigo and ecthyma.
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Erysipelas is the main differential diagnosis. Seal finger is a mycoplasma infection seen in aquarium workers, veterinarians, and professionals working with seals; it is more painful than erysipeloid, but the erythema is less pronounced.81–84 Histopathology reveals perivascular infiltration with lymphocytes and plasma cells in the subcutaneous adipose tissue, and a few granulocytes without pus or necrosis. Fibrosis eventually takes place.85 Involved joints demonstrate a severe inflammatory reaction with chronic granulation tissue and scarring with destruction of the articular cartilage.86Vibrio vulnificus infection is commonly more acute and characterized by rapid spread of the infection with progressive necrosis of the tendon sheath, subcutaneous tissues, and the skin.87 A case of cutaneous diphtheria clinically similar to blistering erysipeloid involved the right fourth toe in a 50-year-old woman; the infection by nontoxin producing Corynebacterium diphtheriae was acquired in South Asia.88 Leishmaniasis of the finger was seen to resemble erysipeloid.89 Subacute parathion intoxication caused a red finger like in erysipeloid.90
Clinical profile and risk factors for mortality in children admitted with diphtheria: an observational study
Published in Infectious Diseases, 2023
Vishnu Mohan, Venkatesh Chandrasekaran, Sujatha Sistla
A vast majority of the study population (95%) were having faucial diphtheria, while 5% presented with laryngeal diphtheria. No cases of cutaneous diphtheria/atypical diphtheria were noted. Fever was the most predominant symptom (97%) followed by sore throat (83%), dysphagia (74.1%), salivary drooling (13.5%), respiratory distress (13.8%), and stridor (12.1%). Our findings are consistent with that of Dash et al. who reported fever (97%), dysphagia (81%) and sore throat (67%) as most predominant in the study population [5]. Maheriya et al. similarly reported that fever (70%) predominates in all cases presenting with diphtheria [10]. The median duration of symptoms before hospitalisation was found to be 4 days (IQR 2–5). The presence of a classical diphtheritic pseudo membrane was noted in all patients (100%). A total of 23 children (39.6%) presented with a typical bull neck.