Diphtheria Polyneuritis

Diphtheria polyneuritis is a neuromuscular condition that is caused by the bacteria Corynebacterium diphtheriae. It classically causes pharyngitis followed by descending weakness that starts with bulbar weakness and progresses to involve the limbs.

Clinical features:

  • Corynebacterium diphtheriae infection: this causes pseudomembrane of the pharynx/tonsils, URI, sore throat
  • Then at 1-2 weeks pharyngeal & laryngeal paralysis, then loss of accommodation (preserved light reflex), VII, IX, X paralysis
  • Then 5-8 weeks descending motor>sensory neuropathy of arms then legs. May also mimic Guillain-Barre Syndrome
  • Respiratory failure can occur
  • Myocarditis can occur
  • Culture may confirm the diagnosis

Findings on investigations:

CSF analysis:

  • Increased protein: 50-200 mg/dL
  • Pleocytosis: may be absent

Pathology:

  • Segmental demyelination of spinal nerve roots
  • No inflammation

Treatment:

  • Ventilatory support if necessary
  • Antitoxin, even before culture results are known
  • Antibiotics for 2 weeks e.g. Penicillin or erythromycin to eradicate infection

Prevention:

  • Diphtheria vaccine

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