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Volume 3, Number 2—June 1997


Reply to P.D. Ellner

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EID Izurieta H, Strebel P, Youngblood T, Hollis D, Popovic T. Reply to P.D. Ellner. Emerg Infect Dis. 1997;3(2):242-243.
AMA Izurieta H, Strebel P, Youngblood T, et al. Reply to P.D. Ellner. Emerging Infectious Diseases. 1997;3(2):242-243. doi:10.3201/eid0302.970225.
APA Izurieta, H., Strebel, P., Youngblood, T., Hollis, D., & Popovic, T. (1997). Reply to P.D. Ellner. Emerging Infectious Diseases, 3(2), 242-243.

Reply to P.D. Ellner: We agree that diphtheria antitoxin should be administered promptly on the basis of a presumptive clinical diagnosis of respiratory diphtheria. Because laboratory confirmation may be delayed, the decision to treat with antitoxin and the dose of antitoxin must be based on the site and size of the diphtheritic membrane, the degree of toxicity, and the duration of illness (1,2). 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. From 1980 to 1995, only 41 cases were reported (zero to five cases in any given year) (3). With this low incidence, the likelihood that a patient with membranous pharyngitis has respiratory diphtheria is low. In addition, membranous pharyngitis could be associated with infections by other organisms such as streptococci, Epstein Barr virus, Candida albicans, Borrelia vincenti, Herpes simplex virus, Arcanobacterium hemoliticum, nontoxigenic Corynebacterium diphtheriae, and Corynebacterium pseudodiphtheriticum as in the case we reported (4-10).

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.

H.S. Izurieta*, P.M. Strebel*, T. Youngblood†, D.G. Hollis*, and T. Popovic*

Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Rogers Pediatric Clinic, Rogers, Arkansas


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  10. Izurieta HS, Youngblood T, Strebel PM, Hollis DG, Popovic T. Exudative pharyngitis possibly due to Corynebacterium pseudodiphtheriticum, a new challenge in the differential diagnosis of diphtheria: report of a case and review. Emerg Infect Dis. 1997;3:658. DOIPubMed
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DOI: 10.3201/eid0302.970225

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Table of Contents – Volume 3, Number 2—June 1997