Diagnosis and treatment protocols for Diphtheria in Uganda

Clinical Features

Pseudomembranous tonsillitis (grey, tough, sticky membranes) with dysphagia and cervical adenitis. May progress to massive neck swelling ("bull neck"). Airway obstruction when infection extends to nasal passages, larynx, trachea, bronchi. Low-grade fever. Toxin effects: cardiac dysfunction (myocarditis, heart failure), neuropathies (swallowing, vision, breathing, ambulation) 1–3 months after onset. Renal failure.

Investigations

Culture of throat/nasopharyngeal swab for Corynebacterium diphtheriae. Toxin detection.

Antitoxin (HC4)

Diphtheria Antitoxin (DAT) 20,000–100,000 IU IV depending on severity and duration of illness. Give as soon as diagnosis is suspected — do not wait for culture results. Test for hypersensitivity before use.

Antibiotics — Initial (HC4)

Benzylpenicillin 600,000 IU IM 12-hourly until patient can swallow. Child: Procaine benzylpenicillin 50,000 IU/kg per day IM once daily until patient can swallow.

Antibiotics — When Able to Swallow

Penicillin V 250 mg every 6 hours to complete 14 days total. Child 1–6 years: 125 mg 6-hourly. Child <1 year: 12.5 mg/kg every 6 hours.

Penicillin Allergy

Erythromycin 500 mg every 6 hours for 14 days. Child: 50 mg/kg every 6 hours.

Isolation & Contact Management

Isolate patient. Monitor close contacts for 7 days. Prophylactic antibiotics for contacts: Single dose Benzathine Penicillin IM (child <10 years: 600,000 IU; child >10 years and adults: 1.2 MIU). Verify immunisation status of contacts and complete or boost if needed.

Prevention

Immunise all children during routine childhood immunisation (DPT schedule).