How does neurologic toxicity manifest in diphtheria?

Updated: Jan 18, 2019
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Neurologic toxicity is proportional to the severity of the pharyngeal infection. Most patients with severe disease develop neuropathy. Deficits include the following:

  • Cranial nerve deficits including oculomotor, ciliary paralysis, facial, and pharyngeal, or laryngeal nervous dysfunction.

  • Occasionally, a stocking and glove peripheral sensory neuropathy pattern can be observed.

  • Most C diphtheriae associated neurologic dysfunction eventually resolves.

  • Peripheral neuritis develops anywhere from 10 days to 3 months after the onset of pharyngeal disease. It manifests initially as a motor defect of the proximal muscle groups in the extremities extending distally. Various degrees of dysfunction exist, ranging from diminished DTRs to paralysis. [21]

  • Other systems involvement: Diphtheria is occasionally seen in the female genital tract, conjunctivae, or ear.

  • Invasive disease may manifest in multiple organ system disease, though this is rare. [1, 3]

  • Cutaneous diphtheria begins as a painful lesion resembling an erythematous pustule, which breaks down to form an ulcer covered with a gray membrane. [4, 17]

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