Diphtheria or Streptococcal Pharyngitis: A Case Report Highlighting the Diagnostic Dilemma in the Post-vaccination Era

Abstract

Diphtheria is an acute, highly infectious, toxigenic, and vaccine-preventable disease that commonly affects children under 12 years of age. The incidences of diphtheria have significantly dropped due to vaccination with diphtheria, pertussis, tetani (DPT). Recently, there is an increasing trend in reports of diphtheria throughout the world and specifically from developing countries. According to a World Health Organization (WHO) report, more than 80% of the global diphtheria cases in the post-vaccination era were from India and Indonesia. This could probably be signaling its re-emergence, which may be attributed to several factors that include incomplete immunization. Pharyngitis caused by group A Streptococcus is most frequently seen in children and can be clinically similar in presentation to diphtheria. We share our experience of managing a case of an eight-year-old child, who was clinically suspected to be suffering from diphtheria.

Impact of a three-dose diphtheria outbreak response immunization in East Java, Indonesia, 6 months after completion

“…Many differential diagnoses are based on the presence of a white membrane, such as other types of bacterial tonsillitis, fungal infections, herpetic ulcer, infectious mononucleosis, and post tonsillectomy condition. 1,2,[32][33][34][35] Usually, there were no significant fluctuations in the number of diphtheria cases except for January until March 2018,. when the number of reported cases increased after the Ministry of Health declared a national diphtheria outbreak in December 2017. This was, possibly, the result of mass publicity and societal panic.…”

“…Many differential diagnoses are based on the presence of a white membrane, such as other types of bacterial tonsillitis, fungal infections, herpetic ulcer, infectious mononucleosis, and post tonsillectomy condition. 1 , 2 , 32 33 34 – 35 …”

Diphtheria Outbreak among Children in 2017–2018: a Single Centre Study in Indonesia

“…Most diphtheria patients feel pain when swallowing. [27][28][29] Sore throat, runny nose, hoarseness, shortness of breath, chest pain, palpitations, nausea, and vomiting are rarely found in cases of diphtheria. In contrast to a study in Andhra Pradesh, India Meera, most diphtheria patients experience sore throat, runny nose, nausea, and vomiting.…”

Дифтерія Потребує Уваги: Сучасний Стан Проблеми Та Власне Спостереження

“…В країнах з найбільшою кількістю випадків 66 % хворих були невакцинованими, 63 % -це діти молодше 15 років [3]. Понад 80 % випадків дифтерії реєструються в Індії та Індонезії [4]. Під час спалаху на острові Ява загальний рівень смертності сягав 28 % [5].…”