From the Guidelines
Diphtheria and membranous tonsillopharyngitis are distinct conditions with different etiologies, presentations, and management strategies, and it is crucial to differentiate between them to provide appropriate treatment and prevent complications. The key differences between the two conditions lie in their causative agents, clinical manifestations, and potential for systemic complications. Diphtheria is specifically caused by Corynebacterium diphtheriae, which produces a potent exotoxin that can lead to severe systemic complications, including myocarditis, peripheral neuropathy, and respiratory failure 1. In contrast, membranous tonsillopharyngitis is typically caused by viral infections, such as Epstein-Barr virus, or bacterial infections like Group A Streptococcus.
Etiology and Presentation
The membrane in diphtheria is characteristically thick, gray, adherent, and bleeds when removed, extending beyond the tonsils to other parts of the pharynx 1. In contrast, the membrane in tonsillopharyngitis is usually confined to the tonsils, less adherent, and doesn't typically bleed when removed. Diphtheria requires immediate treatment with diphtheria antitoxin and antibiotics, along with respiratory support if needed, whereas membranous tonsillopharyngitis is treated based on the causative agent, with antibiotics for bacterial causes and supportive care for viral causes.
Management and Prevention
Diphtheria is preventable through vaccination with diphtheria toxoid-containing vaccines, such as DTaP/Tdap 1. In contrast, there is no specific vaccine for most causes of tonsillopharyngitis. Diphtheria is a notifiable disease that requires public health intervention, including contact tracing and prophylaxis. The most recent and highest quality study recommends that adults receive a diphtheria-toxoid–containing vaccine every 10 years after completing a primary childhood vaccination series 1.
Key Differences
Some key points to consider when differentiating between diphtheria and membranous tonsillopharyngitis include:
- Causative agent: Corynebacterium diphtheriae vs. viral or bacterial agents
- Clinical presentation: Thick, gray, adherent membrane in diphtheria vs. less adherent membrane in tonsillopharyngitis
- Systemic complications: Diphtheria can cause myocarditis, peripheral neuropathy, and respiratory failure, whereas tonsillopharyngitis typically does not
- Treatment: Diphtheria requires immediate treatment with diphtheria antitoxin and antibiotics, whereas tonsillopharyngitis is treated based on the causative agent
- Prevention: Diphtheria is preventable through vaccination, whereas there is no specific vaccine for most causes of tonsillopharyngitis.
From the Research
Difference between Membranous Tonsilopharyngitis and Diphtheria
- Membranous tonsilopharyngitis is characterized by the formation of a membrane in the throat, similar to diphtheria, but the causes and clinical manifestations may differ.
- Diphtheria is a potentially fatal infection caused by toxigenic Corynebacterium diphtheriae strains, characterized by the formation of a pseudomembrane in the throat, and can lead to systemic effects such as myocarditis and neuropathy 2.
- In contrast, membranous tonsilopharyngitis may be caused by various factors, including viral or bacterial infections, and may not always be associated with systemic effects.
Clinical Diagnosis and Treatment
- Clinical diagnosis of diphtheria is confirmed by the isolation and identification of the causative Corynebacterium spp., usually by bacterial culture followed by enzymatic and toxin detection tests 2.
- Treatment of diphtheria involves the timely administration of diphtheria antitoxin and antimicrobial therapy, while membranous tonsilopharyngitis may be treated with antibiotics or other medications depending on the underlying cause.
- Vaccination against diphtheria is effective in preventing the disease, but may not provide complete protection against membranous tonsilopharyngitis 3.
Differential Diagnosis
- Differential diagnosis between diphtheria and tonsillitis, including membranous tonsilopharyngitis, is crucial to ensure proper treatment and management of the disease 4.
- A profound analysis of hemogram with calculations of special parameters and variants of ESR/leukocyte count ratio may be helpful in distinguishing between these diseases 4.