The Diagnosis of Diphtheria Today

Easton, Herbert Gordon (1954) The Diagnosis of Diphtheria Today. MD thesis, University of Glasgow.

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SECTION I. (1) It is concluded that while the unprecedented extent of the recent decline in the incidence of diphtheria is attributable to large-scale prophylactic inoculation, the decline in the severity of the disease, which continued over many years but has not been well-marked since the introduction of mass inoculation, must be mainly attributed to other factors - such as improvement in the hygienic and nutritional state of the community, more early diagnosis (and thus more effective treatment), and more accurate diagnosis (the result of the realisation that diphtheria may occur in clinically atypical forms, and of the availability of bacteriological facilities for the diagnosis of such cases). (2) A series of cases of diphtheria occurring during the year 1947-48 is described and compared with two other series, the others consisting of cases occurring during the years 1942 and 1951 respectively. In spite of the very marked decline in the incidence of diphtheria which took place between 1942 and 1951, the features of the disease were much the same in each of the three series. (3) With regard to the comparative characteristics of diphtheria in inoculated and uninoculated subjects, it was found that the typical membrane of the disease occurred slightly more frequently in the 'inoculated' group of cases than in the 'uninoculated', but that in the former group the patients were more often admitted to hospital relatively early in their illness, the membrane was much less often extensive,/ extensive, and toxic complications were very much less frequent. (4) Attention is directed to certain factors which have been shown to, or might be thought to, play a part in determining whether an individual infected with C. diphtheriae will develop symptoms or not and, if so, whether the diagnosis of diphtheria will be made or not. With regard to 'atypical' attacks of diphtheria (without the formation of the typical membrane of the disease, but with signs of follicular or catarrhal tonsillitis or pharyngitis), it is suggested that it is virtually impossible to determine the true incidence of such attacks, but that it is probably not so that, as is sometimes implied, they seldom occur except in previously inoculated subjects (and in those who have had previous attacks of diphtheria). In fact, in the present series of cases it was found, as stated above, that typical membrane formation occurred more frequently in the inoculated than in the uninoculated, and that atypical attacks were correspondingly less frequent in the former group. Further, regarding the total suspected-diphtheria admissions with signs of follicular or catarrhal tonsillitis, the diagnosis was confirmed in only half as many of the cases with a history of inoculation as of those without. (5) It is pointed out that it is often impossible to differentiate, with any reasonable degree of assurance, between atypical diphtheria (with signs of, for example, follicular tonsillitis) and other disease occurring in a/ a carrier. While consideration of the epidemiological circumstances may assist in the diagnosis, the shick test is only of limited value. The difficulties which may arise in the treatment of such cases are briefly referred to: while toxic complications are most unlikely to occur, that possibility cannot be entirely dismissed. (6) The factors which are of importance in the diagnosis of diphtheria are considered in detail (they are summarised on p. 200 ff.). it is concluded that the criteria laid down in such classic accounts as those of Bretonneau and Ker are still, to a large extent, valid. in applying these criteria in present-day circumstances, however, it is necessary to bear in mind, first, that it is now realised that diphtheria may occur relatively commonly in clinically atypical forms, and, second, the implications of the recent extraordinary decline in the incidence of the disease. (7) The following conclusions were formed regarding the cases in which the diagnosis of diphtheria was not confirmed (a) Streptococcal tonsillitis was the condition most frequently mistaken for diphtheria. (b) Infection with staphlococci, or with certain of the other common aerobic organisms, is probably not a frequent cause of tonsillitis. (c) Vincent's organisms were present in large numbers in a considerable proportion of both the diphtheria and other cases. The significance of this bacteriological/ bacteriological finding is discussed in some detail. It is stressed that the finding does not indicate that the presence of some other disease, for example, diphtheria or streptococcal tonsillitis, is any the less likely. (d) The possibility is entertained that infection with a non-virulent strain of C. diphtheriae may be capable of causing tonsillitis. There is no evidence to show that this infection can cause diphtheria. (e) Of the other diseases which may simulate diphtheria, glandular fever, tuberculosis, and syphilis are briefly considered. Although this was not so of the case of glandular fever encountered in the series, that disease may mimic diphtheria particularly closely. (Abstract shortened by ProQuest.).

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1954
Depositing User: Enlighten Team
Unique ID: glathesis:1954-78949
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09

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