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QuotationMarkLeft.png Respiratory or cutaneous diphtheria is caused by toxigenic strains of C. diphtheriae and C. ulcerans, and, very rarely, C. pseudotuberculosis. C. diphtheriae is a non-sporing, nonencapsulated, and non-motile Gram positive bacillus (8). Four biovars of C. diphtheriae can be distinguished biochemically: gravis, intermedius, mitis, and belfanti (9). In the United Kingdom (UK), most infections in recent years have been caused by biovar mitis (around 80%) followed by biovar gravis (7). The clinical and public health management is identical for all toxigenic strains. QuotationMarkRight.pngPHE Diphtheria guidance.


Diphtheria has been virtually eradicated by immunisation in most developed countries. However, it should be considered in patients from areas with a poor public health infrastructure.


Diphtheria causes a sever sore throat, characterised by the formation of an adherent grey pseudomembrane on the back of the oropharynx. The pathogenesis is diphtheria toxin mediated. Inflammation of the upper airway can be so intense, it threatens to compromise the airway. Anaesthetic support and intubation may be required.

Diphtheria can also cause cardiac conduction defects due to cardiotoxic effects of the diphtheria toxin. ECG/cardiac monitoring is advisable.


A clinical diagnosis. ECG monitoring recommended.

Blood tests

There is no bacteraemia associated with Diphtheria infection, so blood cultures will not yield this pathogen, but where the diagnosis is not obvious, blood cultures should be taken in case the illness is not diphtheria.



ABC. Protect the airway. A specific diphtheria anti-toxin exists.




Immunisation against diphtheria is part of the UK routine childhood immunisation schedule. The vaccine is administered as DTPHib.


Statutorily notifiable

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