Diphtheria of the skin A36.3

Very rare notifiable (suspected disease, illness, death, pathogen detection) infection of the skin with Corynebacterium diphtheriae (can occur today as traveler's dermatosis). A distinction is made between:

• Wound diphtheria (pathogen entry on a pre-existing wound)
• primary skin diphtheria (entry of the pathogen via healthy skin)
• secondary skin diphtheria (autoinoculation of the skin in case of pre-existing diphtheria).

Penetration of the pathogen into small skin lesions by droplet or smear infection, also through infected material.

Wound diphtheria: Infection of a pre-existing wound results in the formation of a purulent wound covered with membranous coatings and an oedematous, strongly reddened area.

Primary skin diphtheria: Entry of the pathogen into the organism via the skin (heteroinoculation). Initially development of one (or more) small pustule or a haemorrhagic blister in swollen and highly red surrounding skin; with pronounced, usually strongly reddened collateral edema, rapid flat ulceration and development of a peripherally growing skin ulcer with grey-white, later also brown-black coatings.

Secondary skin diphtheria: Autoinoculation of the skin in pre-existing diphtheria with superficial membranous coatings on a discretely edematous environment.

S.a.o. ecthyma-like diphtheria, gangrenous diphtheria, impetiginous diphtheria, phlegmonous diphtheria and diphtheria, ulcerous form.

• Systemic antibiosis with penicillin: infants, children (e.g. megacillin dry juice) 3 times/day 1/4-3 ml. (1 measuring spoon per 5-6 kg KG). Adolescents, adults (e.g. penicillin film): 3 times/day 0.5-1.5 mega for 10 days (possibly higher doses see case history).
• For penicillin allergy erythromycin (e.g. erythro of ct dry juice): children up to 8th LJ: 30-50 mg/kg bw/day p.o. adolescents and adults: 1.5-2 g/day p.o. in 3-4 ED.

Favorable with appropriate therapy. With regard to toxin formation, it is unclear whether an antitoxin should be applied systemically. However, it appears that only very small amounts of toxin are absorbed in cutaneous infestations, so that systemic toxin effects (polyneuritis (A36.0), myocarditis (A36.8) ) do not occur. However, some authors advocate the early use of an antitoxin.

The 65 year old German holidaymaker (holiday resort Sri Lanka) developed a massive (erysipelas-like) painful swelling and reddening of the back of the forefoot after a 21-day beach holiday with the formation of several blisters and pustules, which developed into extensive ulcerations after a few days. "He stepped in something on the beach", but did not pay any further attention.

BSG: 70/95; CRP: 50.0 mg/dl (normal value < 0.5 mg/dl); neutophilic leukocytosis (leukocyte count 12,000 per ml), ASL: 511IU/ml.

Wound swab: C.diphtheriae mitis and group G streptococci

Therapy: Pencillin G 3 x 10 million IU/day i.v. + erythromycin 2x500mg/day p.o. over a period of 14 days.

Wound swab:

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