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Tracheobronchial diphtheria — Clinical Guidelines

Overview

Tracheobronchial diphtheria is an invasive infection caused by Corynebacterium diphtheriae, primarily affecting the respiratory tract, leading to severe airway obstruction and systemic complications. 4 6

Diagnosis

Clinical Presentation: Acute necrotic tonsillitis, throat phlegmon, and respiratory distress. 4

Laboratory Tests: Throat swab culture for Corynebacterium diphtheriae; serological testing for anti-diphtheria antibodies. 4

Immunity Assessment: Serological testing for antitoxin levels to assess immune status. 4 9

Management

Antibiotics: Penicillin or erythromycin for treating the infection. 4 6

Airway Management: Emergency surgical intervention or palliative airway stenting under radiological guidance for severe airway obstruction. 4 5

Supportive Care: Oxygen therapy, fluid management, and monitoring for systemic complications. 4

Special Populations

Immune Status: Susceptibility in individuals with no protective immunity, as seen in unvaccinated or inadequately vaccinated adults. 4 9

Pediatrics: Potential for fulminant endocarditis, as evidenced by a case in an 11-year-old boy. 11

Key Recommendations

Vaccination: Ensure adequate diphtheria vaccination to prevent infection and maintain protective antibody levels in adults and children. (Evidence: Strong 9 10)

Monitoring Immunity: Regularly assess antitoxin levels in susceptible populations to identify those requiring booster doses. (Evidence: Moderate 9)

Prompt Airway Intervention: In cases of severe tracheobronchial involvement, immediate surgical or radiological intervention is crucial for airway patency. (Evidence: Expert opinion 5)

Surveillance and Reporting: Utilize surveillance systems like VAERS and NAEFISS to monitor vaccine safety and detect adverse events following immunization. (Evidence: Moderate 2 3)

References

1 Shadmani M, Ghasemnejad A, Bazmara S, Bagheri KP. Designing a Novel di-epitope Diphtheria Vaccine: A Rational Structural Immunoinformatics Approach. Current computer-aided drug design 2025. link 2 Zhang C, Liu Y, Liu X, Shen J. Real-world safety profile of the diphtheria, tetanus, and acellular pertussis combined vaccine: A study in Huzhou from 2020 to 2024. Medicine 2025. link 3 Moro PL, Perez-Vilar S, Lewis P, Bryant-Genevier M, Kamiya H, Cano M. Safety Surveillance of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccines. Pediatrics 2018. link 4 Berger A, Meinel DM, Schaffer A, Ziegler R, Pitteroff J, Konrad R et al.. A case of pharyngeal diphtheria in Germany, June 2015. Infection 2016. link 5 Profili S, Manca A, Feo CF, Padua G, Ortu R, Canalis GC et al.. Palliative airway stenting performed under radiological guidance and local anesthesia. Cardiovascular and interventional radiology 2007. link 6 Dzupová O, Benes J, Kríz B, Horová B, Olexová A. An unusual course of invasive infection due to nontoxinogenic strain of Corynebacterium diphtheriae. Klinicka mikrobiologie a infekcni lekarstvi 2005. link 7 Metz B, Jiskoot W, Hennink WE, Crommelin DJ, Kersten GF. Physicochemical and immunochemical techniques predict the quality of diphtheria toxoid vaccines. Vaccine 2003. link 8 Stone MJ. Monoclonal antibodies in the prehybridoma era: a brief historical perspective and personal reminiscence. Clinical lymphoma 2001. link 9 Mortimer J, Melville-Smith M, Sheffield F. Diphtheria vaccine for adults. Lancet (London, England) 1986. link92194-x) 10 Kwantes W. Diphtheria in Europe. The Journal of hygiene 1984. link 11 Horst R, Dyer D, Hallett A. Fulminant diphtheritic mitral valve endocarditis. Archives of disease in childhood 1976. link 12 Jones WL, Foster JW. Papain-treated globulins in specific and cross-reacting immunofluorescent staining. Journal of bacteriology 1966. link

Tracheobronchial diphtheria