Diphtheria differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Respiratory diphtheria must be differentiated from respiratory tract or other infections that present with fever, neck swelling, cough and/or pharyngeal exudates. Cutaneous diphtheria must be differentiated from other bacterial and fungal causes of skin ulceration.

A group of respiratory diseases can present with symptoms such as fever, sore throat, pharyngeal exudates and/or neck swelling, which may mimic the symptoms of a diphtheria infection. These include:^[1]

• Infectious mononucleosis due to EBV
• Group A streptococci pharyngitis
• Epiglottitis due to Hemophilus influenza type b
• Viral pharyngitis due to influenza, HSV or adenovirus
• Vincent’s angina
• Oral candidiasis

Cutaneous diphtheria due to Corynebacterium diphtheria must be differentiated from other bacterial and fungal diseases that present with a shallow ulcer on the skin:^[2]

• Bacterial causes:
  • Pyoderma due to Staphylococcus aureus or Group A beta-hemolytic streptococci
  • Cutaneous Leishmaniasis
  • Cutaneous Anthrax due to Bacillus Anthracis
  • Cutaneous mycobacterial infections due to Mycobacterium tuberculosis, Mycobacterium marinum or Mycobacterium ulcerans
• Fungal causes:
  • Sporotrichosis
  • Mycetoma
  • Chromoblastomycosis

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