Ophthalmologic Manifestations of Diphtheria Follow-up

  • Author: Andrew A Dahl, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 7, 2010
 

Further Outpatient Care

  • Patients should receive follow-up care until the conjunctivitis is resolved.
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Deterrence/Prevention

  • From 1991 through 1998, there was a massive epidemic of diphtheria in the Independent States of the Former Soviet Union, representing the first large-scale diphtheria outbreak in developed countries in more than 30 years. This occurred because of vaccine shortages and laxity in diphtheria immunization programs. Beginning in 1995, aggressive control strategies were implemented through mass vaccination with diphtheria toxoid, resulting in a major decrease in new cases of diphtheria by 2000.
  • The availability of vaccines in the United States is now threatened by systemic problems in the development, purchase, and distribution of vaccines. The number of companies that produce vaccines for the United States has declined markedly since the 1960s, and today, only 5 companies produce all routine vaccines for this market. There is only one supplier for measles, mumps, and rubella (MMR); diphtheria, pertussis, and tetanus (DPT); and polio; and if this supplier ceases production, it could take years to have a replacement vaccine licensed and publicly available.[1]
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Complications

  • With severe respiratory involvement, death can occur.
  • Optic neuritis has been reported as a possible rare complication of diphtheria immunization.
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Prognosis

  • The prognosis is favorable if detected early in the disease.
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Contributor Information and Disclosures
Author

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Louis E Probst, MD  Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers

Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Sloan FA, Berman S, Rosenbaum S, Chalk RA, Giffin RB. The fragility of the U.S. vaccine supply. N Engl J Med. Dec 2 2004;351(23):2443-7. [Medline].

  2. Burkhard C, Choi M, Wilhelm H. [Optic neuritis as a complication in preventive tetanus-diphtheria-poliomyelitis vaccination: a case report]. Klin Monatsbl Augenheilkd. Jan 2001;218(1):51-4. [Medline].

  3. Chandler JW, Milam DF. Diphtheria corneal ulcers. Arch Ophthalmol. Jan 1978;96(1):53-6. [Medline].

  4. Coachman J. Diphtheric conjunctivitis. Mer J Ophth. 1951;34:1176.

  5. Dittmann S, Wharton M, Vitek C, et al. Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned. J Infect Dis. Feb 2000;181 Suppl 1:S10-22. [Medline].

  6. Fuchs E. Textbook of Ophthalmology. 1889.

  7. Hardy IR, Dittmann S, Sutter RW. Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union. Lancet. Jun 22 1996;347(9017):1739-44. [Medline].

  8. [Best Evidence] Pichichero ME, Rennels MB, Edwards KM, et al. Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. JAMA. Jun 22 2005;293(24):3003-11. [Medline].

  9. Rolleston JD. Diphtheric paralysis. Arch Pediatr. 1913;30:335-45.

  10. Rolleston JD, Ronaldson GW. Acute Infectious Diseases. 1940.

  11. Tharmaphornpilas P, Yoocharoan P, Prempree P, et al. Diphtheria in Thailand in the 1990s. J Infect Dis. Oct 15 2001;184(8):1035-40. [Medline].

  12. Walshe FMR. On the pathogenesis of diphtheric paralysis. Q J Med. 1918-19;12:14-37.

 
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