The patient for this week is a lady in her mid-twenties who had recently been caring for a family struck down with a severe upper respiratory tract infection. Now she too had a severe sore throat and a high fever and was finding it increasingly difficult to swallow. She became delirious and started to hallucinate. Her young daughter also had the same types of symptoms, but if anything was more unwell. The doctor had been called, he diagnosed “putrid throat” and said there was nothing more he could do to save the lives of Demelza and her daughter Julia… the situation looked bleak for the Poldark’s…
Poldark is the hit BBC TV drama, but what is putrid throat? Is this condition just a dramatic fantasy of the BBC scriptwriters?! I think it is real! It is very likely that the Poldark’s had the condition diphtheria. This is an acute bacterial infection of the upper respiratory tract caused by the bacterium Corynebacterium diphtheriae. Back in the 18th Century they did not know the cause and the only treatment was leeching or honey in hot water. The reason it was so feared is that it was one of the most common causes of death and killed almost all of the children it affected.
Since the introduction of a vaccine in 1942, diphtheria has become very uncommon in the UK. Today, all children born in the UK are offered the vaccine as part of their primary childhood immunisations (it is the “D” of the DTP+Hib vaccine). The few cases seen in the UK now are in non-immunised patients who usually acquire their infection in Eastern Europe and the former Soviet Union as vaccination there is no longer routine practice.
Clinical Features
Diphtheria most commonly affects the upper respiratory tract but it can affect any mucous membrane including the conjunctivae, vagina or ear. Diphtheria can also cause skin infections. Asymptomatic colonisation is more common than infection.
The respiratory features of the classical presentation of diphtheria are:
Since the introduction of a vaccine in 1942, diphtheria has become very uncommon in the UK. Today, all children born in the UK are offered the vaccine as part of their primary childhood immunisations (it is the “D” of the DTP+Hib vaccine). The few cases seen in the UK now are in non-immunised patients who usually acquire their infection in Eastern Europe and the former Soviet Union as vaccination there is no longer routine practice.
Clinical Features
Diphtheria most commonly affects the upper respiratory tract but it can affect any mucous membrane including the conjunctivae, vagina or ear. Diphtheria can also cause skin infections. Asymptomatic colonisation is more common than infection.
The respiratory features of the classical presentation of diphtheria are:
- Severe sore throat
- Painful cervical lymphadenopathy
- Swelling of the neck leading to a “bull neck” appearance
- Asymmetrical adherent greyish white membranes (pharyngeal membranes), with surrounding inflammation, which may extend into the trachea and cause airway obstruction (diphtheria looks more like opaque Clingfilm or plastic food wrap whereas in tonsillitis there is pus on the tonsils and no membrane, see image below)
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