Diphtheria with Diffuse Neck Swelling, Duration ≥ 48 Hours, or Severe Disease
Clinical Scenario
This protocol applies to diphtheria presentations that have progressed beyond early, localised disease. The defining features of this scenario are any one of the following:
- Diffuse swelling of the neck ("bull neck")
- Diphtheria of any anatomical site with symptom duration of 48 hours or more
- Severe disease — respiratory distress or haemodynamic instability (shock)
Why This Presentation Matters
Diffuse neck swelling, prolonged symptom duration (≥ 48 hours), and systemic severity markers such as respiratory distress or shock indicate extensive or advanced disease. These features are associated with imminent, life-threatening airway compromise and require immediate clinical attention.
Treatment Approach — Partial Overview
When airway obstruction is imminent, urgent airway intervention is central to management. The specific approach used depends on the experience of the treating clinical team.
The full structured regimen — including the complete set of intervention options, decision criteria, and sequencing — is available via the protocol link below.
References
- Diffuse swelling of the neck
- Any disease ≥ 48 hours
- Severe disease (respiratory distress, shock)
- Severe/extensive disease: duration of 3 or more days, or diffuse neck swelling (the so called "bull neck"), or respiratory distress, or hemodynamic instability.
- In patients with imminent airway obstruction, urgent airway intervention may be lifesaving.
- The possible options include basic airway manoeuvres, endotracheal intubation, cricothyroidotomy (needle or surgical approach), and tracheostomy.
- The risks and benefits of each approach will depend on the experience of the treating medical personnel.
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