Diphtheria can infect many sites, but almost all severe cases will involve the nose, throat, or larynx. The early presentation is unremarkable, with sore throat and mild fever, or a bloody nasal discharge. Over 24 h there is a worsening of symptoms, and the diagnostic gray-white adherent membrane becomes apparent and spreads. All cases where the diagnosis is likely should be treated as diphtheria. Occasionally the onset may be very rapid.
The diagnosis is confirmed by isolating Corynebacterium diphtheriae from a throat or nasal swab.
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