Sunday, February 13, 2011

Diphtheria as a cause of sore throat

I read with interest the editorial in AFP's January 1st issue, "Avoiding Sore Throat Morbidity and Mortality: When Is It Not 'Just A Sore Throat'?" It brought back memories. I was surprised that diphtheria was not mentioned as a cause of tonsillitis and sore throat.

I graduated from Minnesota Medical School in 1944 after a 9-month Ob-Gyn residency. I was then sent to Japan to be Chief of Obstetrics and Gynecology at the 118th Station Hospital, 24th Infantry Division, at Fukuoka Kyushu, Japan. On one occasion, as officer of the day, I admitted a newly arrived recruit to the hospital with tonsillitis. A viral culture was taken and a smear swab sent to our lab. He was given sulfanilamide (penicillin was just being tried as a new wonder drug). We had a wake-up call when he died shortly after being admitted. He was a new recruit from a ship docked at Yokohama that was manned mainly by soldiers from the rural South where childhood vaccinations were not always routinely administered. We quickly quarantined the ship's personnel, many of whom were experiencing similar symptoms.

Dr. Cy (Cyrus) Lifshultz, an internist from the northeast U.S., was our medical officer in charge of infectious disease. Dr. Lifshultz stayed up all night with these very sick men, spraying their throats with a hand syringe containing penicillin. He also painstakingly removed the scar tissue that lined the throat and upper lung areas. Dr. Lifschultz never got an award for what he did, but in my opinion, he deserved the Medal of Honor.

Fortunately, routine vaccination has made diphtheria a rare cause of sore throat in the U.S. today. However, when treating unvaccinated populations in other areas of the world, clinicians would be wise to not underestimate diphtheria – it is deadly.

Frederick M. Hass, MD
Minneapolis, Minnesota

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