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Diphtheria
Dr Yusuf Imran
J.N Medical college
J.N Medical College
AMU- INDIA
INTRODUCTION
• Diphtheria is an highly infectious and communicable disease characterized by involvement of the respiratory system , the local production of membrane and general symptoms caused by absorption of toxin .
Problem Statement
WORLD
Developed countries – rare
Developing countries - endemic
The true number of cases and deaths are unknown because of incomplete reporting from most countries.
Problem Statement
• India
☺ Endemic Disease
☺ Declining trend due to increasing cover of immunization .
1987 – 12952
2005 - 10231
Declined by 21%
Epidemiological triad
• Agent
( Corny bacterium)
Host Factors Envrnt factors
( Children <5) ( Winter month)
Agent
• The causative organism is corny bacterium diphtheria
Sources are cases and carriers
Organism will be present in the nasopharyngeal secretions, skin lesion discharge, contaminated fomites and infected dust
Period of infectivity is 14-28 days from the onset of diseases
Host factors
• Affects children of 1-5 years of age
• It effects both sexes.
Environmental factors • It is common in winter although it occurs in all
seasons
Mode of transmission
• Droplet nuclie
• Infected cutaneous lesions
• Infected object or dust, contaminated with nasopharyngeal secretions
Direct person- to-person transmission by contact with respiratory secretions and cutaneous lesions. Cutaneous lesions are important in transmission particularly in countries warm climates.
Portal of entry
• Respiratory route
• skin cuts and wounds
Incubation period2-6 days
Types of diphtheria• Pharyngotonsillar diphtheria
• Laryngotracheal diphtheria
• Nasal diphtheria
• Cutaneous diphtheria
Sign/ symptoms
1. In pharyngotonsillar diphtheria
Sore throat
Difficulty in swalloing
Low grade fever
In early stages – whitish membrane which can be wiped off easily over pharynx or tonsil
Later it becomes thick, blue –white to grey –black and adherent. It is difficult to remove if tried to remove it will. Result in bleeding
Mucosal erythema around the membrane
Edema of submandibular area
Bull neck appearance
2. Laryngo tracheal diphtheria
It is preceeded by pharyngotosilar
hoarseness of voice
Brassy cough
3. Nasal Diphtheria
Unilateral or bilateral serosanguineous ( blood and serous fluid ) discharge from the nose
Excoriation of upper lip
Toxemia is minimal
4. Cutaneous diphtheria
May occasionally involve skin or conjunctiva.
Differential diagnosis
Membranous Tonsillitis
Vincent’s Angina
Infectious mononucleosis
Agranulocytosis
Leukemia
Aphthous ulcers
Traumatic ulcer
Foreign body (Nasal Diphtheria)
Diagnosis
• Schick test
Schick test toxin .2 ml is injected in to forearm as test arm and in to opposite arm control arm same amount of inactivated toxin ( IM)
Positive reaction
Test arm- with in 24-36hrs, a circumscribed red flash of 10-15 diameter. It reaches maximum by 4th to 7th day and later on slowly fades in to brown patch
Control arm-
No change occurs
Negative reaction
no reaction on both arm
Pseudo-positive reaction
Test arm- a red flash of size less than true reaction
Control arm – a red flash of size less than the positive reaction.
Combined reaction
Test arm- positive reaction
Control arm- pseudo-positive reaction
Prevention and control
• Early detection of cases and carriers
• Isolation
• Treatment
Cases
Diphtheria antitoxins ranging 10,000 to 80,000 units or more are administered iv or im depending on severity of care
2.5 lakh unit penicillin QID for 5 days
250mg erythromycin QID
Carrier
Oral erythromycin for 10 days
Contacts
If immunized previously with in 2 year – no action needed
If immunized long back ( more than 2 years)- DT booster dose
If not immunized at all- prophylactic benzathine penicillin or erythromycin + active immunization
• Immunization
Combined vaccine
as per national schedule
Note- Vaccine should be kept in 4-8 degree c
Use within a week from day of issue to sub centre
• Antiserum
For treatment purposeAnti sera Purpose Dose Route
Diphtheria anti toxin
prophylactic 500-2000 unit SCor IM
Diphtheria anti toxin
Treatment 10,000 to 30,000 unit or 40,000 to 1,00,000 unit ( 2 Doses with an interval of ½ to 2 hrs)
IMIV
Complications
1. Respiratory Failure – Occlusion of the airway by the membrane.
2. Myocarditis – Occurs by 2nd week. Can lead to CHF, arrhythmia or sudden death.
3. Neurological –
Palatal palsy
Ocular Palsy
Loss of accommodation
Polyneuritis
4. Renal Complications – Oliguria / Proteinuria
Summarization
• Diphtheria is a endemic, respiratory tract , communicable disease comes under six killer disease caused by corny bacterium diphtheriae.
• Commonly seen in children less than five years and in winter season
• Mainly four types . Pharyngotonsilar, laryngotracheal, nasal and cutaneous .
• Diagnosed by Schick test / Albert stain / Culture.
• Early detection and treatment is the best way of prevention and control.
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