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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