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Diphtheria dr yusuf imran
Diphtheria is a highly infectious respiratory disease caused by Corynebacterium diphtheriae that is endemic in developing countries. It mainly affects children under 5 years of age and occurs more commonly in winter months. There are four main types - pharyngotonsillar, laryngotracheal, nasal and cutaneous. Diagnosis involves tests like the Schick test or culture. Prevention relies on early detection, treatment, immunization as per national schedules, and isolating cases and carriers. Complications can impact the respiratory, cardiac, neurological and renal systems if not treated promptly.
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Overview of diphtheria as an infectious respiratory disease caused by toxins.
Diphtheria is endemic in developing countries; trends show decline in India due to immunization.
Overview of agent (Corynebacterium), host (children), and environmental factors affecting transmission.
Discussion on various types of diphtheria and their respective symptoms; highlights symptoms like sore throat.
Listing conditions that may be misdiagnosed as diphtheria, including tonsillitis and leukemia.
Schick test for diagnosing diphtheria; explains positive, negative, and pseudo-positive reactions.
Prevention via immunization and early detection; treatment strategies including antitoxins and antibiotics.
Potential serious complications from diphtheria include respiratory failure, myocarditis, and neurological issues.
Recap of diphtheria as a major communicable disease, its types, diagnosis, and prevention strategies.
Closing remarks and gratitude for attention.
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Diphtheria dr yusuf imran
- 1. Diphtheria Dr Yusuf Imran J.NMedical college J.N Medical College AMU- INDIA
- 2. INTRODUCTION • Diphtheria isan 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 .
- 3. 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.
- 4. Problem Statement • India ☺Endemic Disease ☺ Declining trend due to increasing cover of immunization . 1987 – 12952 2005 - 10231 Declined by 21%
- 5. Epidemiological triad • Agent (Corny bacterium) Host Factors Envrnt factors ( Children <5) ( Winter month)
- 6. Agent • The causativeorganism 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
- 7. Host factors • Affectschildren of 1-5 years of age • It effects both sexes. Environmental factors • It is common in winter although it occurs in all seasons
- 8. 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.
- 9. Portal of entry •Respiratory route • skin cuts and wounds Incubation period 2-6 days Types of diphtheria • Pharyngotonsillar diphtheria • Laryngotracheal diphtheria • Nasal diphtheria • Cutaneous diphtheria
- 10. Sign/ symptoms 1. Inpharyngotonsillar 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
- 11. Mucosal erythemaaround the membrane Edema of submandibular area Bull neck appearance
- 12. 2. Laryngo trachealdiphtheria 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
- 13. 4. Cutaneous diphtheria May occasionally involve skin or conjunctiva.
- 14. Differential diagnosis MembranousTonsillitis Vincent’s Angina Infectious mononucleosis Agranulocytosis Leukemia Aphthous ulcers Traumatic ulcer Foreign body (Nasal Diphtheria)
- 15. Diagnosis • Schick test Schicktest 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
- 16. Negative reaction no reactionon 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
- 17. 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
- 18. Carrier Oral erythromycinfor 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
- 19. • Immunization Combined vaccine asper national schedule Note- Vaccine should be kept in 4-8 degree c Use within a week from day of issue to sub centre
- 20. • Antiserum For treatmentpurposeAnti 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) IM IV
- 21. 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
- 22. Summarization • Diphtheria isa 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.
- 23.