DIPHTHERIA BY D.pptx how to diagnosis and clinical presentation

About diphtharia

1. DIPHTHERIA DR. MANSI PATEL DR. DIPESH PATEL

2. INTRODUCTION AGENT : CORYNEBACTERIUM DIPHTHERIA & CORYNEBACTERIUM ULCERANS. BEFORE INVENT OF TOXIN DIPHTHERIA WAS MAJOR CAUSE OF MORTALITY IN CHILDREN HENS KNOWN AS “STRANGLING ANGEL OF CHILDREN”

3. CULTURE MEDIA LOFFLER MEDIUM: APPEARS GREY IN COLOR TELLURITE MEDIUM: 3 TYPE COLONIES SEEN 1) MITIS: SMOOTH, BLACK, CONVEX, HEMOLYTIC 2) GRAVIS: GREY, RADIALLY STRIATE, SEMI ROUGH, NON HEMOLYTIC 3) INTERMEDIUS: SMALL SMOOTH, BLACK CENTER, NON HEMOLYTIC

4. EPIDEMIOLOGY INCEDENCE PEAK DURING COOLER MONTHS IT IS MORE COMMON IN LOWER SOCIO ECONOMIC CLASS POPULATION , OVERCROWDING, POOR SANITATION, UNHYGINE, CLOSE CONTACT IS RISK FACTOR CHILDREN BETWEEN 1 TO 5 YEAR ARE COMMONLY INFECTED. MODE OF TRANSMISSIN ARE DROPLETS, FOMITES, SKIN LESION, AND INGESTION OF INFECTED MILK.

5. ETIOPATHOGENESIS PATHOGEN: CORYNEBACTERIUM GRAM POSITIVE, AEROBIC, NONMOTILE,NON CAPSULATED.

6. CLINICAL FEATURES NASAL DIPHTHERIA MIMIC COMMON COLD CHARACTERISED BY RUNNING NOSE. PHARYNGEAL AND TONSILLAR DIPHTHERIA BEGINS WITH LOSS OF APPETITE, LOW GRADE FEVER, MALAISE, MEMBRANE WHITE OR GREY AFTER 1 OR 2 DATYS APPEARS OVER TONSIL, PHARYNGEAL WALL, SOFT PALATE, MAY EXTEND TOLARYNX AND TRACHEA CAUSING RESPIRATORY COLLAPSE

7. CUTANEOUS DIPHTHERIA BEGINS AS A VESICLE , PUSTULE TURN INTO ULCER WITH DARK PSEUDO MEMBRANE; MORE COMMON IN LEG,FEET AND HAND. PAIN IS THERE FOR FIRST 3 Dys , RESOLVE IN 6-12 WEEKS. CONJUCTIVAL DIPHTHERIA OTITIS EXTERNA SEPTIC ARTHRITIS MYOCARDITIS APPEARS AFTER 10-14 DAYS DUE TO TOXINS LIVER NECROSIS, ADRENAL HEMORRHAGE, ACUTE TUBULAR NECROSIS

8. MODALITIES OF DIAGNOSIS DIPHTHERIA IS A CLINICAL DIAGNOSIS. THROAT OR SKIN SWAB SEND FOR SMEAR AND CULTURE. RAPID ENZYME IMMUNE ASSAY TO DETECT DIPHTHERIAL TOXIN. SCHICK TEST FOR IMMUNE STATUS OF PERSON

9. TREATMENT DIPHTHERIAL ANTITOXIN DIPHTHERIA ANTITOXIN IS GOLD STANDARD TREATMEN. DOSE TYPE UNIT PHARYNGEAL OR LARYNGEAL DIPHTHERIA 20000 - 40000 NASOPHARYNGEAL DIPHTHERIA 40000 - 60000 SEVERE LARYNGEAL OR PHARYNGEAL DIPHTHERIA 80000 -120000 CUTANEOUS DIPHTHERIA 20000 - 40000

10. SENSITIVITY TESTING MUST BE DONE BEFORE INJECTION BY 0.02ML OF 1:1000 DILUTION OF HORSE SERUM IN ONE HANDAND NEGETIVE CONTROL NORMAL SALINE IN OTHER HAND. IF PATIENT HAS ERYTHEMA MORE THAN 3mm THAN DESENSITISATION MUST BE DONE INTRA VENOUS ROUTE IS PREFERED FOR INJECTING ANTITOXIN. ANTITOXIN NEUTRILISE TOXINS CIRCULATING IN BLOOD .

11. ANTIBIOTIC ANTIBIOTIC TREATMENT CONSIST OF 14 DAYS COURSE OF ERYTHROMYCINE OR PENICILLINE. AQUEUS PENICILLIN IN DOSE OF 100000 – 150000 UNIT/KG / DAY IN FOUR DEVIDED DOSE INTRAVENOUSLY. PROCAINE PENICILLIN 25000 – 50000 UNIT/KG/DAY IN TWO DEVIDED DOSES. ERYTHROMYCIN IS RECOMMENDED IN PENICILLINE SENSITIVE INDIVIDUAL IN DOSE OF 40 – 50 MG/KG/DAY IN FOUR DEVIDED DOSES. THROAT SWAB MUST BE TAKEN AFTER 2 WEEK OF THERAPY, IF POSITIVE SINGLE DOSE OF BENZATHINE PENICILLINE IS ENOUGH TO ERADICATE IN DOSE OF 6,00,000 ONIT FOR CHILDREN <30KG AND 1,200,000 FOR CHLIDREN >30KG.