Diptheria

This ppt contains all information about epidemiology of Diptheria. It is useful for students of medical field learning preventive and social medicine, Swasthavritta (Ayurved), nursing and everyone who is interested in knowing about it.

1. Diphtheria
Dr. Shubhangi S. Kshirsagar
Assistant professor
Department of Swasthavritta & Yoga

2. •Diphtheriaisanacuteinfectiousdisease
causedbytoxigenicstrainofCornybacterium
diphtheriae.

3. •Thebacillimultiplylocally,usuallyinthethroatand
elaborateapowerfulexotoxinwhichisresponsible
for-
a.Theformationofagrayishoryellowish
membrane(falsemembrane)commonlycover
thetonsils,pharynx,larynxwithwelldefinededges
andmembranecannotbewipedaway.
b.Markedcongestion,oedemaorlocaltissue
destruction
c.Enlargementoftheregionallymphnodes
d.Signsandsymptomsoftoxaemia.

4. Epidemiological
determinant

5. Agent factors
1. Agent -
Corynebacteriumdiphtheriaeis a gram positive, non-
motile organism.
It has no invasive power, but produces a powerful
exotoxin.
2. Source of infection
a.Case –subclinical to clinical
b.Carriers –more common source of infection.
95 carriers for 5 subclinical case

6. •Carriers may be temporary or chronic; Nasal or
throat carriers.
•Nasal carriers are particularly dangerous source of
infection because of frequent shedding of organism
into the environment than throat carriers.
•Temporary carriers state may last for about a
month.
•Chronic carriers may persist for a year or
so, unless the patient is treated.

7. 3.Infectivematerial
•Nasopharangealsecretion
•Dischargesfromskinlesion
•Contaminatedfomites
•Infecteddust
4.Periodofinfectivity
•Varyfrom14-28daysfromtheonsetofdisease.
•Butcarriersmayremaininfectiveformuch
longerperiods.

8. Host factors
1.Age–particularly affects children aged 1-5.
2.Sex–both sexes affected
3.Immunity–Infant born of immune mothers
are relatively immune during first few weeks
or months of life.

9. Environmental factors
•It occurs in all seasons, although winter month favour
its spread.
•In Kolkata, the highest incidence was reported in
August; in Mumbai in winter months; and Delhi,
during August to October.

10. Mode of transmission
•MainlybyDropletinfection
•Itcanbealsotransmitteddirectlyto
susceptiblepersonfrominfectedcutaneous
lesions.

11. Portal of entry
a.Respiratory tract –common
b.Non-respiratory route –skin where cuts,
wounds and ulcers, umbilicus in new born.

12. Incubation period
•2-6days
•Occasionally longer

13. Clinical features
•Respiratory tract forms of diphtheria consist
of -
a.Pharyngotonsillardiphtheria
b.Laryngotrachealdiphtheria
c.Nasal diphtheria
d.Combination of these

14. 1. Pharyngotonsillardiphtheria
•Sorethroat
•Difficultyinswallowing
•Lowgradefever
•Examinationofthroatmayshowsonlymilderythema,
localizedexudate,orapseudo-membrane.
•Membranemaylocalizedorapatchoftheposterior
pharynxortonsil,maycovertheentiretonsil,orless
frequentlymayspreadtocoverthesoftandhardpalateand
posteriorportionofpharynx.

15. •Inearlystage,pseudomembranemaybe
whitishandmaybewipeoffeasily.
•Themembranemaybeextendtobecome
thick,bluewhitetograyblackandadherent.
•Attemptstoremovethemembraneresultsin
bleeding.
•Patientwithseverdiseasemayhavemarked
oedemaofthesubmandibularareaand
anteriorportionoftheneck,alongwith
lymphadenopathy,givingacharacteristic“bull-
necked”appearance

18. 2. Laryngotrachealdiphtheria
•Precededbypharyngotonsillardisease
•Fever,hoarsenessandcroupycoughatpresentation
•Iftheinfectionextendintobronchialtree,itisthe
mostsevereformofdisease.
•Diphtheriabacilliwithinthemembranecontinueto
producetoxinactively.
•Toxinisabsorbedandresultindistanttoxicdamage.
•inlaterstage,difficultyinvision,speech,swallowing
ormovementofarmsorlegs.
•Toxinalsoproducenervedamageandresultingin
paralysisofthesoftpalate,eye,musclesor
extremities.

19. 3. Nasal diphtheria
•It is the mildest form of respiratory diphtheria.
•Usually localized to the septum or turbinates
of one side of the nose.
•Occasionally a membrane may extend into the
pharynx.

20. Cutaneousdiphtheria–
•Commonintropicalareas.
•Itoftenappearsasasecondaryinfectionofa
previousskinabrasionorlesion.
•Thepresentinglesion,oftenanulcer,maybe
surroundedbyerythemaandcoveredwith
membrane.

21. •Nonrespiratorymucosalsurfacei.e.
conjunctivaeandgenitalsmayalsobesitesof
infection.

22. Control of diphtheria
1.Case and carriers
2.Contacts
3.Community

23. 1. Case and carriers
1. Early detection of case and carriers
2. Isolation of all cases and carriers in hospital for 14 days
or until proved free of infection.
3. Treatment of cases and carriers
A. Cases -
a. Diptheriaantitoxin -IM/IV in doses ranging from 20000
to 1,00,000 units or more depending upon the severity
of the case, after preliminary test dose of 0.2ml
Subcutaneously to detect sensitization to horse serum.

24. b. Penicillin or erythromycin for 5-6days
2.Carriers –treat with Erythromycin for 10 days.
Case Diptheriaantitoxin dose
Mild early pharangealor
laryngeal
20,000-40,000units
Moderatenasopharangeal 40,000-60,000 units
Severe, extensive or late
( 3daysor more)
80,000-1,00,000 units

25. 2. Contacts
•Whereprimaryimmunizationorboosterdosewas
receivedwithinprevious2years,nofurtheraction
needed.
•Whereprimarycourseorboosterdoseofdiphtheria
toxoidwasreceivedmorethan2yearsbefore,onlya
boosterdoseofdiphtheriatoxoidneedbegiven.
•Non-immunizedclosecontactsshouldreceive
prophylacticpenicillinorerythromycinand1000-2000
unitsofdiphtheriaantitoxin
•Contactsshouldbeplacedundermedicalsurveillance
andexamineddailyforatleastaweek.

26. 3. Community
•Activeimmunizationwithdiphteria
toxoidofallinfantsasearlyinlifeas
possible,asscheduled,withsubsequent
boosterdosesevery10yearsthereafter.