Dpt

1. Diphtheria.Pertussis.Tetanus

2. Diphtheria
Caused by Corynebacterium
diphtheriae
An aerobic gram-positive bacillus
Man-to-man transmission
Incubation period- 2-5 days
Primarily a disease of children
75% children immune by 10 years
Involves respiratory mucous membrane

3. Clinical manifestation
Tonsillopharyngeal, laryngeal, nasal &
tracheobronchial involvement
s/s- fever with systemic toxicity, sore throat,
dysphagia, hoarseness, rhinorrhea, cough, Cxal LNE
Characteristic pseudomembrane over tonsils, that
bleeds on attempt to remove
Complication- local or toxin mediated
Respiratory obstruction
Myocarditis- arrythmias &/or heart failure
Polyneuritis- IX/X Cr. n., proximaldistal weakness, distal paresthesias
Pneumonia

4. Management
Diagnosis- mostly empirical, based on s/s
± pseudomembrane
Diphtheria antitoxin- horse antiserum
IV infusion over 60 mins
20,000100,000 units, depending on severity
Watch for serum sickness
Antibiotics- macrolide or penicillin
Macrolide or Rifampicin for carriers
Vaccination- toxoid- DPT/DT/Td

5. Pretussis- whooping cough
Caused by Bordetella pertussis
A gram-negative coccobacillus
Man is the only host
Transmitted by airborne respiratory
secretions from an infected individual
No carrier state
Incubation period- 7-10 days

6. Clinical manifestation
3 stages- clasically
Catarrhal- non-specific URTI, most infectious, x 1-2 wk
Paroxysmal- bouts of severe cough (whoop),
more at night, x 2-4 wk
Convalescent- less intense cough, not infectious, 3-4 wk
In adults- prolonged bronchitis
Complications-
Pneumonia, commonly due to secondary bacterial infection
Seizures, encephalopathyFND
Otitis media
Hemorrhage, due to severe cough

7. Management
Diagnosis-
Markedly increased TLC, with lymphocytosis
B. pertussis from nasopharyngeal swab
Treatment-
Supportive care
Antibiotics early- macrolide or co-trimoxazole
Prophylaxis with macrolide for contacts
Vaccination-

Adsorbed whole-cell vaccine, part of DPT

8. Tetanus
A neurologic disorder, characterised by
increased muscle tone & spasms
Caused by tetanospasmin, a toxin produced
by Clostridium tetani
C. tetani- a motile anaerobic gram-positive
bacillus with a terminal spore
Sporadic disease, caused by contamination
of wound with spores, that germinate under
suitable conditions, to produce neurotoxin
Infectionsymptom- ~7 days

9. Clinical manifestation
Progressive skeletal muscle involvement
Trismus, dysphagia
Rigid abdomen, stiff proximal limb muscles (hands/feet- spared)
Facial grimace
Arched back- opisthotonus
Paroxysmal painful generalized spasms
Complications-
Sympathetic overactivity
Pneumonia
Fractures
Asphyxia

10. Management
Diagnosis- clinical
Treatment-
Supportive care
Wound care
Antibiotic- Penicillin or Clindamycin
Antitoxin- Tetanus immunoglobulin
Diazepam & neuromuscular blockade with mech. vent.
Course- 4-6 weeks, with complete recovery
Prognosis- early disease with short course
has poor prognosis
Vaccine- DPT in children & Td in adults