INFECTIOUS CONDITIONS DIPHTHERIA POWER POINT.pptx

PEADS

1. Diphtheria

2. PRESENTER CHILEYA M. EVANS EN, RN,BSc UNZA SCHOOL OF SCIENCES

3. INTRODUCTION Diphtheria is one of the contagious paediatric illnesses which affect the skin and the respiratory tract. The word diphtheria comes from the Greek word for leather or rubber membrane, which refers to the tough pharyngeal membrane which is the clinical hallmark of infection. In countries that do not have routine immunization against this infection, the mortality rate varies from 1.5 to 25 percent.

4. GENERAL OBJECTIVE At the end of the Discussion, students should demonstrate an understanding of diphtheria and be able to manage a patient with diphtheria.

5. SPECIFIC OBJECTIVES Define diphtheria . Outline the mode of transmission Outline the risk factors Discuss the pathogenesis of diphtheria. Outline the clinical features of diphtheria

6. CONT’D Discuss the management of diphtheria. Outline preventive measures State the prognosis. List the complications of diphtheria .

7. DEFINITION Diphtheria I s an acute infectious disease caused by Corynebacterium diphtheriae gram-positive bacilli, which primarily infects the throat and upper airways and produce toxins that effect other organs.

8. Mode of transmission It is transmitted by close contact with the discharge from an infected person's eyes, nose, throat or skin. It takes four forms; - nasal -skin -pharyngeal -laryngeal

9. Nasal Diphtheria This is characterized by purulent blood stained discharge from the nose . SKIN DIPTHERIA Cutaneous diptheria may occur at one or more sites, usually localised to areas of previous mild trauma or bruising.

10. MODE OF TRANSMISSION CONT.. Classical Diphtheria presents with faucial, laryngeal and nasal lesions faucial Diphtheria PHARYNGEAL DIPTHERIA This presents mainly with a sore on either tonsils, pharynx and uvular. In mild cases the membranes maybe minimal or absent .

11. CONT’D Inflammation of the soft tissue in the neck and enlarged cervical lymph nodes give rise to a bull neck in severe cases, The disease presents with toxaemia, malaise, anorexia , low grade fever and sore throat .

12. Laryngeal Diphtheria This is characterized by fever, increased stridor, respiratory distress and a cough. In severe cases of laryngeal involvement, the membranes extended into the trachea causing increasing obstruction

13. CONT’D The detached piece of membrane may block the air ways causing sudden death . Laryngeal and Pharyngeal involvement may co-exist. Toxaemia in this case is less.  

14. RISK FACTORS Unvaccinated or inadequately vaccinated persons Those travelling to areas where diphtheria is common Close contact with infected persons. Inhaling the aerosolized secretions of an infected person - air-borne droplets expelled from the body.

15. CONT.. Sneezing and coughing are the most frequent ways the infection is spread. Direct contact with the secretions from the nose and throat of an infected person. Direct contact with a skin ulcer of an infected person. Possibly, but very rarely, through contaminated personal or household items.  

16. Epidemiology The incubation period is 2 - 7 days or longer, The causative agent is a gram positive bacillus. The disease is transmitted by droplet infection from respiratory tract of the infected person or carrier. The most affected patients are those of first 10 years of life ,

17. Pathogenesis Once infected, the bacilli settle on the upper respiratory tract where they multiply to produce exotoxins. The exotoxins are absorbed by the cell membranes causing tissue necrosis in the local area of the bacillary colonies .

18. CONT’D This is followed by an inflammatory response producing a path of exudates. The toxins are absorbed and distributed by the blood stream or lymphatic to many parts of the body, but has the affinity for the heart, nervous and renal tissue.

19. CONT’D The membrane is produced by the bacilli and is white or gray and it forms mainly on the throat and nose causing hoarse brassy cough with stridor or respiratory distress.

20. IMAGE OF THE MEMBRANE

21. IMAGE OF A MEMBRANE

22. IMAGE OF SKIN DIPTHERIA

23. Clinical features It has Local and systemic manifestations which depend on the site and extent of the characteristic membrane of the diphtheria {false membrane ).

24. CONT.. Swollen neck glands- due to infection localisation of infection in upper airway. Nasal discharge and congestion in the case of nasal diptheria Pain when swallowing due to lesions on pharynx Pallor (skin is pale)/Listlessness; due to poor oxygen perfusion

25. CONT.. Bull neck - in about 10% of cases the neck will become very bloated; this is informally referred to as bull neck because of the inflammatory process in the upper airway. Sore throat: because of bacteria invasion in the lining of the throat. Low-grade fever: due to the infection and toxins produced

26. CONT.. Loss of appetite : as a psychological effect of dysphagia Enlarged lymph nodes located in the neck, attempt to fight infection A greyish coloured membrane : may form over the nose, throat and tonsils blocking the airway and making it difficult to swallow. Persons may develop a barking cough and death is likely when this occurs.

27. Management Diagnosis History This may be history of illness from the parents or patient Physical examination This is clinical and based on the   distribution and appearance of the sore around the throat.

28. LAB findings Swabs from the site of characteristic membrane for culture reveals the diphtheriae bacilli . Presumptive rapid diagnosis in which methylene blue and Gram stain or immune fluorescent staining is done on the throat cultures to detect the bacteria

29. LAB CONT … Cardiac enzyme, serum aspartate transaminase (AST) helps to detect myocarditis. Immunological demonstration of toxin A subunit in vitro by Elek plate test. WBC Count reveals moderate leukocytosis and thrombocytopenia

30. MEDICAL TREATMENT Antibiotics: Erythromycin 30-50mg/kg/day in 4 divided doses Action: it suppresses protein synthesis by binding to ribosomal subunit of susceptible bacterial cell. Side effects : vomiting, diarrhoea, stomatitis, heartburn, vaginitis, moniliasis, anaphylaxis, hepatotoxicity, nephrotoxicity. contraindications : anaphylaxis

31. Treatment cont.. Nursing indication : 1. Assess patient for previous sensitivity. 2. Assess bowel pattern daily. 3. Assess for overgrowth of infections. Ampicillin : Dose : 25-100mg/kg/day in 4 divided doses Action : it interferes with cell wall replication, of susceptible organisms, the cell wall rendered osmotically unstable, swells and bursts from osmotic pressure.

32. Treatment Cont.. Side effects : hallucinations, anxiety, depression, twitching, coma, seizures. Contraindications : hypersensitivity Paracetamol 15mg/kg body wt .

33. Nursing care W ith the general nursing care, the following specific nursing care applies : Admit to isolation facility Supportive care such 0 2 therapy is given especially in obstruction . Oxygen therapy: 1 -2 litres per minute is given to promote perfusion at cellular level, by nasal catheter.

34. Administer antitoxins and antibiotic i.e. x-pen I.V . Psychological care : emotional support needed to both child and parent/caretaker especially that the disease is likely to affect the airway.

35. NRS CARE CONT.. Barrier nursing care - Individuals with diphtheria must be isolated for one to seven days or until two successive cultures show that the individuals are no longer contagious. Children placed in isolation are usually assigned a primary nurse for emotional support .

36. NRS CARE CONT.. Bed rest with intensive nursing care : This is very important for recovery. Fluid therapy: Supplemental fluids are given, such as ringers lactate 3O ml/kg in 24 hrs in divided.

37. NRS CARE CONT.. Cutaneous diptheria : cleanse the wound thoroughly with soap and water and giving individual antibiotics for ten days. Laryngeal diptheria : keep in a high humidified environment. They may also need throat suctioning or emergence surgery if the airway is blocked.

38. NRS CARE CONT.. Continuous monitoring : For heart and other complications is important because diptheria toxin can affect the heart. Vital signs of temperature, pulse and respirations should be done 2 hourly in the acute stage and four hourly when stable. Activity : Facilitate mild to moderate activity to promote quick recovery. Allow for activity in accordance with child’s state of health and balance with rest.

39. CONT’D Monitor and treat arrhythmia as a result of myocarditis Notify local public health authorities Immunization schedule : It is given as a pentavalent vaccine in the form of (DPT-Hib-Hep B) At six weeks of life Four weeks from the first vaccine Four weeks from the second vaccine

40. Prevention Diphtheria vaccine Erythromycin prophylaxis for close contacts prognosis.

41. Prognosis Diphtheria treated or untreated may end fatally Death often occurs in children less than 4 years

42. Complications Laryngeal obstruction Myocarditis with CCF Peripheral neuritis Respiratory paralysis bronchopneumonia

43. EVALUATION What is diptheria? What are the risk factors for acquiring diptheria? What is the pathophysiology of diphtheria? What are the signs and symptoms of diptheria? How would you manage a case of diphtheria? How is the vaccination of diptheria given in Zambia? What are the complications of diphtheria?

44. SUMMARRY We have looked at diphtheria, an acute infectious disease caused by agram positive bacillus. The most affected patients are those of first 10 years of life. We discussed the management and treatment. We said prevention is by Diphtheria vaccine and Erythromycin for those in close contact . The possible complications maybe ,Laryngeal obstruction , Myocarditis with CCF and others.

45. ASSIGNMENT :   Read on Barrier Nursing

46. REFERNCE : Hull David and Johnston Dereck (2008 ). Essential Paediatrics 4 th edition. Churchill, Livingstone. Kurma P and Clarke M (2007) Clinical Medicine , 7 th Edition, Elsevier Saunders, Madrid, Spain, Pg 64 – 68. Skidmore-Roth L. (2007 ) Mosby’s Drug Guide for Nurses , Elsevier, New Yolk, USA Pg 379-384 http ://www.medindia.net/patients/patientinfo/diphtheria_d iagnosis.htm Accessed on 25th January,2021 at 9PM.

47. THE END