Diphtheria

Notes

## Basic introductiona

  • It is caused by the bacterium Corynebacterium diphtheria.
  • There are two types of diphtheria: the type that causes infections of throat and tonsils and another type that causes ulcers on the skin
  • It is most common in unimmunized children

## Statistics

  • Prior to the introduction of its vaccine, diphtheria was a major cause of illness and death among children
  • 30 000 cases and 3000 deaths of diphtheria were reported globally in 2000a
  • 321 cases of diphtheria were reported globally to the WHO in 2014

## Means of transmission

  • Droplet infection (most common)
  • Contact
  • Dairy products
  • Contaminated clothes

## Pathophysiology

  • Corynebacterium diphtheria produces a polypeptide exotoxin that inhibits protein synthesis, causing local tissue necrosis.
Symptoms
  • It can be asymptomatic
  • Weakness
  • Sore throat
  • Hoarseness of voice
  • Loss of voice
  • Fever
  • Inflammation of nerves (neuritis)
  • Cervical lymphadenopathy
  • Thick and gray coating ("pseudomembrane") covering tissues in the nose, tonsils, larynx, and throat
  • Sometimes, barking cough as in croup due to the blocking of the airway by “pseudomembrane”
  • Difficulty in breathing and swallowing
  • Sometimes foul odor
  • Cutaneous diphtheria

_ Pain on the skin

_Tenderness

_Erythema

_Ulceration

## Complications

  • Myocarditis
  • Inflammation of nerves (neuritis)
  • Renal disorders
  • Bleeding disorders such as thrombocytopenia
Diagnosis
  • Clinical review
  • Culture and sensitivity (special media)
  • Detection of toxin (Elek test) – though not readily available
Differential
  • Acute epiglottitis
  • Streptococcus pyogenes pharyngitis
  • Infectious mononucleosis
  • Staphylococcal or streptococcal impetigo
  • Acute necrotizing ulcerative gingivitis (Vincent's angina)
Prevention
  • Diphtheria vaccine
Reference
  1. World Health Organization. (2005). Immunization, vaccines and biologicals: 2002-2003 highlight
  2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf
Management
  • Antitoxin
  • For children : Susp Erythromycin 10mg /kg QID X 2/52
  • For adults : Tabs Erythromycin 500mg QID X 2/52
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