| ID | 182 |
|---|---|
| Name | DIPHTHERIA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis: 1. History- nonimmunised; 1-5 years. 2. Clinical feature- clinical diagnosis is very important. 3. Investigations: a. Identification of organism by Albert’s stain. (KLB) b. Culture of swab to isolate bacilli. c. Blood- leukocytosis d. Urine- may show albumin e. ECG- may show evidence of myocarditis |
| Investigations | |
| Management | Management: 1. Absolute bed rest for at least 3 weeks. 2. Inj. A.D.S is to be given immediately. Mild case- 4,000-8,000 units i.m. Moderate case- 16,000-32,000 units i.m. Severe case- 100,000 units i.m. * Sensitivity test must be done before injection and adrenaline, antihistamine, steroid to be kept ready. 3. Antibiotics- i. Inj. Benzylpenicillin 600mg i.m. or i.v 6 hourly for 7 days. Or. ii. Erythromycin 40mg/kg. daily in 4 divided doses if allergic to penicillin. 4. Tracheostomy may be necessary if there is laryngeal obstruction. 5. Aspirin or codeine in the usual doses for relief of pain. 6. Intravenous fluid is administered if dehydration is present and if patient cannot take by mouth. 7. Notify public health authority. |
| Introduction | It is an acute infection caused by Corynebacterium diphtheric characterised by local growth of organism (in the form of membrane) usually in the upper respiratory tract with a wide spread systemic affect by a powerful exotoxin which mainly involve the heart and nervous system. It usually occurs in infants and children (pre- schooler). The incubation period is 2-4 days. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. The child complains of sore throat. Mild to moderate rise of temperature (99-101 °F). Pulse rate is raised. 2. Characteristic feature is the membrane formation. ‘Wash leather’ elevated greyish-green membrane of variable extent on the tonsils with a well-defined edge and surrounded by a zone of inflammation is diagnostic. The membrane is firm and adherent, bleeds on removal. 3. The child is often of toxic looking. The cervical glands are often enlarged and tender due to secondary infection. There may be swelling of the neck (bull neck). 4. In anterior nasal diphtheria there is nasal discharge often tinged with blood. 5. In laryngeal diphtheria, there is husky voice, high pitched cough and a danger of respiratory obstruction. 6. Complexion pale, pulse rapid and poor in volume. B.P low even pt. died from acute circulatory failure. 7. Involvement of nervous system cause, palatal palsy, nasal voice, nasal regurgitation. paralysis of accomodation. 8. A week or later weakness and paresthesia. 9. In tonsilar diphtheria usually causes sore throat, patient becomes ill and apathetic. |
| Preventions | Prevention: DPT vaccine- 0.5 ml i.m injection is given within 6 weeks to 6 months at 1 month interval in 3 doses then booster doses should be given, (pi. see immunisation schedule). |
| Treatment | |
| Complications | Complications: Respiratory system- i. Respiratory obstruction. ii. Husky voice C.V.S- i. Myocarditis. ii. Arrhythmia. iii. Acute circulatory failure. C.N.S- i. Palatal palsy. ii. Loss of accomodation. iii. Poly neuritis. iv. Paralysis of respiratory muscles. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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