Diptheria

 

Clinical features:

 

• Incubation period 2-5 days (range, 1-10 days)
• May involve any mucous membrane
• Classified based on site of infection
• Anterior nasal
• Tonsillar and pharyngeal
• Laryngeal
• Cutaneous
• Ocular
• Genital
• Pharyngeal & Tonsillar Diptheria
• Insidious onset of exudative pharyngitis
• Exudative spreads over 2-3 days and may form adherent membrane
• Membrane adherent to pharynx and may cause respiratory obstruction
• Fever usually not high but patient appears toxic

 

Complications:

 

• Most complications and death attributed to toxin
• Severity of complications generally related to extent of local disease
• Most common complications are myocarditis and neuritis

i)Ý Myocarditis- abnormal cardiac rhythms can occur, leading to heart failure. If occurrence is early, it is often fatal

ii) Neuritis- this complication affects motor nerves and usually clears completely. Paralysis of the soft palate can frequently be seen in the third week of the illness. Paralysis of the eye muscles, limbs, and diaphram can occur after the fifth week of illness. As a result of the diaphramatic paralysis, secondary pneumonia and respiratory failure can occur.

 

iii) Other complications- these include otitis media and respiratory insufficiency as a result of anÝÝÝÝÝÝÝÝÝÝÝ airway obstruction, especially in infants.

 

-death in 5%-10% for respiratory disease, higher in <5 and >40 years of age

 

Diagnosis

 

-culture of lesions is done to confirm diagnosis

-Gram stain and Kenyon stain

 

Treatment

 

Diptheria Antitoxin

…        first used in 1891

…        produced in horses

…        used only for treatment of diptheria

…        neutralizes only unbound toxin

Antibiotics

…        Ýerythromycin taken orally or by injection