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Diphtheria
• An acute infection by Corynebacterium
diphtheriae (Klebs-loecffler Bacillus)
• Predominantly in upper respiratory tract
• The patognomonic sign is a
pseudomembran
• grayish-white color, which
contains fibrin and necrotic tissue;
• hard to remove, easily bleeding
1883 : Klebs found the bacteria in
pseudomembran
1884 : Loeffler grew the bacteria
1888 : The bacteria makes toxin
1894 : Von Behring found the antitoxin
1913 : Immunization against the disease
Epidemiology
Figure 24.6
Pathogenesis of Diphtheria
• Encounter – Corynebacterium diphtheriae
encountered only from other people (carriers)
• Entry – respiratory droplets; organism
colonizes pharynx
• Spread
• Multiplication
• Evasion of host immune response –
adhesins; toxin may kill phagocytes
contributing to pseudomembrane
• Damage – inflammation; circulating toxin
• Transmission – aerosolized droplets; fomites
Pathogenesis
4. Cutaneous diphtheria
• the area of auricular, conjunctiva,
• umbilicus, vagina
Toxin
• erythrocyte, leukocyte
Diagnosis
1. Clinical manifestations.
2. Direct preparation / positive culture of
throat swab.
3. Immunization history
Differentials diagnosis
• Nasal diphtheria
• Corpus alienium
• Syphilis congenital
• Faucial diphtheria
• Tonsillitis follicularis (lacunaris)
• Fever
• general conditions
• regional lymph node
• direct preparation / culture
• Angina Plaut Vincent
• fragile membrane, thick, smelly, not easy
bleeding
• direct preparation Bacillus fusciformis
(+ gram)
• Laryngitis diphtheria
• laryngitis acute / laryngo tracheitis
• corpus alienum
Complications
• Cardiovascular system Occurred at the end
of the first week or early of the 2nd week . ECG
abnormality 20%.
• ST-segment mild depression; frequently T-wave
inversion at lead 2 or more.
• Disturbances of conductions (bad prognosis)
• BBB (complete heart block)
• Cardiac Sign
• tachycardia in the beginning.
• myocardium acute inflammation bradycardia
• Myocarditis
• weakness of the 1st heart sound
• heart hypertrophy
• gallop rhythm.
• systolic murmur
• Respiratory systems
– Airway obstruction
– Bronchopneumonia
– Atelektasis
Airway obstruction Tracheotomy
• Dyspnea, cyanosis
• Irritability
• Stridor inspiratory
• Retraction
- epigastrium
- intercostals
- suprasternal
Treatment
1. General
- isolation , good nursing
- observation of the complications
- bed rest total
2. Specific
- A.D.S 100.000 UI
- Antibiotic : PP 50.000 UI/KgBW.
Treatment
Depends on :
1. Age
2. Stadium
3. Localization
4. Bacteria pathogenicity (mitis has lower-
virulency)
Prognosis
5. Antitoxin
BCG 1
HepB 1 2 3
Polio 0 1 2 3
DTP 1 2 3 4 5
Campak 1 2
Hib 1 2 3 4
MMR 1 2
Varisela >10