Diagnosis and Management

an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic Gram-positive bacterium. Diphtheria is a contagious disease direct physical contact or breathing the aerosolized secretions of infected individuals

Has largely been eradicated in industrialized nations through widespread vaccination.

Depends upon 1 Location Immunity Toxin circulating in blood Incubation 2-5 days (1-10 days), skin 7 days 1. Low Grade Fever 2. Sore throat 3. Nausea, voiting, rhinorrhea

According to infection site Anterior nasal Tonsil and pharynx Larynx Skin Others ( concjunctiva, canalis auriculus)

Physical Examination Mucous edematous, pseudomembrane Submandibula edema, Bulls neck,

Cardiovascular Neurological Manifestation

Direct Specimen ( methylene blue, Gram) Negative result didnt rule out diagnosis

Loeffler media, Tellurite, Tindale The colonies of C. diphtheriae are small, granular, grey, smooth, and creamy with irregular edges Distinguish 3 types toxigenic strain

Filter paper saturated with diphtheria antitoxin

Resuls: After 48 hrs incubation, the antitoxin diffusing from filter paper strip and the toxigenic strains produce exotoxin, which diffuses and resulted in lines four precipitation lines radiating from intersection of the strip and the growth of organism

Lines of precipitations

Inoculated M.O.

Positive Eleks Test

General Management Isolation room, bed rest Severe casesICU setting obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later seril EKG Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles

Elimination bacillus Toxin Neutralization 1 Nasal/ Faucium mild cases ADS 20-40.000 U iv 2. Faucium moderate ADS 40-60.000 U iv 3. Severe ( bullneck) ADS 80.000- 120.000

Sensitivity test 0,05 cc ADS+ 1cc NS + if Urticaria diametre -1cc Bedreska

0,05cc ADS + NS =1cc, sc. 0,1cc ADS + NS=1cc sc. 0,2cc ADS sc 0,5cc ADS im 1cc ADS im 2cc ADS im 4cc ADS im. 4cc iv until appropriate dose. Interval 15-20 minutet. Observation vital sign s

Antibiotis Penicillin Procain 1200.000 U/day im, bid, 14 days Erythromycin 40 mg/ kgBW/ day po, qid, 14 days Ampicillin, Clindamycin

Booster, Vaccination Chemoprophylactic Penicillin Procain 1200.000 U/day im, bid, 7 days Erythromycin 40 mg/ kgBW/ day po, qid, 7 days ADS 10.000 U im