DIPHTHRERIAE,clinical features of dipthreria,diagnosis of dipthreria,treatment of dipthreria,immunization of dipthreria,immunization

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DIPHTHRERIAE,clinical features of dipthreria,diagnosis of dipthreria,treatment of dipthreria,immunization of dipthreria,immunization

DIPHTHRERIAE,clinical features of dipthreria,diagnosis of dipthreria,treatment of dipthreria,immunization of dipthreria,immunization

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  • 1. GOOD EVENING
  • 2. DIPHTHERIA
    PATHOGENESIS ,DIAGNOSIS
    &TREATMANT
    Presented by-
    Subrata Das
  • 3. Biological Features
    Corynebacteriumdiphtheriae
    • Toxigenic or non toxigenic (lysogenic conversion; infected by Beta phage)
  • Pathogenesis of diphtheria
    Transmission & risk factors
    • solely among humans
    • 4. specially in children
    • 5. spread by droplets
    • 6. secretions
    • 7. direct contact
    • 8. Poor nutrition
    • 9. Crowded or unsanitary living conditions
    • 10. Low vaccine coverage among infants and children
    • 11. Immunity gaps in adults
    • 12. Incubation period -2 to 10
  • Pathogenesis of diphtheria
    includes two distinct phenomena:
    1. Invasion of the local tissues of the throat, which requires colonization and proliferation
    2. Toxigenesis: bacterial production of the toxin. The diphtheria toxin causes the death eukaryotic cells and tissues by inhibition protein synthesis in the cells. The toxin is responsible for the lethal symptoms of the disease.
  • 13. Pathogenesis of diphtheria
    Mechanism of action
    Diphtheria Toxin
    • Component :A/B fragment, joined by S-S bond - A (catalytic domain)
    - B (transmembrane and receptor binding domains)
    • Receptor: heparin-binding epidermal growth factor - rich on cardiac cells and nerve cells
    • 14. Toxin diffuses throughout body via blood - Cardiac, neurologic complications - Heart/respiratory damage, paralysis
  • Diphtheria Clinical Features
    • Early stages: Sore throat. Low fever. Swollen neck glands.
    • 15. May involve any mucous membrane
    • 16. Late stages: Airway obstruction and breathing difficulty. Shock
    • 17. Toxin causing myocarditis, polyneuritis, renal tubular necrosis and other systemic toxic effects.
    • 18. Classified based on site of infection
    anterior nasal
    pharyngeal and tonsillar
    laryngeal
    cutaneous
    ocular
    genital
  • 19. Pharyngeal and Tonsillar Diphtheria
    • Exudate spreads within 2-3 days and may form “wash leather” elevated grayish- green membrane on the tonsil with inflammation
    • 20. Removal leads to bleeding edematous submucosa
    • 21. Insidious onset of exudative pharyngitis
    • 22. Membrane may cause respiratory obstruction & aspiration of the membrane
    • 23. Fever usually not high but patient appears toxic
    • 24. Lymphadenopathy with Bull neck appearance in severe cases
  • Diagnosis
    • Clinical:
    • 25. Muscle weakness, neck rigidity
    • 26. edema
    • 27. a pseudomembranous material in the upper respiratory tract characterizes
    • 28. Laboratory:
    • 29. Culture in the tellurite agar /loeffler’s serum
    • 30. Demonstration of the organism by the albert or methyl-blue stain
  • Treatment & Management
    Methods of Control:
    A. Preventive measures:
    Vaccination
    Public education
    Others
    B:Control of patients, contacts and environment:
    C. Epidemic Measures:
    Prompt reporting
    IG for outbreaks
    Priorities if short of vaccine
  • 31. Management of a emergency case
    DAT and antibiotics(Penicillin G/Roxithromycin) to be started immediately without waiting for lab results.
    Rest and observation, to cover the period of potential cardiac damage and paralysis
    Avoid limbs deformity , ensure joint mobility.
    Tracheostomy and artificial respiration
    Isolation :
    Strict for pharyn. dipth.
    Contact isolation for cutaneous dipth
  • 32. Control and Prevention
    Preventive Measures:
    1- Active immunizatn. with diph. toxoid, including an adequate program to maintain immunity
    Triple Antigen DPaT.
    Routine DTaP Primary Vaccination Schedule
    Dose
    Primary 1
    Primary 2
    Primary 3
    Primary 4
    Age
    2 months
    4 months
    6 months
    15-18 months
    Interval
    ---
    4 wks.
    4 wks.
    6 months
  • 33. Control and Prevention
    Active protection should be maintained by administering a dose of “Td every 10 yrs.” thereafter, (esp. for persons who are at higher risk to pt. exposure e.g. health workers
    Educational measures:
    To inform the public and esp. parents of young children of the hazards of diphtheria and the imp. of immunization.
  • 34. Thank you
  • 35. Questions?