Diphtheria,symptoms,types ,diagnosis,vaccination and treatment.

1. Diphtheria
Dr Yusuf Imran
J.N Medical college
J.N Medical College
AMU- INDIA

2. INTRODUCTION
• Diphtheria is an highly infectious and
communicable disease characterized by
involvement of the respiratory system , the local
production of membrane and general symptoms
caused by absorption of toxin .

3. Problem Statement
WORLD
Developed countries – rare
Developing countries - endemic
The true number of cases and deaths are
unknown because of incomplete reporting from
most countries.

4. Problem Statement
• India
☺ Endemic Disease
☺ Declining trend due to increasing cover
of immunization .
1987 – 12952
2005 - 10231
Declined by 21%

5. Epidemiological triad
• Agent
( Corny bacterium)
Host Factors Envrnt factors
( Children <5) ( Winter month)

6. Agent
• The causative organism is corny bacterium
diphtheria
 Sources are cases and carriers
 Organism will be present in the nasopharyngeal
secretions, skin lesion discharge, contaminated
fomites and infected dust
 Period of infectivity is 14-28 days from the
onset of diseases

7. Host factors
• Affects children of 1-5 years of age
• It effects both sexes.
Environmental factors
• It is common in winter although it occurs in all
seasons

8. Mode of transmission
• Droplet nuclie
• Infected cutaneous lesions
• Infected object or dust, contaminated with
nasopharyngeal secretions
Direct person- to-person transmission by contact
with respiratory secretions and cutaneous
lesions. Cutaneous lesions are important in
transmission particularly in countries warm
climates.

9. Portal of entry
• Respiratory route
• skin cuts and wounds
Incubation period
2-6 days
Types of diphtheria
• Pharyngotonsillar diphtheria
• Laryngotracheal diphtheria
• Nasal diphtheria
• Cutaneous diphtheria

10. Sign/ symptoms
1. In pharyngotonsillar diphtheria
 Sore throat
 Difficulty in swalloing
 Low grade fever
 In early stages – whitish membrane which can
be wiped off easily over pharynx or tonsil
 Later it becomes thick, blue –white to grey –
black and adherent. It is difficult to remove if
tried to remove it will. Result in bleeding

11.  Mucosal erythema around the membrane
 Edema of submandibular area
 Bull neck appearance

12. 2. Laryngo tracheal diphtheria
 It is preceeded by pharyngotosilar
 hoarseness of voice
 Brassy cough
3. Nasal Diphtheria
 Unilateral or bilateral serosanguineous ( blood
and serous fluid ) discharge from the nose
 Excoriation of upper lip
 Toxemia is minimal

13. 4. Cutaneous diphtheria
 May occasionally involve skin or conjunctiva.

14. Differential diagnosis
 Membranous Tonsillitis
 Vincent’s Angina
 Infectious mononucleosis
 Agranulocytosis
 Leukemia
 Aphthous ulcers
 Traumatic ulcer
 Foreign body (Nasal Diphtheria)

15. Diagnosis
• Schick test
Schick test toxin .2 ml is injected in to forearm as
test arm and in to opposite arm control arm
same amount of inactivated toxin ( IM)
Positive reaction
Test arm- with in 24-36hrs, a circumscribed red
flash of 10-15 diameter. It reaches maximum by
4th
to 7th
day and later on slowly fades in to
brown patch
Control arm-
No change occurs

16. Negative reaction
no reaction on both arm
Pseudo-positive reaction
Test arm- a red flash of size less than true
reaction
Control arm – a red flash of size less than the
positive reaction.
Combined reaction
Test arm- positive reaction
Control arm- pseudo-positive reaction

17. Prevention and control
• Early detection of cases and carriers
• Isolation
• Treatment
 Cases
Diphtheria antitoxins ranging 10,000 to 80,000
units or more are administered iv or im
depending on severity of care
2.5 lakh unit penicillin QID for 5 days
250mg erythromycin QID

18.  Carrier
Oral erythromycin for 10 days
 Contacts
If immunized previously with in 2 year – no action
needed
If immunized long back ( more than 2 years)- DT
booster dose
If not immunized at all- prophylactic benzathine
penicillin or erythromycin + active immunization

19. • Immunization
Combined vaccine
as per national schedule
Note- Vaccine should be kept in 4-8 degree c
Use within a week from day of issue to sub centre

20. • Antiserum
For treatment purposeAnti sera Purpose Dose Route
Diphtheria anti
toxin
prophylactic 500-2000 unit SCor IM
Diphtheria anti
toxin
Treatment 10,000 to
30,000 unit or
40,000 to
1,00,000 unit
( 2 Doses with
an interval of ½
to 2 hrs)
IM
IV

21. Complications
1. Respiratory Failure – Occlusion of the airway
by the membrane.
2. Myocarditis – Occurs by 2nd
week. Can lead to
CHF, arrhythmia or sudden death.
3. Neurological –
 Palatal palsy
 Ocular Palsy
 Loss of accommodation
 Polyneuritis
4. Renal Complications – Oliguria / Proteinuria

22. Summarization
• Diphtheria is a endemic, respiratory tract ,
communicable disease comes under six killer
disease caused by corny bacterium diphtheriae.
• Commonly seen in children less than five years
and in winter season
• Mainly four types . Pharyngotonsilar,
laryngotracheal, nasal and cutaneous .
• Diagnosed by Schick test / Albert stain /
Culture.
• Early detection and treatment is the best way of
prevention and control.

23. Thank YouThank You