Diphtheria is an acute bacterial infection caused by Corynebacterium diphtheriae that affects the throat and tonsils. It produces a toxin that can damage organs like the heart and kidneys. Symptoms include a gray membrane in the throat and swollen lymph nodes. It is diagnosed through culture and history. Treatment involves antitoxin and antibiotics. Immunization through the DTaP vaccine is recommended in a series of doses for children and boosters every 10 years to prevent spread through respiratory droplets. Preventive measures include isolation, disinfection, immunization and treating carriers.

1. Unit III
Disorders spread by Droplet
Infection
Diphtheria
Sartaj Aziz Lecturer FUCN

2. OUTLINE
By the end of the session learners will be able to:
🞭 Define Diphtheria
🞭 Describe epidemiological triad, chain of infection
and web of causation.
🞭 Explain Pathophysiology, clinical manifestations,
and preventive measures.
🞭 Discuss the nursing process of a client in hospital
and community settings.
🞭 Discuss the role of a CHN in the prevention and
control of the disease

3. WHAT IS DIPHTHERIA?
“An acute bacterial disease primarily involving tonsils,
pharynx, larynx, nose, occasionally other mucous
membranes or skin and sometimes conjunctivae or vagina.”
(Wint, 2015; M Lo, 2015; Disease Manual)
InfectiousAgent:
 Corynebacterium diphtheria (nonencapsulated, nonmotile,
gram-positive bacillus)
Exotoxins are released when the corny
bacteriophage contains diphtheria toxin
genes.

5. 🞭 3 isolated strains of C. Diphtheria include gravis,
intermedius, and mitis, and are capable of producing
toxins.
🞭 Intermedius is responsible for systemic infection.
🞭 Exotoxins cause severe URTI, localized cutaneous
infections, and rarely systemic infection.
Occurrence:
🞭 Cold and winter months
🞭 Non immunized children and adults.
🞭 Low socio economic conditions
🞭 Over crowding
🞭 Immuno compromised states

6. Reservoir: Humans
Mode of Transmission:
🞭 Contact with a patient or carrier
🞭 Cough or sneeze of infected person
🞭 Rarely, contact with articles soiled with discharges from
lesions of infected people (cup or used tissue)
🞭 Raw milk has served as a vehicle.
Incubation Period
Usually 2–5 days, occasionally longer.
Person can transmit infection upto 6 weeks after initial
infection.

7. Period of Communicability:
🞭 Usually 2 weeks or less, seldom more than 4 weeks.
🞭 Until virulent bacilli have disappeared from discharges
and lesions.
🞭 Effective Antibiotherapy promptly terminates bacteria.

8. PATHOPHYSIOLOGY
🞭 Corynebacterium diphtheria adheres to mucosal epithelial
cells
🞭 Exotoxin, released by endosomes, causes a localized
inflammatory reaction followed by tissue destruction and
necrosis.
🞭 The toxin is made of two joined proteins.
🞭 The toxins spread through bloodstream and cause a thick,
gray coating to form in the: Nose, Throat, Tongue,
Airway.
🞭 Toxins can also damage other organs, including the heart,
brain and kidneys. This can lead to potentially life-
threatening complications, such as myocarditis, paralysis,
or kidney failure, heart block, and CCF.

9. SYMPTOMS OF DIPHTHERIA
🞭 Asymmetrical thick, grayish white coating on the throat
and tonsils.
🞭 Fever and chills
🞭 Swollen glands in the neck
🞭 Loud, barking cough
🞭 Sore throat
🞭 Bluish skin
🞭 Drooling
🞭 Swelling and edema of neck with tracheal airway
obstruction
🞭 General feeling of uneasiness or discomfort.

10. Additional symptoms may occur if infection progresses
includes:
🞭 Dyspnea or Dysphagia
🞭 changes in vision
🞭 slurred speech
🞭 signs of shock, such as pale and cold skin, sweating, and
a rapid heartbeat
🞭 In nasal diphtheria: one sided nasal discharge
🞭 Diphtheria of the skin usually causes ulcers and redness
in the affected area.

11. HOW IS DIPHTHERIA DIAGNOSED?
🞭 History
🞭 Assessment: check for swollen lymph nodes.
🞭 Gray coating on your throat or tonsils.
🞭 Nose and Throat culture
🞭 Differential diagnosis of bacterial (especially
streptococcal) and viral pharyngitis.
🞭 Presumptive diagnosis is based on observation of an
asymmetrical greyish white membrane, extending to
the uvula and soft palate associated with tonsillitis,
pharyngitis or cervical lymphadenopathy, or a
serosanguineous nasal discharge.

12. TREATMENT
🞭 First step of treatment is an antitoxin injection.
🞭 This is used to counteract the toxin produced by the
bacteria.
🞭 Antibiotics, such as erythromycin and penicillin,

13. IMMUNIZATION
🞭 DTaP vaccine is a single shot along with Tetanus and
Pertusis vaccines given in a in a series of five shots. It’s
given at the following ages:
🞭 2 months (6 wks)
🞭 4 months (10 wks)
🞭 6 months (14 wks)
🞭 12 to 18 months
🞭 4 to 6 years
🞭 Vaccines only last for 10 years. A toxoid booster is
required at age 11-12 and every 10 years thereafter as
immunity declines after certain time.

14. PREVENTIVE MEASURES
🞭 Immunization (Diphtheria Toxoid, Tetanus Toxoid and
either acellular pertussis antigens (DTaP) or whole cell
pertussis vaccine (DTP).
🞭 Formulations that combine diphtheria and tetanus
toxoid, whole cell pertussis, and Haemophilus influenzae
type b vaccine (DTP-Hib).
Recommended Immunization Schedule
🞭 Primary doses IM at 6, 10 and 14 weeks of age with a
DTP booster at 18 months to 4 – 5 yrs.
🞭 If the 4th dose is given after the 4th birthday, then pertussis
component of DTP is contraindicated, diphtheria and
tetanus toxoids for children (DT) should be substituted.

15. For 7 years and above:
🞭 A reduced concentration of diphtheria toxoid (adult Td) is
usually given after 7th year as booster doses.
🞭 For unimmunized individual: 3 doses of adsorbed
tetanus and diphtheria toxoids (Td) is advised. 2 doses at
4- to 8-week intervals and the third 6 months to 1 year
after the second dose.
🞭 HCP should be fully immunized and receive a booster
dose of Td every 10 years.
🞭 Strict Isolation for Pharyngeal Diphtheria and contact
isolation for cutaneous diphtheria.
🞭 Situations where culture is impractical, isolation may
end after 14 days of appropriate antibiotic therapy.

16. 🞭 Disinfecion of all articles directly in contact with the
patient.
🞭 Regardless of immunization status, single dose of
Benzathine Penicillin or a 7–10 day course of
Erythromycin (PO, 40 mg/kg/day for children and 1
gram/day for adults) is recommended.
🞭 People handling food and school children should be given
off until nose and throat C/S are negative.
🞭 Prophylactic treatment of carriers: A single dose of
benzathine penicillin G (IM) (600 000 units for persons
under 6 years and 1.2 million units for persons 6 or older)
or a 7–10 day course of erythromycin (PO, 40 mg/kg/day
for children and 1 gram/day for adults) has been
recommended.
🞭 If culture is positive, treat as patients

17. IN EPIDEMICS…..
🞭 Immunize infants and pre school children.
🞭 In adults, immunize high risk group.
🞭 Repeat immunization procedures
🞭 1 month later to provide at least 2 doses to recipients.
🞭 International measures: People travelling to or
through countries where either pharynheal or cutaneous
diphtheria is common should receive primary
immunization if necessary, or a booster dose of Td for
those previously immunized.

18. REFERENCES
🞭 Control of Disease Manual. Retrieved from
http://navybmr.com/study%20material/CCDM.pdf
🞭 Wint, C. (2015). What is Diphtheria? Retrieved from
http://www.healthline.com/health/diphtheria#Overview1
🞭 M Lo, B. (2015). Diphtheria. Retrieved from
http://emedicine.medscape.com/article/782051-overview#a5