Diphtheria is caused by Corynebacterium diphtheriae and presents with a sore throat and formation of a gray membrane in the throat. Pertussis or whooping cough is caused by Bordetella pertussis and presents in three stages including coughing fits. Tetanus is caused by Clostridium tetani spores entering wounds and producing a neurotoxin resulting in painful muscle spasms. Vaccines exist to protect against all three diseases.

1. Diphtheria.Pertussis.Tetanus

2. Diphtheria
 Caused by Corynebacterium
diphtheriae
 An aerobic gram-positive bacillus
 Man-to-man transmission
 Incubation period- 2-5 days
 Primarily a disease of children
 75% children immune by 10 years
 Involves respiratory mucous membrane

3. Clinical manifestation
 Tonsillopharyngeal, laryngeal, nasal &
tracheobronchial involvement
 s/s- fever with systemic toxicity, sore throat,
dysphagia, hoarseness, rhinorrhea, cough, Cxal LNE
 Characteristic pseudomembrane over tonsils, that
bleeds on attempt to remove
 Complication- local or toxin mediated
 Respiratory obstruction
 Myocarditis- arrythmias &/or heart failure
 Polyneuritis- IX/X Cr. n., proximaldistal weakness, distal paresthesias
 Pneumonia

4. Management
 Diagnosis- mostly empirical, based on s/s
± pseudomembrane
 Diphtheria antitoxin- horse antiserum
 IV infusion over 60 mins
 20,000100,000 units, depending on severity
 Watch for serum sickness
 Antibiotics- macrolide or penicillin
 Macrolide or Rifampicin for carriers
 Vaccination- toxoid- DPT/DT/Td

5. Pretussis- whooping cough
 Caused by Bordetella pertussis
 A gram-negative coccobacillus
 Man is the only host
 Transmitted by airborne respiratory
secretions from an infected individual
 No carrier state
 Incubation period- 7-10 days

6. Clinical manifestation
 3 stages- clasically
 Catarrhal- non-specific URTI, most infectious, x 1-2 wk
 Paroxysmal- bouts of severe cough (whoop),
more at night, x 2-4 wk
 Convalescent- less intense cough, not infectious, 3-4 wk
 In adults- prolonged bronchitis
 Complications-
 Pneumonia, commonly due to secondary bacterial infection
 Seizures, encephalopathyFND
 Otitis media
 Hemorrhage, due to severe cough

7. Management
 Diagnosis-
 Markedly increased TLC, with lymphocytosis
 B. pertussis from nasopharyngeal swab
 Treatment-
 Supportive care
 Antibiotics early- macrolide or co-trimoxazole
 Prophylaxis with macrolide for contacts
 Vaccination-

Adsorbed whole-cell vaccine, part of DPT

8. Tetanus
 A neurologic disorder, characterised by
increased muscle tone & spasms
 Caused by tetanospasmin, a toxin produced
by Clostridium tetani
 C. tetani- a motile anaerobic gram-positive
bacillus with a terminal spore
 Sporadic disease, caused by contamination
of wound with spores, that germinate under
suitable conditions, to produce neurotoxin
 Infectionsymptom- ~7 days

9. Clinical manifestation
 Progressive skeletal muscle involvement
 Trismus, dysphagia
 Rigid abdomen, stiff proximal limb muscles (hands/feet- spared)
 Facial grimace
 Arched back- opisthotonus
 Paroxysmal painful generalized spasms
 Complications-
 Sympathetic overactivity
 Pneumonia
 Fractures
 Asphyxia

10. Management
 Diagnosis- clinical
 Treatment-
 Supportive care
 Wound care
 Antibiotic- Penicillin or Clindamycin
 Antitoxin- Tetanus immunoglobulin
 Diazepam & neuromuscular blockade with mech. vent.
 Course- 4-6 weeks, with complete recovery
 Prognosis- early disease with short course
has poor prognosis
 Vaccine- DPT in children & Td in adults