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GOOD EVENING<br />
DIPHTHERIA <br />PATHOGENESIS ,DIAGNOSIS<br /> &TREATMANT<br />Presented by-<br />Subrata Das<br />
Biological Features<br />Corynebacteriumdiphtheriae<br /><ul><li>Toxigenic or non toxigenic (lysogenic conversion; infecte...
specially in children
spread by droplets
secretions
direct contact
Poor nutrition
Crowded or unsanitary living conditions
Low vaccine coverage among infants and children
Immunity gaps in adults
Incubation period -2 to 10</li></li></ul><li>Pathogenesis of diphtheria<br />includes two distinct phenomena:<br />1. Inva...
Pathogenesis of diphtheria<br />Mechanism of action<br />Diphtheria Toxin <br /><ul><li>Component :A/B fragment, joined by...
Toxin diffuses throughout body via blood - Cardiac, neurologic complications - Heart/respiratory damage, paralysis </li></...
May involve any mucous membrane
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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

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

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

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