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Diptheria is an acute infectious disease caused by a bacteria which produces generalized and localized symptoms following the production of a toxin. The disease occurs usually in either pre-winter or late autumn months and could be endemic or epidemic Because of improved immunization procedures the disease is rare in the developed world but still occurs on a mild to moderate scale in the underdeveloped countries.
Man is the reservoir for this infection which is caused by a bacteria known as Corynebacterium diptheriae. The disease is contagious and spreads through droplet infection, a direct contact with the discharges and skin lesions of a person suffering from it. Unpasteurized milk is also recognized as an agent of diptheria.
The incubation period is generally 1-6 days with the point of entry being the nose or mouth, sometimes the eyes, skin or genital mucosa. The bacilli are often localized on the mucosa of the upper respiratory tract.
In untreated cases the infective period is about two weeks.
The symptoms of the disease are caused by the toxin liberated by the bacteria. The toxin spreads its devastating effects via the blood stream. It can damage an organ or tissue, but commonly targets the heart, kidneys and the nervous system.
The severity of the disease depends on first, the site of infection; second, whether the person has been immunized or not; finally, whether the disease process has been there long enough for the toxin to circulate.
Diptheria is rarely seen in the first six months of life as the infant has maternal antibodies. It is a disease found more often in the 2-10 years age group.
In cases where the nose is involved there is hardly any fever or malaise, the only symptom being a running nose where the discharge is first thin and watery, and when the membrane forms on the septum, pink or blood-stained. Diptherial infection is marked by a membrane forming on the site of the lesion, which is grey and the surrounding area a dull red. The surface underneath the membrane is not intact but has debris of necrotic material.
This nasal discharge is most infective. A membrane anywhere else on the mucosal surface of the respiratory tract causes blockage and respiratory distress which is dangerous to life. The initial symptoms of this type of infection are fever, anorexia, headache, and sore throat which rapidly develops into respiratory distress. A patient, particularly a child, may breathe with his mouth, getting more and more restless as time passes. The face becomes puffy, vomiting starts and the child refuses feeds. The pulse is rapid and the face starts to cyanose (become blue). This is an emergency.
Presence of the pseudomembrane in the nose and throat is suggestive of diptheria. The bacteria can be isolated from the lesions and cultured.
Treatment of diptheria is by neutralization of the circulating toxin with antitoxin and antibiotics to eradicate the bacteria.
Diptheritic myocarditis develops in a quarter of the patients suffering from diptheria. It is one of the most serious complications of diptheria and is a common cause of death.
The antitoxin is a serum prepared from horse serum. A sensitivity test has to be done first as some patients may be allergic to the horse serum. Serum now available is made from human sources. However it is best to check instructions and to be given a skin sensitivity dose. There are different regimens for administration of this antitoxin, which the attending physician decides on.
Antitoxin has to administered first—antibiotics cannot replace it. The antibiotics used for eradicating the bacteria are erythromycin or penicillin G.
Treatment is considered complete and successful after cultures for the organism turn negative.
• ECG to monitor if the heart is intact and not involved.
• Respiratory tract observation—that there are no signs of involvement.
• Patients of diptheria require immunization following recovery.
(Drugs mentioned above to be taken on medical prescription only.)
Children up to the age of seven years should receive the DPT schedule. Five doses of DPT vaccine, starting at two, four and six months with a booster dose at 15 to 18 months and at the school-going age of 4-6 years. Booster doses should be given at ten-year intervals with the adult dosages.
Contacts should have their nasal secretions cultured to eliminate the possibility of being infected. If so, they should be treated with penicillin or erythromycin.
Those contacts whose immunization status is not known should be given antibiotic treatment first and after the course is completed, be immunized.
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