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Diphtheria Revised May 2007 Dr. Sarma R V S N Consultant Physician.
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Transcript of Diphtheria Revised May 2007 Dr. Sarma R V S N Consultant Physician.
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Diphtheria
Revised May 2007
Dr. Sarma R V S NConsultant Physician
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Diphtheria
Greek diphthera (leather hide)Caused by Aerobic Gram +ve rods Cornyebacterium diphtheriaeExotoxin production only if
infected by virus phage infected carrying toxin gene
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Gram +ve Bacilli and Colonies
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Diphtheria Epidemiology
Reservoir Human carriers Usually asymptomatic
Transmission Respiratory Skin and fomites rarely
Temporal pattern Winter and spring
Communicability Up to several weekswithout antibiotics
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Diphtheria Clinical Features
Incubation period 2-5 days (range, 1-10 days)
May involve any mucous membraneClassified based on site of infection
anterior nasalpharyngeal and tonsillar laryngealcutaneousoculargenital
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Pharyngeal and Tonsillar Diphtheria
Insidious onset of exudative pharyngitisExudate spreads within 2-3 days and may
form adherent pseudo membraneMembrane may cause respiratory
obstructionFever usually not high but patient appears
toxic
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Thick Membrane
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Pseudo membrane
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‘Bull Neck’
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Skin Lesions
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Diphtheria Complications
Mostly attributable to toxinSeverity generally related to extent of local
diseaseMost common complications are myocarditis
and toxic neuritis with palsyDeath occurs in 5%-10% for respiratory
disease
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Diphtheria Antitoxin (DAT)
Produced in horsesFirst used in the U.S. in 1891Used only for treatment of diphtheriaNeutralizes only unbound toxin
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1940 1950 1960 1970 1980 1990 2000
Cas
esDiphtheria – in USA, 1940-
2005*
Year*2005 provisional total
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DTaP, DT, and Td
DTaP, DT
Td, Tdap (adult)
Diphtheria7-8 Lf units
2-2.5 Lf units
Tetanus5-12.5 Lf units
5 Lf units