Diphtheria

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What is diphtheria?

Diphtheria is a bacterial disease caused by Corynebacterium diphtheriae. The infection commonly affects the throat and may lead to obstruction of the airways and death. Exotoxin-induced damage occurs on organs such as the heart. Nasal diphtheria may be mild, and chronic carriage of the organism frequently occurs; asymptomatic infections are common. Transmission occurs from person to person, through droplets and close physical contact, and is increased in overcrowded and poor socioeconomic conditions. A cutaneous form of diphtheria is common in tropical countries and may be important in transmission of the infection.

How does Diphtheria occur?

Diphtheria affects people of all ages, but most often it strikes unimmunized children. In temperate climates, diphtheria tends to occur during the colder months. In 2000, 30 000 cases and 3000 deaths of diphtheria were reported worldwide.

What are the symptoms of Diphtheria?

The symptoms of diphtheria usually begin two to seven days after infection. Symptoms of diphtheria include fever, chills, fatigue, bluish skin coloration, sore throat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foul-smelling bloodstained nasal discharge and lymphadenopathy. Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.

How can Diphtheria be treated?

Patients with severe cases will be put in a hospital intensive care unit and be given a diphtheria antitoxin. Diphtheria antitoxin is hyperimmune serum produced in horses. Plasma obtained from healthy horses with diphtheria toxin is enzyme refined, purified and concentrated. The antitoxin has the specific capacity of neutralizing the toxin secreted by Corynebacterium diphtheriae, the causative organism of Diphtheria. Antitoxin will only neutralize circulating toxin that is not yet bound to tissue, thus prompt administration is critical. Delayed administration increases the risk of late effects such as myocarditis and neuritis.

Before antitoxin is administered, the patient should be tested for sensitivity to horse serum and if necessary, desensitized. The dose of antitoxin to be administered depends upon the site and extent of the diphtheritic membrane, the degree of toxicity and the duration of illness. Prevention: Toxoid as DTP, DT or Td – at least three primary doses given by the intramuscular route.