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Diphtheria

Diphtheria. Dr. Sarma R V S N Consultant Physician. Revised May 2007. Diphtheria. Greek diphthera (leather hide) Caused by Aerobic Gram +ve rods Cornyebacterium diphtheriae Exotoxin production only if infected by virus phage infected carrying toxin gene. Gram +ve Bacilli and Colonies.

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Diphtheria

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  1. Diphtheria Dr. Sarma R V S N Consultant Physician Revised May 2007

  2. Diphtheria • Greek diphthera (leather hide) • Caused by Aerobic Gram +ve rods • Cornyebacterium diphtheriae • Exotoxin production only if infected by virus phage infected carrying toxin gene

  3. Gram +ve Bacilli and Colonies

  4. Diphtheria Epidemiology • Reservoir Human carriers Usually asymptomatic • Transmission Respiratory Skin and fomites rarely • Temporal pattern Winter and spring • Communicability Up to several weeks without antibiotics

  5. Diphtheria Clinical Features • Incubation period 2-5 days (range, 1-10 days) • May involve any mucous membrane • Classified based on site of infection • anterior nasal • pharyngeal and tonsillar • laryngeal • cutaneous • ocular • genital

  6. Pharyngeal and Tonsillar Diphtheria • Insidious onset of exudative pharyngitis • Exudate spreads within 2-3 days and may form adherent pseudo membrane • Membrane may cause respiratory obstruction • Fever usually not high but patient appears toxic

  7. Thick Membrane

  8. Pseudo membrane

  9. ‘Bull Neck’

  10. Skin Lesions

  11. Diphtheria Complications • Mostly attributable to toxin • Severity generally related to extent of local disease • Most common complications are myocarditis and toxic neuritis with palsy • Death occurs in 5%-10% for respiratory disease

  12. Diphtheria Antitoxin (DAT) • Produced in horses • First used in the U.S. in 1891 • Used only for treatment of diphtheria • Neutralizes only unbound toxin

  13. Diphtheria – in USA, 1940-2005* Year *2005 provisional total

  14. DTaP, DT, and Td Diphtheria 7-8 Lf units 2-2.5 Lf units Tetanus 5-12.5 Lf units 5 Lf units DTaP, DT Td, Tdap (adult)

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