1 / 53

DIPHTHERIA

DIPHTHERIA. Dr. PRACHETH R. Outline. Introduction Magnitude Epidemiology Clinical features Treatment Prevention and Control. Introduction. Greek language : leather Under five Corynebacterium diphtheriae Gradual rise of temperature Greyish-yellow membrane: throat, tonsils.

kendalln
Download Presentation

DIPHTHERIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DIPHTHERIA Dr. PRACHETH R.

  2. Outline • Introduction • Magnitude • Epidemiology • Clinical features • Treatment • Prevention and Control

  3. Introduction • Greek language : leather • Under five • Corynebacteriumdiphtheriae • Gradual rise of temperature • Greyish-yellow membrane: throat, tonsils

  4. Magnitude of the problem • Almost eliminated: developed countries-mass immunization • India: lack –adequate immunization • Around: 4,286 cases and 112 deaths

  5. Agent factors Agent: Corynebacterium diphtheria • Gram-positive , non-capsulated, non-spore forming bacillus. • Appear in pairs, lying: angles- Chinese letter • No invasive power, powerful toxin

  6. Agent

  7. Agent factors Reservoir of infection: man • Human: case/ carrier • Every clinical case: 10 carriers • Temporary or chronic carrier • Nose, throat • Cutaneous >respiratory

  8. Agent factors • Infective materials: nasopharyngeal secretions, discharges: cutaneous lesions, fomites, dust • Period of infectivity: From 2-4 weeks Chronic carriers: one year

  9. Host factors Age incidence: High between 1-5 years • Less in< 6 months • Shift: preschool to school age Gender: equal Immunity: Almost 70 percent: subclinical infection. • More than 85% coverage: herd immunity

  10. Environmental factors • Highest in winter season: indoor life, overcrowding

  11. Modes of transmission • Droplet mode: commonest • Direct contact: cutaneous diphtheria • Indirect: fomites- handkerchiefs, pens, plates, cups

  12. Portal of entry • Commonest: respiratory tract • Occasionally: abraded skin, mucous membrane

  13. Pathology and pathogenesis • Respiratory tract: inhalation • Implant: upper respiratory passage- tonsils, nasopharynx or larynx, multiply-inflammatory reaction • No circulation: no invasive power • Exotoxin: circulation- toxaemia: necrosis • Fibrin clots, necrosed cells (dead/living bacilli, leucocytes): pseudo-membrane (greyish yellow)

  14. Pathology and pathogenesis • They reach lymph nodes: enlarged, tender • Exotoxin: fixed- heart , cranial nerves (glossopharyngeal) • Myocarditis, heart failure • Palatal paralysis, nasal regurgitation • Toxin: lose toxicity-few months

  15. Clinical features • Incubation period: 2-6 days • Disease begins quietly • Gradual rise of temperature, headache, body ache, malaise • Specific features: type

  16. Clinical features Pharyngotonsillar: sore throat, low grade fever, difficult swallowing • Pseuodmembrane • Severe: oedema –submandibular, lymphadenopathy: bull neck Laryngotracheal: hoarseness, fever, cough, dyspnoea

  17. Clinical features • Nasal: mildest form • Cutaneous: secondary infection: abrasion • Patients: seek treatment-lesion

  18. Clinical features

  19. Clinical features

  20. Control of diphtheria Cases and carriers: • Early detection: • Active search: family, school contacts • Swabs: nose, throat • Carriers: culture • Isolation: • At least 14 days • Two consecutive swabs, 24 hours apart

  21. Control of diphtheria • Treatment: • Cases: • Diphtheria Antitoxin : IM/IV -20,000 to 100,000 units • Preliminary test dose: 0.2 ml SC • Mild , early pharyngeal: 20,000-40,000 • Moderate nasopharyngeal: 40,000-60,000 • Severe: 80,000-100,000. • Penicillin/erythromycin: 5-6 days

  22. Control of diphtheria • Carriers: • Ten day : oral erythromycin Contacts • Within 2 years : no action • More than 2 years: booster dose • Non-immunized: prophylactic penicillin/erythromycin, 1000-2000 units • Medical surveillance: one week, bacteriological: several weeks

  23. Control of diphtheria Community: • Active immunization as per National Immunization Schedule • Immunize: maternal immunity lost • Does not prevent carrier state

  24. Vaccination • Combined vaccines • Single vaccines • Antisera: Diphtheria Antitoxin

  25. DPT vaccine (Triple Antigen) • Killed , bacterial , liquid vaccine • Dose: 0.5 ml • Antero-lateral aspect of thigh • Reactions: pain, fever: next day. Rarely: anaphylactic shock, convulsions • Contraindications: convulsions, reaction to previous dose • Storage: 2-8 degree C

  26. DPT vaccine • Instructions: • Report if child develops reactions • Report for next dose • Complete schedule positively

  27. DPT vaccine

  28. DPT vaccine

  29. Pentavalent vaccine • Five individual vaccines conjugated in one

  30. Pentavalent vaccine

  31. Whooping cough Dr. Pracheth R

  32. Objectives • Explain epidemiology • Enumerate control measures

  33. Outline • Introduction • Problem statement • Epidemiology • Clinical features • Control

  34. Introduction • Acute infectious, young children • B. pertussis • Insidious onset, mild fever, irritating cough • Gradually: paroxysmal- whoop (loud crowing inspiration) • Severe-atypical without whoop • Hundred Day Cough

  35. Whoop

  36. Problem Statement • 1.29 Lakh cases globally • Most lethal: those not immunized • Underlying malnutrition, respiratory infections • India: decline • Cases: 39,091.

  37. Epidemiology-Agent factors • Agent: • Most: B.pertussis • Small (5%): B.parapertussis • Certain viruses (Adenovirus, Parainfluenza viruses)

  38. B.pertussis

  39. Agent factors • Source of infection: • Infects only man • Source: case • No evidence: subclinical, chronic carrier state • Infective material: • Bacilli: abundant- nasopharyngeal, bronchial secretions • Contaminated objects.

  40. Agent factors • Infective period: • Most infective: catarrhal stage • Week after exposure-3 weeks after onset-paroxysmal stage-diminish after catarrhal • Secondary Attack Rate: 90%- unimmunized contacts

  41. Host factors • Age: • Disease: infants, children • Below 6 months: highest deaths • Older children: atypical course • Sex: • Incidence, fatality: female>males.

  42. Host factors • Immunity: • Recovery/ adequate immunization: followed by immunity • Second attacks usually mild • Infants susceptible from birth • No cross immunity.

  43. Environmental factors • Throughout the year • Seasonal trend: more cases-winter • Overcrowding • Socio-economic status.

  44. Mode of transmission • Spreads: droplet infection, direct contact • Fomites: very small. Incubation period: • 7-14 days

  45. Clinical features • Local infection; organism: not invasive • Multiplies: surface epithelium-respiratory tract • Inflammation, necrosis of mucosa • Secondary bacterial invasion

  46. Clinical features Catarrhal stage: • Lasts: 10 days • Insidious onset, sneezing, lacrimation Paroxysmal stage: • Lasts 2-4 weeks • Rapid cough, deep high-pitched inspiration (whoop) Convalescent stage: 1-2 weeks

  47. Control Cases: • Early diagnosis, treatment, isolation • Bacteriological examination: nose and throat secretions: nasopharyngeal swab • Fluorescent antibody technique • Patient isolated: non-infectious • Erythromycin: 30-40mg/kg, 4 divided doses-10 days

  48. Control • Paroxysmal stage: antibiotics-no change clinical course • Eliminate bacteria –nasopharynx Contacts: • Young children: away • Erythromycin/ampicillin-10 days • Infant: DPT best protection

  49. DPT vaccine (Triple Antigen) • Killed , bacterial , liquid vaccine • Dose: 0.5 ml • Antero-lateral aspect of thigh • Reactions: pain, fever: next day. Rarely: anaphylactic shock, convulsions • Contraindications: convulsions, reaction to previous dose • Storage: 2-8 degree C

  50. Pentavalent vaccine • Five individual vaccines conjugated in one

More Related