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 The Respiratory SystemDiphtheria Synonyms : Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, Diphtheria
is an acute infection of the upper respiratory tract or skin caused by toxin
producing gram-positive Corinebacterium
diphtheriae, which spreads by droplets. The toxin
is absorbed into the mucous membranes and causes destruction of epithelium and superficial inflammatory response.
The necrotic epithelium becomes embedded in fibrinous exudate containing red
and white cells, forming a greyish ‘pseudomembrane?/i>
commonly present over the tonsils, pharynx or larynx. The membrane is firmly
attached, and any attempt to remove it will result in bleeding. The toxin is also absorbed into the circulation and can cause toxic injury to heart muscle, liver, kidneys and the nervous system. The infection may occur rarely on the conjunctiva or the genital tract, or it may complicate wounds, abrasions or diseases of the skin. The average incubation period is 2-4 days. Clinical features: < BACK TO TOP >
Early
manifestations of diphtheric pharyngitis are mild sore throat, moderate fever,
and malaise, followed fairly rapidly by severe prostration, tiredness and
rapid pulse (tachycardia); tachycardia is largely due to toxic myocarditis.
A pharyngeal membrane forms and may spread into the nasopharynx or
the trachea, producing breathing difficulties.
The
membrane is ‘dirty?greyish-green tough membrane with a well-defined edge
and surrounded by a narrow zone of erythema and a broader zone of oedema.
There
may be swelling of the neck (‘bull
neck? due to diffusion of the toxin into the neck tissue, and tender
enlargement of the cervical lymph nodes.
In the
mildest infections, especially in the presence of a high degree of immunity, a
membrane may never appear and the throat is merely slightly red.
With
anterior nasal infection there is also nasal discharge often tinged with
blood.
In
laryngeal diphtheria there is a husky voice, a high-pitched cough, and a
danger of respiratory obstruction which can be fatal if tracheostomy is not
carried out.
Death
from acute circulatory failure
may occur within the first 10 days, but today it is a very rare outcome. Complications:
Diphtheric myocarditis
characterised by electrocardiographic changes, arrhythmias or even cardiac
failure, and carries significant mortality. However, in patients who survive
these changes are reversible
and there is no permanent damage to the heart left. Polyneuritis of the nerves innervating the palate and pharyngeal muscles can cause nasal speech and regurgitation of food through the nose. Paralysis of accommodation and diplopia (seeing in duplicate) often follows and may be inferred from the patient’s complaint of difficulty in reading small print. Neuritis may also involve peripheral motor nerves supplying the intercostal muscles, diaphragm and other muscle groups, causing muscle weakness. Recovery from such neuritis is always ultimately complete. Diagnosis: < BACK TO TOP >
Diagnosis
is mainly established on a clinical basis.
Direct
smears may reveal bacteria on specially stained preparation, but bacterial
isolation and culture is more reliable. The white blood cell count is usually normal, but haemolytic anaemia and thrombocytopenia are frequent. Management < BACK TO TOP >
Admission
to isolation facility is necessary to prevent transmission to susceptible
individuals.
Horse-sourced
diphtheria antitoxin should be administered IM or IV as soon as possible to
neutralise the toxin not bound to cells.
Antibiotics
such as penicillin or erythromycin are given to eradicate the bacteria and
prevent spread.
Any
complication has to be treated appropriately; tracheostomy for respiratory
obstruction, appropriate symptomatic and supportive treatment of myocarditis
and heart failure.
Protection
of close contacts as in the family is carried out by giving erythromycin.
Mortality
rates vary from 3% to 25% and are particularly high in the presence of early
myocarditis. Prevention: Active immunisation with diphtheria toxoid combined with pertussis and tetanus toxoids is a part of standard immunisation schedule. Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Diphtheria :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Diphtheria :- (source : -) |
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