Diphthe

ria Definition :
* Acute infection caused by
CORYNEBACTERIUM DIPHTERIAE
* Upper respiratory tract infection
* Becomes PSEUDOMEMBRANE
* Release exotoxin.

Corynebacterium diphtheriae
 Epidemiology

* Incidence worldwide
* Peak incidence : spring and winter
* Indonesian- crowded people
* Transmission trough :
Air : droplet infection
Contaminated food
 Pathogenesis &pathology.
Enter through mouth and nose
Incubation 2-4 days- toxin production protein
synthesis disorder
Colonisation corynebacterium diphteriae in:
Respiratory tract mucosal
Skin/ ocular mucosa/genital
Sites of colonisation become necrosis &
local inflammation&exudate a gray
brown adherent
pseudomembrane(removal is difficult and
reveals a bleeding edematous submucosa)
 Pathogenesis and pathology

Membrane consist of:

Fibrin
Leucocytes
Erythrocyte
Epithelial cells
 Clinical manifestation

Based on location:
Tonsill & pharinx diphtheria
A gray brown adherent pseudomembrane
Bull neck
Respiration distress
Nasal diphtheria
fever, rhinore,excoriation
 Clinical manifestation
Aural,konjungtiva and vulvovaginal
diphtheria
Ulcerative lesion with based of
membranosa
Conjunctival palpebra lesion
red,edema and membrane
External otitis
 Clinical manifestation

Larinx diphtheria :
Membrane expanded to pharinx.
Stridor inspiratoir, hoarseness and
cough
Larinx obstruction.
 Clinical manifestation
Based on location and complication
to differ severity of illness:

Mild diphtheria :in tongue, mouth

and tonsill with out bull neck. Sign
only dysphagia
 Clinical manifestation

Moderate diphtheria : in the larinx

and pharinx without bull neck.

Severe diphtheria : in larinx/pharinx

and faucial with bull neck or
myocarditis
 Diagnosis.
Was made based on the clinical
manifestation without wait
laboratorium results
Anamnesis :
Sub febril fever( 2-4 days)
Cough, commoncold and dysphagia
Snoring (never snoring before sick
Dysphonia, hoarseness
 Diagnosis.
Physical examination :

A gray brown adherent pseudomembrane

(removal is difficult and reveals a bleeding
edematous submucosa)
Severe cases, there is airway obstruction
 Based on airway obstruction
-severity
Jackson i :
Dyspneu, inspiration stridor, suprasternal
retraction, good general presentation
Jackson ii :
Jackson i + epigastrial retraction and gelisah
Jackson iii :
Jackson ii + intercostal retraction, air hunger
 Diagnosis.
Laboratorium :
A swab specimen with neisser staining
appear diphtheria basilli.
Culture from specimen in loeffler
medium identified the species.
Ecg to know myocarditis.
(Ckmb,cpk,sgot)
 Defferential diagnosis
faucial diphtheria

Angina plaut vincent:

Thick and white membrane , bad
smelling, difficult to become bleeding
Tonsilitis follikularis.
High grade fever, the child became
no fatigue
White membrane, soft, rapuh and
no bleeding
 Defferential diagnosis
faucial diphtheria

Mononukleosis infeksiosa:
Membran in the tonsill
General limfoid swelling
Lien enlargement
Peripheral blood count : abnormal
lymphocyte
 Defferential diagnosis
laring diphtheria
Angioneurotik oedema larinx:
Because immunologi respon, sign :
dyspneu , cyanosis , acute suprasternal
retraction.(Respon with adrenalin)
Larinx foreign bodies
From anamnesis.
Acute laringitis :
Fever, cough, hoarseness-afoni, dyspneu,
stridor.
 Complication
Respiratory tract :
Respiratory obstruction with
complication :
Bronkopneumonia
Atelektasis
Respiratory failure.
Urogenital :
nefritis.
 Complication
Cardiovaskular : myocarditis
Central nervous system:
Paralysis/ palatum mole parese
(rinolali),dysphagia.
Reversible week i & ii
Paralisis/ocular musculus parese
(strabismus, acomodation disorder)
after week iii
 Management
Nursing aspect :
Isolation room with jacket, mask, google
Assesment to progression of membrane
and do throat swab every day
Jackson ii consult throat-nose and ear
division tracheostomi
Pasca tracheostomi : canul nursing
Serial ecg (depend on )
 Management
Medicamentosa aspect :
D.A.T. With dosis : 40.000 iu (mild) ; 80.000
( moderate) ; 120.000 (severe)
Antibiotic penisilin prokain 50.000 iu/ body
weight given for 10 days
Give sedative : phenobarbital 3-5
mg/bodyweight/days
Severe cases: prednison 1-1,5
mg/bodyweight for reduce myocarditis
incidence
Myokarditis : corticosteroid i.V
 Management
Dietetic aspect
Depend on general presentation :
If mild and can eat oral feeding
If severe consider feeding by ngt
total parenteral nutrition.
Every day observe fluid
requirement, calori and electrolite
 Prognosis.
Depend on :
Age (younger more bad) and general
presentation
Course of the disease and complication
Location of the membrane
As soon as diagnosis
Threatment
Immunization status
 Prevention :
Isolation :
Isolation, out from isolation room after 3
times throat swab (-)
Immunization :
Basic vaccination dpt : aged 2,3,4
months
Booster : aged 18 months and 4-6
years
 Prevention
Immunization after 3 months
exposure
Prevention to contact
Must be isolation 7 days, if symptom
(+) threated, symptom (-)
immunization.
Investigation and threat carrier
Do throat swab, if positive threated