Disease condition

What is Diptheria?

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Written by Neha

DEFINITION:-

It is an acute bacterial disease, formed of a membrane in the upper respiratory tract.

It is rare< 6 month of age.

The Preschoolers are very prone to it.

CAUSATIVE AGENTS

The causative agents are: Coryne bacterium diptheriae, a gram positive pleomorphic rod that grows on loeffler medium.

MODE OF TRANSMISSION

Through a Droplet infection.

INCUBATION PERIOD:- 2-5 days

CLINICAL FEATURES

  1. FAUCIAL DIPHTHERIA: The most frequent site is Tonsils.
  2. Sore throat
  3.  difficulty in swallowing
  4. General malaise
  5. Tachycardia
  6. Moderate fever
  7. lymphadenopathy.
  8. Membrane: whitish gray membranes are formed, which is attached to the underlying mucosa over the tonsils, anterior pillars, and uvula, also extends to the pharynx. It’s difficult to remove the membrane without damaging the mucosa and thus without a bleed.
  • LARYNGEAL DIPTHERIA: It’s most serious but, less common.
  • Hoarseness
  • Aphonia
  • Croup
  • Barking cough
  • Dyspnea and cyanosis
  • Restlessness and anxiety
  • Prostration
  • Bull neck due to gross cervical lymphadenopathy
  • Brawny edema of the neck.
  • NASAL DIPTHERIA: It is uncommon but a potent source of infection to others. It occurs in infants. The manifestations are:
  • Visible membranes over turbinates
  • Nasal discharge with serosanguineous and foul smelling, which may be either unilateral or bilateral.
  • epistaxis
  • Excoriation of nose and upper lip
  • Nasal obstruction

CUTANEOUS AND RARE DIPTHERIA

Diptheric membranes may be found on skin, open wounds, genitalia and conjunctiva and in ears.

DIAGNOSIS

  • Throat swab
  • Culture on loeffler medium
  • Quick diagnosis, fluorescent antibody technique.

MANAGEMENT

  • SPECIFIC TREATMENT – immediate administration of antitoxin. Eg. Idiopathic serum, dosage 20- 100 thousand unit (I/M, I/V OR BOTH)
  • The recommended dosage of antidiphtheritic serum for the treatment of diphtheria is 48 hrs or less duration 
  • Vaccination
  • Administer antibiotics such as erythromycin, amoxicillin rifampicin, or clindamycin for 2 weeks
  •  proper bed rest for 2 weeks.
  • Isolation
  • Maintenance of fluid and dietetic adequacy
  • Antipyretics
  • Frequent aspiration and high humidity
  • Tracheostomy and mechanical ventilator.

COMPLICATIONS:

  • Bronchopneumonia
  • Nephritis
  • Myocarditis
  • Paralysis 
  • Pharyngeal and palatal paralysis is manifested by nasal voice, dysphagia, nasal regurgitation, and failure to lift the palate
  • Ocular paralysis occurs late and is second in frequency.
  • General paralysis occurs quite late. There may be quadriplegia, paralysis of neck muscles, and respiratory embarrassment
  • Gastritis
  • Hepatitis

NURSING MANAGEMENT

  • Use droplet precautions for pharyngeal disease and precautions for the cutaneous disease.
  • Monitor closely for signs of increasing respiratory distress as well as cardiac and neurologic complication
  • Always keep emergency airway equipment readily available
  • Administer antibiotics
  • Use oral suction gently

About the author

Neha

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