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An overview of the disease diphtheria and the medical definition

Diphtheria Definition Diphtheria is a potentially fatal, contagious disease that usually involves the nose, throat, and air passages but may also infect the skin. Its most striking feature is the formation of a grayish membrane covering the tonsils and upper part of the throat.

Description Like many other upper respiratory diseases, diphtheria is most likely to break out during the winter months. At one time it was a major childhood killer, but in the early 2000s it is rare in developed countries because of widespread immunization. Persons who have not been immunized may get diphtheria at any age. The disease is spread most often by droplets from the coughing or sneezing of an infected person or carrier.

The incubation period is two to seven days, with an average of three days. It is vital to seek medical help at once when diphtheria is suspected, because treatment requires emergency measures for adults as well as children. Demographics Diphtheria is a reportable disease in many countries in the world. Since 1988, all confirmed cases in the United States involved visitors or immigrants. In countries that do not have routine immunization against this infection, the mortality rate varies from 1.

Causes and symptoms The symptoms of diphtheria are caused by toxins produced by the diphtheria bacillus, Corynebacterium diphtheriae from the Greek for "rubber membrane".

  1. The most vulnerable patients are children under age 15 and those who develop pneumonia or myocarditis.
  2. Erythromycin appears to be more effective than penicillin in treating people who are carriers because of better penetration into the infected area.
  3. Material from the swab is put on a microscope slide and stained using a procedure called Gram's stain. The incubation period is two to seven days, with an average of three days.

In fact, toxin production is related to infections of the bacillus itself with a particular bacteria virus called a phage from bacteriophage, a virus that infects bacteria. The intoxication destroys healthy tissue in the upper area of the throat around the tonsils or in open wounds in the skin. Fluid from the dying cells then coagulates to form the telltale gray or grayish green membrane. Inside the membrane, the bacteria produce an exotoxin, which is a poisonous secretion that causes the life-threatening symptoms of diphtheria.

The exotoxin is carried throughout the body in the bloodstream, destroying healthy tissue in other parts of the body. The most serious complications caused by the exotoxin are inflammations of the heart muscle myocarditis and damage to the nervous system. The risk of serious complications is increased as the time between onset of symptoms and the administration of antitoxin increases, and as the size of the membrane formed increases. The myocarditis may cause disturbances in the heart rhythm and may culminate in heart failure.

The symptoms of nervous system involvement can include seeing double diplopiapainful or difficult swallowing, and slurred speech or loss of voice, which are all indications of the exotoxin's effect on nerve functions.

The exotoxin may also cause severe swelling in the neck "bull neck". The signs and symptoms of diphtheria vary according to the location of the infection. Nasal Nasal diphtheria produces few symptoms other than a watery or bloody discharge.

  • This germ produces a toxin that can harm or destroy human body tissues and organs;
  • Blazing the Iditarod Trail.

On examination, there may be a small visible membrane in the nasal passages. Nasal infection rarely causes complications by itself, but it is a public health problem because it spreads the disease more rapidly than other forms of diphtheria.

Pharyngeal Pharyngeal diphtheria gets its name from the pharynx, which is the part of the upper throat that connects the mouth and nasal passages with the voice box. This is the most common form of diphtheria, causing the characteristic throat membrane. The membrane often bleeds if it is scraped or cut. It is important not to try to remove the membrane because the trauma may increase the body's absorption of the exotoxin. Laryngeal Laryngeal diphtheria, which involves the voice box or larynx, is the form most likely to produce serious complications.

People may have a severe coughhave difficulty breathing, or lose their voice completely. The development of a bull neck indicates a high level of exotoxin in the bloodstream. Obstruction of the airway may result in respiratory compromise and death. Skin This form of diphtheria, which is sometimes called cutaneous diphtheria, accounts for about 33 percent of all diphtheria cases. It is found chiefly among people with poor hygiene.

Any break in the skin can become infected with diphtheria. The infected tissue develops an ulcerated area, and a diphtheria membrane may form over the wound but is not always present. The wound or ulcer is slow to heal and may be numb or insensitive when touched. When to call the doctor A doctor should be called whenever a case of diphtheria is suspected.

Diagnosis Because diphtheria must be treated as quickly as possible, doctors usually make the diagnosis on the basis of the visible symptoms without waiting for test results. In making the diagnosis, the doctor examines the affected person's eyes, ears, nose, and throat in order to rule out other diseases that may cause fever and sore throat, such as infectious mononucleosisa sinus infection, or strep throat. The most important single symptom that suggests diphtheria is the membrane.

When a person develops skin infections during an outbreak of diphtheria, the doctor will consider the possibility of cutaneous diphtheria and take a smear to confirm the diagnosis. Laboratory tests The diagnosis of diphtheria can be confirmed by the results of a culture obtained from the infected area. Material from the swab is put on a microscope slide and stained using a procedure called Gram's stain.

The diphtheria bacillus is Gram-positive which means it holds the dye after the slide is rinsed with alcohol. Under the microscope, diphtheria bacilli look like beaded rod-shaped cells, grouped in patterns that resemble Chinese characters.

Another laboratory test involves growing the diphtheria bacillus on a special material called Loeffler's medium. Treatment Diphtheria is a serious disease requiring hospital treatment in an intensive care unit if the person has developed respiratory symptoms.

Treatment includes a combination of medications and supportive care. Antitoxin The most important step is prompt administration of diphtheria antitoxin, without waiting for laboratory results. The antitoxin is made from horse serum and works by neutralizing any circulating exotoxin. The doctor must first test people for sensitivity to animal serum. No human antitoxin is available for the treatment of diphtheria.

The dose ranges from 20,000 to 100,000 units, depending on the severity and length of time of symptoms occurring before treatment. Diphtheria antitoxin an overview of the disease diphtheria and the medical definition usually given intravenously. Antibiotics Antibiotics are given to wipe out the bacteria, to prevent the spread of the disease, and to protect people from developing pneumonia.

They are not a substitute for treatment with antitoxin. Both adults and children may be given penicillin, ampicillin, or erythromycin. Erythromycin appears to be more effective than penicillin in treating people who are carriers because of better penetration into the infected area.

Cutaneous diphtheria is usually treated by cleansing the wound thoroughly with soap and water and giving an individual antibiotics for ten days.

  • Exotoxin —A poisonous secretion produced by bacilli that is carried in the bloodstream to other parts of the body;
  • It is important not to try to remove the membrane because the trauma may increase the body's absorption of the exotoxin;
  • Approximately every ten years, booster doses of the adult form of the vaccine, tetanus-diphtheria toxoids vaccine Td , may be needed to maintain immunity.

Supportive care Persons with diphtheria require bed rest with intensive nursing care, including extra fluids, oxygenation, and monitoring for possible heart problems, airway blockage, or involvement of the nervous system.

People with laryngeal diphtheria are kept in a croup tent or high-humidity environment; they may also need throat suctioning or emergency surgery if their airway is blocked. People recovering from diphtheria should rest at home for a minimum of two to three weeks, especially if they have heart complications. In addition, persons should be immunized against diphtheria after recovery, because having the disease does not always induce antitoxin formation and protect them from reinfection.

Prevention of complications People with diphtheria who develop myocarditis may be treated with oxygen and with medications to prevent irregular heart rhythms. An artificial pacemaker may be needed. Persons with difficulty swallowing can be fed through a tube inserted into the stomach through the nose.

Persons who cannot breathe are usually put on mechanical respirators. Prognosis The prognosis depends on the size and location of the membrane and on early treatment with antitoxin; the longer the delay, the higher the death rate.

The most vulnerable persons are children under the age of 15 years and those who develop pneumonia or myocarditis. An overview of the disease diphtheria and the medical definition and cutaneous diphtheria are rarely fatal. Prevention Prevention of diphtheria has four aspects: Immunization Universal immunization is the most effective means of preventing diphtheria. The standard course of immunization for healthy children is three doses of DPT diphtheria-tetanus-pertussis preparation given between two months and six months of age, with booster doses given at 18 months and at entry into school.

Adults should be immunized at ten-year intervals with Td tetanus-diphtheria toxoid. A toxoid is a bacterial toxin that is treated to make it harmless but still can induce immunity to the disease.

Isolation of affected persons Individuals with diphtheria must be isolated for one to seven days or until two successive cultures show that the individuals are no longer contagious. Children placed in isolation are usually assigned a primary nurse for emotional support. Identification and treatment of contacts Because diphtheria is highly contagious and has a short incubation period, family members and other contacts of persons with diphtheria must be watched for symptoms and tested to see if they are carriers.

Reporting cases to public health authorities Reporting is necessary for tracking potential epidemics, to help doctors identify the specific strain of diphtheria, and to see if resistance to penicillin or erythromycin has developed. Parental concerns Parents in the United States should ensure that their children have full immunizations against diphtheria. Completion of the three-shot series initiates lifelong immunity from diphtheria.

Bacillus —A rod-shaped bacterium, such as the diphtheria bacterium. Carrier —A person who possesses a gene for an abnormal trait without showing signs of the disorder. The person may pass the abnormal gene on to offspring.

Cutaneous —Pertaining to the skin Diphtheria-tetanus-pertussis DTP vaccine —The standard vaccine used to immunize children against diphtheria, tetanus, and whooping cough. A so-called "acellular pertussis" vaccine aP is usually used since its release in the mid-1990s.

Diphtheria

Exotoxin —A poisonous secretion produced by bacilli that is carried in the bloodstream to other parts of the body. Gram stain —A staining procedure used to visualize and classify bacteria.

The Gram stain procedure allows the identification of purple gram positive organisms and red gram negative organisms. This identification aids in determining treatment.

Diphtheria - The disease

Loeffler's medium —A special substance used to grow diphtheria bacilli to confirm the diagnosis. Myocarditis —Inflammation of the heart muscle myocardium. Toxoid —A preparation made from inactivated exotoxin, used in immunization. Edited by Eugene Braunwald et al. Edited by Richard E. Blazing the Iditarod Trail.