DIPHTHERIA

• Diphtheria


  Acute febrile infection of the tonsil, throat, nose, larynx or wound marked by patches of grayish membrane from which the diphtheria bacillus is readily cultured
• Etiologic Agents


  Corynebacterium, diphtheria (Klebs-Loeffier bacillus)
• Sources of Infection


  • Discharges and secretion from mucus surface of nose and nasopharynx and from skin and other lesions
  • Reservoir: Man
• Mode of Transmission


  Contact with a patient or carrier or with articles soiled with discharges of infected persons<|>Milk (vehicle)
• Incubation Period


  2 to 5 days
• Period of Communicability


  2 weeks to more than 4 weeks<|>Variable until virulent bacilli has disappeared from secretions and lesions
• Types of Diphtheria


  • Nasal
  • Tonsillar
  • Nasopharyngeal
  • Laryngeal
  • Wound / Cutaneous
• Nasal Diphtheria


  • With foul-smelling serosanguinous secretions from the nose
• Tonsillar Diphtheria


  • Low fatality rate
  • Lesions are confined to the tonsils only but tend to spread over the pillars, into the soft palate and uvula
• Nasopharyngeal Diphtheria


  • Cervical lymph nodes are swollen
  • Neck tissues are edematous
• Laryngeal Diphtheria


  • Most commonly found in children ages 2 to 5 years old
  • It is considered as most severe and more fatal type due to anatomical reason
  • There is moderate hoarseness; voice is diminished until it is finally absent
  • Most fatal
• Wound / Cutaneous Diphtheria

  • Affects to mucous membrane and any break in the skin
• Clinical Manifestations


  • Bull neck formation (swelling of the soft tissues of the neck)
  • Exudates forming the membrane are grayish in appearance (Pseudomembrane)
  • Fatigue / malaise
  • Slight sore throat
  • Breathing difficulty
  • Husky voice
  • Swelling of the palate
  • Low-grade fever
• Methods of Prevention and Control

  • Active immunization of all infants and children with 3 doses of DPT
  • Pasteurization of milk
  • Education of parents
  • Reporting of case to the Health Officer of proper medical care
• Diagnostic Tests


  • Swab from the nose and throat
  • Schick Test
  • Virulence Test
  • Moloney Test
• Schick Test


  Involves giving an injection of 0.1 mL of dilute diphtheria toxin intradermally<|>Area is checked in 3-4 days and the reaction is documented<|>Positive Test is indicated by inflammation or induration at the point of injection. This indicates that the client lacks antibodies to diphtheria
• Treatment Modalities


  • Penicillin
  • Anti-toxin
  • Erythromycin
• Nursing Care


  • Follow prescribed dosage and correct technique in administering anti toxin
  • Provide comfort
  • Absolute bed rest for at least two weeks
  • Soft-food diet; small frequent feedings
  • Ice collar applied to the neck
  • Visiting bag should be set up outside the room of the patient of should be far from the bedside of the patient
  • Watch for signs of shock, which can develop suddenly as a result of systematic vascular collapse, airway obstruction, or anaphylaxis
  • If neuritis develops, tell the patient it's usually transient. Be aware that peripheral neuritis may not develop until 2 to 3 months after the onset of illness
  • Explain how to properly dispose of nasopharyngeal secretion and teach proper infection precautions