Diphtheria and

Diphtheria Toxoid
Djauhar Ismail
Sub Bagian Tumbuh Kembang Anak/
Pediatri Sosial
Bagian IKA FK UGM/ RSUP Dr. Sardjito

Diphtheria

Greek diphthera (leather hide)

Recognized by Hippocrates in
5th century BCE
Epidemics described in
6th century
C. diphtheriae described by Klebs in 1883
Toxoid developed in 1920s

Corynebacterium diphtheriae

Aerobic gram-positive bacillus

Toxin production occurs only
when C. diphtheriae infected by virus (phage)
carrying tox gene
If isolated, must be distinguished from normal
diphtheroid

Diphtheria Clinical Features

Incubation period 2-5 days

(range, 1-10 days)
May involve any mucous membrane
Classified based on site of infection
anterior nasal
pharyngeal and tonsillar
laryngeal
cutaneous
ocular
genital

Pharyngeal and Tonsillar Diphtheria

Insidious onset of exudative pharyngitis

Exudate spreads within 2-3 days and may form
adherent membrane
Membrane may cause respiratory obstruction
Fever usually not high but patient appears
toxic

Diphtheria Complications

Most attributable to toxin

Severity generally related to extent of local
disease
Most common complications are
myocarditis and neuritis
Death occurs in 5%-10% for respiratory
disease

Diphtheria Antitoxin

Produced in horses
First used in the U.S. in 1891
Used only for treatment of diphtheria
Neutralizes only unbound toxin

Diphtheria Epidemiology

Reservoir

Human carriers
Usually asymptomatic

Transmission

Respiratory
Skin and fomites rarely

Temporal pattern Winter and spring

Communicability Up to several weeks

without antibiotics

Diphtheria - United States, 1940-2005*

Year
*2005 provisional total

Diphtheria - United States, 1980-2005*

Year
*2005 provisional total

Diphtheria United States, 1980-2004

Age Distribution of Reported Cases

N=53

DTaP, DT, and Td

DTaP, DT
Td, Tdap
(adult)

Diphtheria
7-8 Lf units

Tetanus
5-12.5 Lf units

2-2.5 Lf units

5 Lf units

DTaP and pediatric DT used through age 6 years. Adult Td for

persons 7 years and older. Tdap for persons 10-18 years
(Boostrix) or 11-64 years (Adacel)

Diphtheria Toxoid

Formalin-inactivated diphtheria toxin

Schedule Three or four doses + booster

Booster every 10 years

Efficacy

Approximately 95%

Duration

Approximately 10 years

Should be administered with tetanus toxoid as DTaP, DT, Td,

or Tdap

Routine DTaP Primary Vaccination

Schedule
Dose
Primary 1
Primary 2
Primary 3
Primary 4

Age
2 months
4 months
6 months
15-18 months

Interval
--4 wks
4 wks
6 mos

Children Who Receive DT

The number of doses of DT needed to complete

the series depends on the childs age at the first
dose:

if first dose given at <12 months of age, 4 doses are

recommended
if first dose given at >12 months, 3 doses complete the
primary series

Routine DTaP Schedule

Children <7 years of age
Booster Doses

4-6 years of age, before entering school

11-12 years of age if 5 years since last dose
(Tdap)
Every 10 years thereafter (Td)

Routine Td Schedule
Unvaccinated Persons 7 Years of Age

Dose*
Primary 1
Primary 2
Primary 3

Interval
--4 wks
6-12 mos

Booster dose every 10 years

*ACIP recommends that one of these doses (preferably the
first) be administered as Tdap

Diphtheria and Tetanus Toxoids

Adverse Reactions

Local reactions (erythema, induration)

Exaggerated local reactions (Arthus-type)
Fever and systemic symptoms not common
Severe systemic reactions rare

Diphtheria and Tetanus Toxoids

Contraindications and Precautions

Severe allergic reaction to vaccine

component or following a prior dose
Moderate or severe acute illness

Pertusis
Djauhar Ismail
Sub Bagian Tumbuh Kembang Anak/
Pediatri Sosial
Bagian IKA FK UGM/ RSUP Dr. Sardjito

Pendahuluan

batuk rejan, batuk seratus hari

Infeksi saluran nafas, Bakteri Bordetela
pertusis ( gram negatif)
Penularan: air borne droplet
Endemik , WHO: 600.000 kematian/ tahun pd
anak yang belum imunisasi < 1 tahun, ok Ig
G ibu tidak protektif

Gejala klinis

Inkubasi: 6-20 hari, rata-rata 7 hari

Perjalanan penyakit: 6-8 minggu, 3 stadium:
Katarlis (prodomal, preparoksimal)
Paroksimal, spasmodik
Konvalesens (penyembuhan)
Tergantung:
Umur: muda berat, lama
status imunisasinya

Stadium kataralis

1-2 minggu
Seperti common cold
Pilek, injeksi konjungtiva, lakrimasi, batuk
ringan, demam ringan
Sangat infeksius

Stadium paroksimal

2-4 minggu
Frekuensi, derajat batuk
Batuk khas ( whoop), pada bayi muda: apneu
Serangan batuk: muka merah, sianosis, mata
menonjol, lidah terjulur, lakrimasi, hipersalivasi
Muntah berat badan turun
Pencetus: stres ( menangis, sedih, gembira), aktifitas
fisik.

Stadium konvalesens

1-2 minggu
Frekwensi dan berat menurun
Pada beberapa pasien, akan timbul serangan
batuk paroksimal berulang infeksi saluran
nafas atas

Diagnosis

Perjalanan klinis
Riwayat imunisasi
Lab: lekositosis dgn limfositosis absolut
Biakan
Serologi

Penyulit

Pneumonia 90 % kematian, Ok B pertusis, infeksi

sekunder
Aktifasi TB laten
Atelektasis, ruptur alveoli, emfisema
Perdarahan subkonjungtiva
Kejang, koma, ensefalitis
Dehidrasi, hiponatremia
Penurunan BB

Pengobatan dan pencegahan

Imunisasi, DPT
Isolasi
Eritromisin 50 mg/ kg BB/ hari, stadium
kataral
Nutrisi.

EKSANTEMA SUBITUM
(Roseola Infantum,
Pseudorubela, Eksantema
Kritikum, Fifth Disease, Three
Days Fever)
Djauhar Ismail
Sub Bagian Tumbuh Kembang Anak/
Pediatri Sosial
Bagian IKA FK UGM/ RSUP Dr. Sardjito

Eksantema Subitum

Penyakit virus yang menyerang bayi dan anak

kecil
Demam selama 3-5 hari
Perbaikan klinis bersamaan munculnya ruam
pada kulit

EPIDEMIOLOGI

Penyebab utama Human Herpes Virus-6

Jarang dijumpai pada bayi <3 bulan dan > 4

tahun

Terbanyak umur 7-13 bulan

Penularan mungkin dari saliva orang dewasa

yang mengandung virus.

GEJALA KLINIS

Masa inkubasi: 7-17 hari (umumnya 10 hari)

Gejala mendadak demam tinggi (39,1oC 41,2oC)
Lama demam 3-5 hari
Kejang dapat timbul
Temperatur umumnya turun secara krisis
KU anak baik
Batuk dan rinitis ringan
Anak besar mengeluh sakit kepala dan sakit perut
Muntah dan diare jarang
Inflamasi ringan faring & tonsil
Palfebra terlihat oedem terasa berat (heavy eyelids)
Kesan mengantuk

lanjuta
n

Eksantema muncul waktu suhu menurun/ normal

Makula eritematosus/ muakulopapular menyebar
Diameter 2-5mm, memucat bila ditekan
Jelas terlihat di lehar dan punggung
Dapat dijumpai pada ekstremitas bagian proximal dan
muka

lanjutan

Deskuamasi jarang, tidak ada hiperpigmentasi

Menghilang setelah 24-48 jam
LABORATORIUM
- dalam 24-36 jam terjadi leukositosis (16.00020.000/mm3), tetapi kemudian terjadi leukopenia
(3000-5000/ mm3)
- Netropenia absolut dan limpositosis relatif

DIAGNOSIS BANDING

Permulaan demam, sulit

Dengan timbulnya ruam (rubela, campak, dengue
dan alergi obat)
Rubela: eksantema disertai panas
Campak:
- didahului demam 3-4 hari sebelum munculnya
ruam
- masih demam 2 hari berikutnya
- disertai batuk, pilek, konjunctivitis, bercak
koplik

PENYULIT
- yang sering kejang
- yang lain: kelainan neurologik, ensefalitis,
hemiplegia, paresis dan retardasi mental
PENGOBATAN
- tidak spesifik
- demam diberi asetaminofen
- kejang demam dan penyulit neurologik
lainnya ditangani dengan cara semestinya.
PENCEGAHAN
- tindakan pencegahan yang tepat, tidak ada