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Diphtheria

Diphtheria

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Published by al yves roman

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Published by: al yves roman on Jun 14, 2010
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01/07/2013

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‡ Diphtheria is a life-threatening disorder lifecaused by a highly contagious bacterial infection, the Corynebacterium diphtheriae, diphtheriae, an anerobic gram

+ bacterium. It primarily bacterium. affects the upper respiratory tract and even spread to the heart and the peripheries when the disease progress. progress.
» Diphtheria is a contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. individuals.

‡ Corynebacteria are GramGram-positive, aerobic, nonmotile, rod-shaped rodbacteria classified as Actinobacteria. ‡ related phylogenetically to mycobacteria and actinomycetes. ‡ They undergo snapping movements just after cell division, which brings them into characteristic forms resembling Chinese letters or palisades.

‡ Etiologic agent = Cornebacterium diphtheriae ‡ Reservoir = Human carriers are the reservoir for C. diphtheriae, and are usually asymptomatic ‡ Portal of Exit = Respiratory droplets; aerosolized secretions of infected individuals

‡ Mode of Transmission = person-to-person spread. ‡ Portal of Entry = mucus membranes in the respiratory tract ‡ Susceptible Host = immunocompromised individuals

‡ PREDISPOSING FX
² RACE ² AGE ² GENDER

‡ PRECIPITATING FX
² Known exposure, current epidemic, and travel to endemic areas increases risk. ² Compromised host, individuals ² Cornebacterium Diphtheria

INVASION OF THE BACTERIA (CORNEBACTERIUM DIPHTHERIAE w/ ave. incubation period of 2-7 days)

SECRETIONS OF THE EXOTOXINS

INHIBITION OF THE PROTEIN SYNTHESIS

INACTIVATION/ MODIFICATION OF KEY CELLULAR CONSTITUENTS

CELL DEATH

‡ infects the epithelium of the skin and the mucosa of the upper respiratory tract, leading to inflammation of those tissues ‡ Diphtheria classically involves the tonsils and pharynx, although the nose and larynx are also common foci of infection ‡ The local inflammation in the upper respiratory tract leads to an accumulation of inflammatory cells, necrotic epithelial cells, and organism debris, which form the characteristic adherent grey pseudomembrane.

‡ Attempts to remove the pseudomembrane result in bleeding and expose an inflamed erythematous mucosa. Due to local neurological effects of the exotoxin, paralysis of the palate and hypopharynx can also occur. This paralysis, in occur. combination with inflammation and oedema of the upper respiratory tract, can lead to airway obstruction. In addition, obstruction. systemic spread of the toxin can cause injury to the kidneys, heart, and neural tissue

‡ MUSCULOSKELETAL ² fatigue ² edema ‡ HEENT ² Sore throat ² Swelling throat or ² ´bull neckµ ² Headache ² Double vision ‡ CARDIOVASCULAR SYSTEM ² low blood pressure ² cardiomyopathy ² peripheral neuropathy ‡ RESPIRATORY SYSTEM ² dyspnea ‡

‡ GASTROINTESTINAL SYSTEM ² paralysis of the palate ² hypopharynx ² dysphagia ² nausea and vomiting ‡ INTEGUMENTARY SYSTEM ² chills and fever ² exposed erythematous mucosa or lesions ‡

‡ Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or ‡ Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

‡ diphtheria anti-toxin - The patient must be tested for sensitivity before antitoxin is given.

‡ A throat culture is a technique for identifying disease bacteria in material taken from the throat.
² RESULT: A gram + bacteria, Cornebacterium diphtheriae

NURSING INTERVENTIONS
‡ Administer Oxygen
² (as obstruction in the throat may require intubation and tracheostomy)

‡ ‡ ‡ ‡

Encourage bed rest Provide safety Monitor vital signs ( esp. HR) Administer medications as indicated

ISOLATION!!!

‡ The diphtheria vaccine is an inactivated toxin called a toxoid. It is made by growing the bacteria in a liquid medium and purifying and inactivating the toxin. ‡ In the 1940s, diphtheria toxoid was combined with pertussis vaccine and tetanus toxoid to make the combination DTP vaccine.

‡ The DTaP, DT, Td, and Tdap preparations are all given as an injection in the anterolateral thigh muscle (for infants and young toddlers) or in the deltoid muscle (for older children and adults). ‡ The usual schedule for infants is a series of four doses given at two, four, six, and 15-18 months of age. A fifth shot, or booster dose, is recommended at 4-6 years of age, unless the fourth dose was given late (after the fourth birthday).

Immunochromatographic Strip Test for Rapid Detection of Diphtheria Toxin: Description and Multicenter Evaluation in Areas of Low and High Prevalence of Diphtheria

‡ An immunochromatographic strip (ICS) test was developed for the detection of diphtheria toxin by using an equine polyclonal antibody as the capture antibody and colloidal goldlabeled monoclonal antibodies specific for fragment A of the diphtheria toxin molecule as the detection antibody. The ICS test has been fully optimized for the detection of toxin from bacterial cultures

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