CHAPTER I INTRODUCTION

I.1

Background I choose this problem because I live in Jakarta and the disease becomes an endemic in almost all over Jakarta. Each year in Jakarta, the Diptheriae disease cases keep increasing together with the number of its victim. Even tough with small number of victims, the disease continuously infecting people during the whole year, and in certain months the number of infections and the victims reach its peak. In this peak time, the number of infections usually followed by the increasing of death that caused by the disease. Then, myocarditis as one of the complication that may occur as the result of the disease also make the number of the death victims even worse.

I.2

Problems In the early 2005 Diptheriae has shockingly resurgence in Jakarta. Since January until march 5th 2005, the total Diptheriae cases in all section in Jakarta had reach 6.105 cases, with the death case was 254 lives. The highest case is in South Jakarta with 11.534 cases, and the highest CFR is in East Nusa Tenggara province.

I. 3.

Limitation of the Problems 1. What is Diptheriae? 2. What are the causes of Diptheriae? 3. 4. How is Diptheriae diagnosed? What is the treatment of Diptheriae? 1

5. 6. 7. 8.

What is Myocardistis? What are the causes of Myocarditis? How is Myocarditis diagnosed? What is the correlation between Diptheriae and Myocarditis?

I.4

Objectives The objectives writing this paper are to find out: 1. 2. 3. 4. 5. 6. 7. What Diptheriae is. What causes of Diptheriae. How Diptheriae can diagnosed. How to treat Diptheriae. What Myocarditis is. What causes of Myocarditis. How Myocarditis can diagnosed.

Are there correlation between lung diptheriae and myocarditis.

I.5

Methods of Writing The writing of paper is carried out by a library research and also via internet.

I.6

Frame of Writing Chapter I. Introduction I.1 Background I.2 Problems I.3 Limitation of Problems I.4 Objectives

I.5 Methods of writing I.6 Frame of writing Chapter II. Diptheriae II.1 Definition II.2 Etiology II.3 Risk Factor II.4 Sign and Symptoms II.5 Screening Diagnosis II.6 Complication II.7 Treatment Chapter III. Myocarditis III.1 Definition III.2 Etiology III.3 Clinical Manifestation and Diagnosis Chapter IV. The Correlation between Diptheriae and Myocarditis Chapter V. Conclusion References

CHAPTER II DIPTHERIAE

II.1

Definition Diphtheria is an acute bacterial disease that usually affects the tonsils, throat, nose or skin. The disease typically causes a bad sore throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray covering in the back of your throat that can make breathing difficult. Diphtheria can also infect your skin. Years ago, diphtheria was a leading cause of death among children. Today, diphtheria is rare in the United States and other developed countries thanks to widespread vaccination against the disease. Medications are available to treat diphtheria. However, in advanced stages, diphtheria can cause damage to your heart, kidneys and nervous system. Nearly one out of every 10 people who get diphtheria die of it.

. II.2 Etiology The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. Some types of C. diphtheriae release a toxin, a poison, which can damage the heart, the brain and the nerves. You contact diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria passes from an infected person to others through:

Sneezing and coughing, especially in crowded living conditions.

 Contaminated personal items, such as tissues or drinking glasses that have been
used by an infected person.

Contaminated household items, such as towels or toys.

You can also come in contact with diphtheria-causing bacteria by touching an infected wound. People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks even if they don't show any symptoms.

II.3

Risk Factors Children younger at the age of 7 - 10 years old and adults older than 60 are particularly at risk of contracting diphtheria, as are: People living in crowded or unsanitary conditions Undernourished people Children and adults who don't have up-to-date immunizations People who have a compromised immune system Diphtheria is rare in the United States and Europe, where health officials have been immunizing children against it for decades. In the United States, fewer than five cases have occurred each year since 1980, according to the Centers for Disease Control and Prevention. However, diphtheria is still common in developing countries where immunization rates are low. For example, large outbreaks of diphtheria occurred in the 1990s throughout Russia and the independent countries of the former Soviet Union, resulting in some 5,000 deaths. Control measures have since been implemented, but a risk of diphtheria remains in those areas. 5

Most cases of diphtheria occur in unvaccinated or inadequately vaccinated people. Diphtheria poses a threat to U.S. citizens who may not be fully immunized and who travel to other countries or have contact with immigrants or international travelers coming to the United States. . II.4 Sign and Symptoms Signs and symptoms of diphtheria may include: A sore throat and hoarseness Swollen glands (enlarged lymph nodes) in your neck A thick, gray membrane covering your throat and tonsils Painful swallowing Difficulty breathing or rapid breathing Nasal discharge Fever and chills Malaise Signs and symptoms usually begin two to five days after a person becomes infected, but they may take as many as 10 days to appear. You may mistake diphtheria in its initial stages for a bad viral sore throat. Other early symptoms include a mild fever and swollen glands in the neck signs and symptoms of other, much more common types of infection such as strep throat or mononucleosis. The bacterium that causes diphtheria attacks mucous membranes that line the nose and throat and cover the tonsils. The throat becomes inflamed. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway.

A hallmark sign The bacteria may produce a toxin that can lead to a thick, gray to covering in your nose, throat or airway a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing. In more advanced stages, a person with diphtheria may have severe difficulty breathing and may show signs of respiratory distress such as rapid breathing, a rapid heartbeat and cold, clammy skin. Some people become infected with diphtheria-causing bacteria, but they develop only a mild case of the illness and show no signs or symptoms of the disease. They're said to be carriers of the disease, because they may be contagious without showing signs or symptoms of illness. Skin (cutaneous) diphtheria Diphtheria occurs in two types. One type involves the mucous membranes of your nose and throat, and the other involves the skin. A wound infected with bacteria is typically red, painful and swollen. A wound infected with diphtheria-causing bacteria also may have patches of a sticky, gray material. Although it's more common in tropical climates, cutaneous diphtheria also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions.

II.5

Screening Diagnosis Doctors may suspect diphtheria in a sick child who has a sore throat with a gray membrane covering the tonsils and throat. Doctors confirm the diagnosis by

taking a sample of the membrane from the child's throat with a swab and having the bacteria grown (cultured) in a laboratory. Doctors can also take a sample of tissue from an infected wound and have it tested in a laboratory, to test for the type of diphtheria that affects the skin (cutaneous diphtheria). If a doctor suspects diphtheria, treatment begins immediately, even before the results of bacterial tests are available.

II.6

Complication Left untreated, diphtheria can lead to: Breathing problems. Diphtheria-causing bacteria may produce a toxin, a poison. This toxin damages tissue in the immediate area of infection the nose and throat, for example. This localized infection produces a tough, gray-colored membrane which is composed of dead cells, bacteria and other substances on mucous membranes inside your nose and throat. This membrane, or covering, is dangerous because it can obstruct breathing. Heart damage. The diphtheria toxin may spread through your bloodstream and damage other tissues in your body, such as your heart muscle. One complication of diphtheria is inflammation of the heart muscle (myocarditis). Signs and symptoms of myocarditis include fever, vague chest pain, joint pain and an abnormally fast heart rate. Damage to the heart from myocarditis may be only slight, showing up as minor abnormalities on an electrocardiogram, or very severe, leading to congestive heart failure and sudden death. Kidney damage. The diphtheria toxin may damage the kidneys, affecting their ability to filter wastes from the blood.

Nerve damage. The toxin can also cause nerve damage, targeting certain nerves such as those to the throat, making swallowing difficult. Nerves to the arms and legs may also become inflamed, causing muscle weakness. In severe cases, nerves that help control the muscles used in breathing may be damaged, leading to paralysis of these muscles and trouble breathing. With treatment, most people with diphtheria survive these complications, but recovery is often slow. Diphtheria is fatal in approximately one in 10 cases.

II.7

Traetment Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these medications: An antitoxin. After doctors confirm that a person has diphtheria, the infected child or adult receives a special antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein (intravenously) or into a muscle (intramuscular injection). But first, doctors may perform skin allergy tests to make sure that the infected person doesn't have an allergy to the antitoxin. Persons who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage. Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious. Children and adults who have diphtheria often need to be in the hospital for treatment. They may be isolated in an intensive care unit because diphtheria can spread easily to anyone not immunized against the disease.

Doctors may remove some of the thick, gray covering in the throat if the covering is obstructing breathing. There may be other complications of diphtheria that need treatment. Inflammation of the heart (myocarditis) is treated with medications. In advanced cases, a person with diphtheria may need the assistance of a machine that helps them breathe (ventilator) until the infection is successfully treated. Preventive treatments If you've been exposed to a person infected with diphtheria, see a doctor for testing and possible treatment. Your doctor may give you a prescription for antibiotics to help prevent you from getting the infection. You may also need a booster dose of the diphtheria vaccine. Doctors treat people who are found to be carriers of diphtheria with antibiotics to clear their systems of the bacteria, as well.

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CHAPTER III MYOCARDITIS

III.1

Definition Myocarditis is an inflammatory disease of the myocardium with a wide range of clinical presentation, from subtle to devastating. It is diagnosed by established histologic, immunologic, and immunochemical criteria. Myocarditis is described as an inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes. It usually manifests in an otherwise healthy person and can result in rapidly progressive (and often fatal) heart failure and arrhythmia. When myocarditis is severe enough, the pumping action of your heart weakens and your heart is unable to supply the rest of your body with enough oxygen-rich blood. Clots can form in the heart as well, potentially leading to a stroke or heart attack. Myocarditis may develop as a complication of an infectious disease, usually caused by a virus. It can occur in people of all ages and is diagnosed more often in men than in women. Treatment of myocarditis depends on the underlying cause.

III.2

Ethiology Any condition that makes myocarditis , including:

Bacteria (such as bacterium Corynebacterium diphtheriae. ) Viruses (coxsackievirus B) Medications that may cause an allergic or toxic reaction (as with infection or severe allergic reactions)

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III.3

Clinical Manifestation and Diagnosis When myocarditis is severe, it can permanently impair your heart muscle. As its pumping action weakens, strain is put on your heart, causing progressive heart failure. Your heart becomes unable to pump efficiently enough to supply your body with the oxygen-rich blood it requires. A failing heart can also trigger the formation of blood clots that may lead to a stroke or a heart attack. To make or confirm a diagnosis of myocarditis and determine its severity, most commonly:

Electrocardiogram (ECG). This test evaluates your heart's electrical patterns and can detect abnormal rhythms, as well as a weakened or damaged heart muscle.

Chest X-ray. An X-ray of your chest will image your heart, showing its size, shape and structure. An X-ray of your lungs can indicate whether there's a buildup of fluid in your lungs.

Echocardiogram. Sound waves, or ultrasound, can create moving images of the beating heart. An echocardiogram may detect enlargement of your heart, poor pumping function, valve problems or fluid around your heart.

Blood tests. These tests measure white and red blood counts, as well as levels of certain enzymes that indicate damage to your heart muscle. Blood tests can also detect antibodies against viruses and other organisms that may indicate a myocarditis-related infection.

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CHAPTER IV CORRELATION BETWEEN DIPTHERIAE AND MYOCARDITIS

As we know in the previous chapter that myocarditis is one of the complications that may occur in Diphtheria disease. The diphtheria infection by the toxin of Corynebacterium diptheriae will trigger the antibody formation and further more it will make the inflammation the thick muscular layer of your heart. The diphtheria toxin can enter to your blood and spread trough your bloodstream and it will go to your heart ,make a serious pain if the heart pumping the blood. When myocarditis is severe, it can permanently impair your heart muscle. As its pumping action weakens, strain is put on your heart, causing progressive heart failure. Your heart becomes unable to pump efficiently enough to supply your body with the oxygen-rich blood it requires. A failing heart can also trigger the formation of blood clots that may lead to a stroke or a heart attack. Why children at the age of 7 10 years old become one a group of people that easy to get diphtheria? The reason is children at the age of that always playing around in the dirty place and not good enough to keep they sanitation. Statistics said that South Jakarta had a lot of that group at the population. When children develop myocarditis, they may experience the following signs and symptoms: High temperature Loss of appetite Breathing difficulties

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Bluish or grayish discoloration of the skin

CHAPTER V CONCLUSION

Diphtheria is one of disease that attack the children, this is not the most often disease that attack the children but this is the serious disease that can make fatal infection. It is cause by Corynebacterium diptheria by droplet inhalation infection. This disease has the symptoms like A sore throat and hoarseness , painful swallowing, swollen glands (enlarged lymph nodes) in your neck , a thick, gray membrane covering your throat and tonsils , difficulty breathing or rapid breathing ,nasal discharge , fever and chills , malaise and further it may causing Myocarditis. Myocarditis is a clinical syndrome that happens if the thick muscular layer of heart is inflammation. When children develop myocarditis, they may experience the following signs and symptoms: high temperature, loss of appetite, breathing difficulties and bluish or grayish discoloration of the skin

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REFERENCES

1. Goldman L, Ausiello D, eds. Cecil Textbook of Medicine, 22nd Ed. Philadelphia, PA: Saunders; 2004. 2. http://adam.about.com/encyclopedia/000039.htm 3. http://www.depkes/dbd.htm
4. http://www.mayoclinic.com

5. http://www2.dw-world.de/indonesia/wissenschaft/1.115106.1.html 6. http://www.nlm.nih.gov/medlineplus/ency/article/000666.htm 7. http://www.pubmedcentral.nih.gov 8. http://www.pubmed.gov

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