II.

PATHOPHYSIOLOGY AND MANAGEMENT

A. Schematic Diagram
PREDISPOSING FACTORS:
a. Children & adults who
lack immunization
b. Immunocompromised
status
c. Nationality (cases are
higher in less developed
countries)
PRECIPITATING FACTORS:
a. Poor hygiene
b. Close contact with
infected person/s
c. Exposure to overcrowding
ETIOLOGICAL AGENT: d. Poor sanitary conditions
Corynebacterium diphtheriae e. History of travel to areas
(gram +, rod-shaped, endemic for Diphtheria
nonmotile, aerobic bacteria) f. Sharing utensils & fomites
with person suffering
MODE OF TRANSMISSION: from Diphtheria
a. Respiratory route (droplet),
b. Fomites
c. Carriers

CUTANEOUS MODE OF ENTRY:

a. Open lesions
DIPHTHERIA b. Respiratory tract
(nose, throat &
nasopharynx)
Tissue necrosis

Initiation on superficial layers of

mucous membrane and epithelial
Skin ulcer membrane surfaces.

SIGNS & SYMPTOMS: DT Toxin has 2 main subunits:

C. diphtheriae produces a cytotoxic
A subunit: enzyme that constitutes
a. Chronic non- protein called Diphtheria Toxin (DT
the toxic part
healing ulcers Toxin)
with well B subunit: binds to host cell
defined margins receptors
b. Punched-out
ulcers AB toxin enters cells by endocytosis

Contents of vacuole become acidic,

causing the A & B portions of the
toxin to separate.

A B
 SIGNS &
SYMPTOMS: Removed from cell by exocytosis.
Enter cytoplasm of the cell and
a. Low grade exerts its toxic effects.
fever
b. General MANAGEMENT:
malaise a. Isolate pt. to prevent spread
c. Weakness A toxin carries out the transfer of b. Penicillin G is given
ADP-ribose to elongation factor 2 (Erythromycin in case of allergy)
(EF 2) c. Elek’s test is done to prove if
infecting bacteria is toxigenic.
d. Diphtheria Antitoxin is given to
counter the effects of the
Inhibits protein synthesis. bacteria.

Toxin absorption of adjacent cells;

continued exotoxin production

Attaches to pharyngeal epithelial SIGNS & SYMPTOMS:

cells and releases DT toxins which PHARYNGEAL a. Sore throat
causes: DIPHTHERIA b. Tonsillitis
a. Inflammation to the area c. Neck swelling
b. Necrosis (Bull’s neck)

Necrotic tissue builds up in the

SIGNS & SYMPTOMS: DIAGNOSTIC METHODS:
pharynx or larynx: a. Culture of swab
a. Gray adherent, Pseudomembrane from pharynx
leathery membrane b. Elek’s Test
(Pseudomembrane)
c. Polymerase Chain
b. Difficulty breathing
Reaction for
c. Stridor
IF LEFT UNTREATED: exotoxin gene

C. diphtheriae gradually Portion of pseudomembrane

invades deeper into the can detach and get lodged in
pharyngeal wall. trachea or bronchi.

Block airways completely.

Exotoxin absorption by
blood & lymphatics

DEATH BY ASPHYXIATION

Affects distant organs

 Heart Kidneys Nerves

Myocarditis Acute Tubular

Nerve demyelination
Necrosis

 Polyneuropathy
SIGNS & SYMPTOMS:  Oculomotor Palsy
a. Visual impairment  Affects Phrenic Nerve
b. Diplopia
c. Inability to move eyes
d. Dyspnea
e. Oliguria
f. Arrythmias
LEGEND

IF MANAGED/TREATED: SIGNS & SYMPTOMS

DIAGNOSTIC METHODS

GOOD PROGNOSIS
MANAGEMENT

LEADS TO