DIPHTHERIA & PERTUSSIS

Regional Epidemiology Surveillance Unit

Jerick C. Omega, RPh

VPD Surveillance Officer
DIPHTHERIA
• Diphtheria is a serious infection caused by strains of bacteria
called Corynebacterium diphtheriae that make toxin.
• It is characterized by a sore throat and mild fever at first
followed by an adherent pseudomembrane in the tonsil,
pharynx, larynx or nasal cavity
• It can lead to difficulty breathing, heart rhythm problems, and
even death.
 Symptoms of diphtheria include:
• a thick grey-white coating that may cover the back of
your throat, nose and tongue.
• a high temperature (fever)
• sore throat.
• swollen glands in your neck.
• difficulty breathing and swallowing.
Differential Diagnosis for Diphtheria:
• Epiglottitis • Pharyngitis
• Infective Endocarditis • Peritonsillar Abscess
• Infectious Mononucleosis • Retropharyngeal Abscess
• Myocarditis • Rheumatic Fever
• Oropharyngeal/
esophageal candidiasis
 CASE DEFINITION/CLASSIFICATION:
• Suspected Case: Any person with illness of
upper respiratory tract characterized by
pharyngitis, nasopharyngitis, tonsillitis or
laryngitis and adherent pseudomembrane of
the tonsils, pharynx, larynx and/or nose
 CASE DEFINITION/CLASSIFICATION:
• Laboratory-Confirmed Case: A case is a
person (regardless of a symptoms) with
Corynebacterium spp. Isolated by culture and
positive for toxin production
 Outbreak Investigation
• Special consideration: Sometimes during outbreak
investigation when household contacts are investigated,
people will be identified with positive Corynebacterium
cultures and evidence of toxigenicity, who do not meet the
suspected case definition. These people should still be
reported as laboratory-confirmed cases, as their treatment
and public health response is the same as the other
laboratory-confirmed cases.
 Specimen Collection
Disease Specimen Specimen Amount Storage Timing of Photo
Container Sample Temperature collection

Diphtheria Amies OPS 1 2-8 C As soon

Transport (Polyester, sample suspicion
Medium rayon or arises and
(Plain) nylon swabs before anti-
should be microbial
used) therapy
PERTUSSIS
• Pertussis, also known as whooping cough, is a very contagious
respiratory illness caused by a type of bacteria
called Bordetella pertussis.
• It is characterized by severe coughing which sometimes end
with whooping sound when the person breathes in.
• It spreads easily from person to person mainly through
droplets produced by coughing or sneezing. The disease is
most dangerous in infants, and is a significant cause of disease
and death in this age group.
 Symptoms of Pertussis
STAGE 1
Early symptoms can last for 1 to 2 weeks and usually include:
• Runny or stuffed-up nose
• Low-grade fever (less than 100.4°F)
• Mild, occasional cough (babies do not do this)
• Apnea (life-threatening pauses in breathing) and cyanosis
(turning blue or purple) in babies and young children
STAGE 2

• 1-2 weeks after the first symptoms start, people with

pertussis may develop paroxysms—rapid, violent,
and uncontrolled coughing fits that usually last 1-6
weeks or longer. These coughing fits generally get
worse and become more common as the illness.
Coughing fits can cause people to:
• Make a high-pitched “whoop” sound when they are
finally able to inhale at the end of a coughing fit
• Vomit during or after coughing fits
• Feel very tired after the fit
• Struggle to breathe
Differential Diagnosis for Pertussis:
• Bronchiolitis
• Bacterial pneumonia
• Interstitial pneumonitis
• Congestive heart failure
• COPD
• Asthma
• Respiratory Syncytial Virus
 CASE DEFINITION/CLASSIFICATION:
Suspected Case: Any person with cough lasting at least 2 weeks
with at least one of the following:
- Paroxysms (i.e. fits) of coughing
- Inspiratory “whooping”
- Post-tussive vomiting (i.e. vomiting immediately after
coughing) without other apparent cause
- Apnea, with or without cyanosis (For infants < 1 year old)
 CASE DEFINITION/CLASSIFICATION:
Confirmed Case:
• A suspect case that is laboratory confirmed or
epidemiologically linked to a laboratory-confirmed case
• Laboratory criteria for diagnosis: Isolation of Bordetella
pertussis from clinical specimen
 Specimen Collection
Disease Specimen Specimen Amount Storage Timing of Photo
Container Sample Temperature collection
Pertussis Regan- NPS (Dacron 1 sample 2-8 C As soon
Lowe or Calcium suspicion
Medium Alginate Swab arises and
– not cotton) before anti-
microbial
therapy
UTM NPS (Dacron 1 sample 2-8 C As soon
(Universal or Calcium suspicion
Transport Alginate Swab arises and
Medium) – not cotton) before anti-
microbial
therapy
THANK YOU!