Diphtheria - Causes, Symptoms and Treatment
Diphtheria is an acute, highly contagious toxin-mediated infection caused by corynebacterium diphtheriae, a grampositive rod that usually infects the respiratory tract, primarily the tonsils, nasopharynx, and larynx, usually producing a membranous pharyngitis. GI and urinary tracts, conjunctivae, and ears are rarely involved.
Thanks to effective immunization, diphtheria is rare in many parts of the world, including the United States. Since 1972, the incidence of cutaneous diphtheria has been increasing, especially in the Pacific Northwest and the Southwest, in areas where crowding and poor hygienic conditions prevail. Most victims are children under age 15; about 10% of patients die. Recent outbreaks have occurred in the newly independent states adjacent to the former Soviet Union.
Causes of Diphtheria
Transmission usually occurs through intimate contact or by airborne respiratory droplets from asymptomatic carriers or convalescing patients; many more people carry this disease than contract active infection. Diphtheria is more prevalent during the colder months because of closer person-to-person contact indoors. But it may be contracted at any time during the year. Humans are the only known reservoir for this bacteria.
Signs and Symptoms of Diphtheria
Most infections go unrecognized, especially in partially immunized individuals. The incubation period for diphtheria is normally 1 week.
Some of the Common Symptoms may be:
Attempts to remove the membrane usually cause bleeding, which is highly characteristic of diphtheria. If this membrane causes airway obstruction (especially likely in laryngeal diphtheria), signs include tachypnea, stridor, possibly cyanosis, suprasternal retractions, and suffocation, if untreated. In cutaneous diphtheria, skin lesions resemble impetigo.
Complications include thrombocytopenia, myocarditis, neurologic involvement (primarily affecting motor fibers but possibly also sensory neurons), renal involvement, and pulmonary involvement (bronchopneumonia) due to C. diphtheriae or other superinfecting microbes.
Diagnosis of Diphtheria
Examination showing the characteristic membrane and a throat culture, or culture of other suspect lesions growing C. diphtheriae, confirm this diagnosis.
Treatment for Diphtheria
Treatment must not wait for confirmation by culture. Standard treatment includes diphtheria antitoxin administered I.M. or I.V.; antibiotics, such as penicillin or erythromycin, to eliminate the microbes from the upper respiratory tract and other sites, to terminate the carrier state; measures to prevent complications; and possible tracheotomy if airway obstruction occurs.
Diphtheria infection doesn't confer immunity, therefore diphtheria immunization should be given during convalescence.
Special Considerations and Prevention Tips for Diphtheria
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