BREAKING NEWS

06 June 2010

DIPHTHERIA

DIPHTHERIA
acute contagious disease characterized by general toxemia emanating from localized inflammatory process characterized by the formation of “pseudomembrane” commonly in the face area & tonsils, & the elaboration of a powerful exotoxin affecting the impt. viscera as the heart & kidneys & the peripheral nervous system.

Causative Agent:
Corynebacterium diphtheriae or Klebs Loffler bacillus

Modes of Transmission:
Direct contact – discharges form respiratory passages; saliva
Indirect contact – though various articles including toys & clothing contaminated by infected individual

Incubation period:
1 to 7 days

Signs and Symptoms:

Nasal
dryness & excoration of upper lip & nares with serosanguinous secretions
presence of pseudomembrane in nasal system.

Pharyngeal
pseudomembrane on throat (oropharynx)
bull neck appearance

Laryngeal
Laryngeal stridor – harsh sound heard on inspiration
Hoarseness of voice leading to aphonia (no voice) reversible
Signs of respiratory distress
Cutaneous or extra pulmonary
spread of causative agent outside of respiratory tract (ears, eyes, wound)

Diagnostic Exam:
Nose & throat culture – there must be 3 consecutive (-) result
Schick’s test – det susceptibility & immunity to diphtheria.
Molony test – det hypersensitivity to diphtheria anti-toxin

Treatment:
Drugs – (ADS) anti-diphtheria serum à to neutralize toxins = IM, IV ANST
Antibiotics – Penicillin G. Sodium, Eythromycin to kill the causative agent
Supportive
O2 inhalation
Tracheostomy
Suction secretions

Nursing Care:
TSB for fever
Provide liquid to soft diet with minimal CHON & sufficient CHO
Strict isolation
CBR – no early ambulation
Increase fluid intake
Small frequent feedings
Maintain patent airway
Proper disposal of naso-pharyngeal secretions
Diversional activities to children

Complications:
Myocarditis – dec apical pulse < 60 lead to cardiac arrest.
Peripheral neuritis
Broncho pneumonia

Prevention:
Avoid MOT
Immunization – DPT 0.5cc IM – vastus lateralis
given at the same time with OPV 6,10,14 wks
after DPT don’t massage to prevent lump forming
put hot moist compress if with lump formation
expect fever within 24 hrs -- give Paracetamol q4hours for 24 hours
check patient's temp before giving DPT
don't give succeeding doses if patient experienced convulsion

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