By : Dina Israni Putri

Diphtheria

Corynebacterium diphtheriae

acute infectious disease

spreads easily

attacked mainly the upper respiratory tract

a typical pseudomembranous formation

Corynebacterium diphtheriaeGram-positive,aerobic,nonmotile,rod-shaped bacteria. characteristic of forming irregular shaped, club-shaped or V-shapedChinese letters.

Airborne respiratory

droplets

Exudates from infected skin

lesions

Direct contact with

respiratory secretions

Clinical SymptomsThe incubation period : 2-6 daysUsually the disease slightly veiled attacks, such as :

- mild sore throat-heat is not high, ranging between 37.8 º C - 38.9 º C. -Initially only throat hiperemis but most have occurred membranes white / grayish.

Within 24 hours of the membrane can spread and cover the tonsils, palate Molle, uvula. 

At - first, a thin membranewhite and webbed becomes thick gray / black difficult to be lifted 

According to its severity, the disease is divided into 3 levels• Mild infections

pseudomembran only found in the nasal mucosa with only symptoms of painful swallowing

 • Moderate Infection -pseudomembran have attacked until the pharynx-swelling of the larynx

• Severe infection-severe respiratory obstruction -with complication (myocarditis , paralysis and Nefritis)

Nasal diphtheria- Cold- Secretions that come out mixed a little blood from pseudomembranous

Pharyngeal and Tonsillar Diphtheria- Acute Sore throat- Pseudomembranous extend to the nasopharynx and larynx- Breath odor- bullneck

Larygeal anf Tracheal Diphtheria- Hoarseness and stridor- dispnea, cyanosis and looked suprasternal and epigastrium retraction - bull neck

ImmunizationDPTType : - DTwP (whole pertusis)

- DTaP ( accellular pertusis)Dossage : 0,5 mg IM or subcutan

DosePrimary 1Primary 2Primary 3Primary 4

Age2 months4 months6 months15-18 months

Interval ---4 wks4 wks6 mos

DTaP, DT

Td, Tdap (adult)

Diphtheria7-8 Lf units

2-2.5 Lf units

Tetanus5-12.5 Lf units

5 Lf units

DTaP and pediatric DT used through age 6 years. Adult Td for persons 7 years and older. Tdap for persons 10 through 64 years or 11 through 64 years

Routine DTaP Schedule for Children Younger Than 7 Years of Age

4 through 6 years of age, before entering school

11 or 12 years of age if 5 years since last dose (Tdap)

Every 10 years thereafter (Td)

Booster Doses

Dose*Primary 1Primary 2Primary 3

Interval ---4 wks6 to 12 mos

Booster dose every 10 years

*For children 10 years of age and older ACIP recommends that one of these doses (preferably the first) be administered as Tdap

TreatmentNon spesific Spesificcomplete bed rest, isolation of patients soft foods are easily

digested, contains enough protein and calories

Antibiotic- Penicilin procain- Eritromicin- Linkomicin

ADSCorticosteroid

Type Doses

Nasal Diphtheria 20.000 Intramuskular

Tonsingeal Diphtheria 40.000 Intramuskular/intravena

Faringeal Diphtheria 40.000 Intramuskular/intravena

Laringeal Diphtheria 40.000 Intramuskular/intravena

Combination 80.000 Intravena

Diphtheria+ complication, Bull Neck 80.000-120.000 Intravena

Late treatment (>72 h), in anywhere 80.000-120.000 Intravena

Prognosis1. Age of patients

2. Antitoxin treatment time

3. Type of clinical diphtheria

4. Patient's general condition

Thank You