Dr Kalyan Diphtheria Epidemiology Organism Gram Positive bacillus Corynebacterium diphtheriae Source of infection Secretions and discharge from infected person or carrier ID: 1044970
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1. Diphtheria, Pertussis and TetanusDr Kalyan
2. Diphtheria Epidemiology : Organism: Gram Positive bacillus, Corynebacterium diphtheriae. Source of infection: Secretions and discharge from infected person or carrier. Portal of entry: RT, Skin, Conjunctiva
3. Pathology Exotoxin : A and B. Local lesions: Pseudo-membrane formation. Systemi Effects: CVS CNS Renal system.
4. Clinical featuresIncubation period: 2-5 days. Constitutional symptoms: Local manifestations: 1. Nasal diphtheria; 2.Faucial diphtheria: 3.Laryngotracheal diphtheria: 4.Unusual sites;
5. Complications Myocarditis: End of 1st week, abdominal pain, vomiting, dyspnea, systemic venous congestion, tachycardia,extrasystoles, thready pulse, soft mufled1st heart sound. Neurological complications; palatal palsy, loss of accommodation, polyneuritis. Renal: oliguria,proteinuria
6. Diagnosis Clinical examination,Demonstration of organism by Albert”s stain From the lesionsIsolation of organism by culture from the lesions.Rapid diagnosis by Fluoresent antibody technique
7. Differential diagnosisNasal diphtheria – FB Nose, Congenital syphilisFaucial diphtheria- Acute membranous tonsilitis.Moniliasis,IMN.Laryngeal diphtheria—Croup, Acute epiglottis Retropharyngeal abscess
8. TreatmentPrinciples: Antitoxin Antibiotics Supportive Symptomatic Management of complications
9. AntitoxinPharyngeal / laryngeal20,000- 40,000 U Nasopharyngeal 40,000 – 60,000UExtensive disease80,000- 1,20,000U
10. AntibioticsProcaine penicillin: 3- 6 lakhs IM 12th Hrly 14 days (or)Erythromycin 25 – 30 mg/kg /day
11. Management of complicationsMyocarditis; Restriction of fluids and salts Bed rest Diuretics . DigoxinRespiratory obstruction : Huminified oxygen TracheostomyNeurological complications NG feeds Ventilator support
12. Prevention: Isolation of the case Disinfection of articles Chemoprophylaxis of close contacts Erythromycin 40 -50 mg/kg /day for 7 days Benzathene penicillin 6 – 12 lakhs IM Single doseActive Immunization
13. Whooping cough PertussisEpidemiology: Age incidence : < 4 yr Mode of infection- Droplet infection Organism: Non motile Gm Negative bacilllus- Bordetella pertussis
14. Clinical featuresIncubation period: 7 -14 daysClinical stage 1: Catarrhal stage: Lasts for 7 – 10 days Most infectuous period Clinical features :Cough Which become paroxysmal in the later part of this phase Coryza With little naso pharyngeal secretions
15. Clinical stage 2 : Paroxysmal Phase: Laasts for 2- 4 weeksSevere cough in explossive manner ending with whoop, paroxysms of cough are precipitated by cold air, food , cold liquidsChild appear choked,unable to breatheAnxious with suffused face
16. Clinical Stage 3: Convalesent phase: Lasts for 2- 4 weeks Frequency and severity of paroxysms decreases gradually
17. ComplicationsRespiratory: Atelectasis, pneumonia, Bronchiectasis, Pneumothorax, Subcutaneous emphysema, Accentuation of dormant TB focus*Neurological: Convulsions Encephalopathy Focal intracranial Hemorrhages
18. GIT; Hernia Rectal ProlapseHemorrhagic: Subconjuctival hemorrhageMalnutrition
19. DiagnosisTLC Elevated Rapid diagnosis by fluoresent antibody stainingIsolation of organism in cultures
20. Differential diagnosisFB in air passagesTB hilar lynphadenitisBronchiolitisAdenovirus infection of RT
21. TraetmentErythromycin 40- 50 mg/kg/day for 14 daysBronchodilator therapy by nebulisationBetamethasone in life thretening states - O.75mg/kg/day
22. PreventionActive immunisation: Primary at 6.10,14 weeks booster after 1 year of age.
23. Tetanus Some 60% of tetanus deaths occur in neonates and children under the age of 5.The World Health Organization has repeatedly failed to meet its deadlines for tetanus elimination and the disease remains an important global health concern.The causative agent of tetanus, Clostridium tetani is a ubiquitous organism, present in the soil and in human and animal faeces.
24. Neonatal tetanus usually arises from contamination of the umbilical stump.Even after maternal immunization, the infant is still at risk in many countries, as malaria and HIV reduce placental transfer of protective antibody.
25. Clinical manifestationTetanus is most often generalized but may also be localized.Incubation period -2 to 14 daysIn generalized tetanus the presenting symptom in about half of cases is trismus (masseter muscle spasm, or lockjaw)Tetanus toxin does not affect sensory nerves or cortical function, the patient unfortunately remains conscious, in extreme pain, and in fearful anticipation of the next tetanic seizure.
26. Neonatal tetanus, the infantile form of generalized tetanus, typically manifests within 3-12 days of birth.Localized tetanus results in painful spasms of the muscles adjacent to the wound site and may precede generalized tetanus. Results of routine laboratory studies are usually normal.
27. Treatment Surgical wound excision and debridement.Surgery should be performed promptly after administration of human tetanus immunoglobulin (TIG) and antibiotics.Single intramuscular injection of 500 units of TIG to neutralize systemic tetanus toxin, but total doses as high as 3,000-6,000 U are also recommended.Oral (or intravenous) metronidazole (30 mg/kg/day, given at 6 hr intervals; maximum dose, 4 g/day) decreases the number of vegetative forms of C. tetani and is currently considered the antibiotic of choice.Diazepam provides both relaxation and seizure control.The initial dose of 0.1-0.2 mg/kg every 3-6 hr intravenously.
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