Diphtheria Diphtheria is an acute infectious disease caused by the bacteria Corynebacterium diphtheriae.

Causes Diphtheria spreads through respiratory droplets (such as those produced by a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms. Diphtheria can also be spread by contaminated objects or foods (such as contaminated milk). The bacteria most commonly infects the nose and throat. The throat infection causes a gray to black, tough, fiber-like covering, which can block the airways. In some cases, diphtheria may first infect the skin, producing skin lesions. Once infected, dangerous substances called toxins, produced by the bacteria, can spread through your bloodstream to other organs, such as the heart, and cause significant damage. Risk factors include crowded environments, poor hygiene, and lack of immunization. Symptoms Symptoms usually occur 2 to 5 days after you have come in contact with the bacteria.
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Bluish coloration of the skin Bloody, watery drainage from nose Breathing problems o Difficulty breathing o Rapid breathing o Stridor Chills Croup-like (barking) cough Drooling (suggests airway blockage is about to occur) Fever Hoarseness Painful swallowing Skin lesions (usually seen in tropical areas) Sore throat (may range from mild to severe)

Exams and Tests The health care provider will perform a physical exam and look inside your mouth. This may reveal a gray to black covering (pseudomembrane) in the throat, enlarged lymph glands, and swelling of the neck or larynx. Tests used may include:
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Gram stain or throat culture to identify Corynebacterium diphtheriae Electrocardiogram (ECG)

Treatment If the health care provider thinks you have diphtheria, treatment should be started immediately, even before test results are available.

Diphtheria antitoxin is given as a shot into a muscle or through an IV (intravenous line). The infection is then treated with antibiotics, such as penicillin and erythromycin. People with diphtheria may need to stay in the hospital while the antitoxin is being received. Other treatments may include:
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Fluids by IV Oxygen Bed rest Heart monitoring Insertion of a breathing tube Correction of airway blockages

Pathophysiology The organism usually infects the epithelium of the skin and the mucosa of the upper respiratory tract, leading to inflammation of those tissues. Diphtheria classically involves the tonsils and pharynx, although the nose and larynx are also common foci of infection. The average incubation period is 2 to 7 days (range 1 to 10 days), after which signs and symptoms of inflammation develop. The accompanying fever does not usually exceed 39C (102.2F) The local inflammation in the upper respiratory tract leads to an accumulation of inflammatory cells, necrotic epithelial cells, and organism debris, which form the characteristic adherent grey pseudomembrane. Attempts to remove the pseudomembrane result in bleeding and expose an inflamed erythematous mucosa. Due to local neurological effects of the exotoxin, paralysis of the palate and hypopharynx can also occur. This paralysis, in combination with inflammation and oedema of the upper respiratory tract, can lead to airway obstruction. In addition, systemic spread of the toxin can cause injury to the kidneys, heart, and neural tissue Nursing care : -The aims of treatment are to inactivate toxin, to kill the organism, and to prevent respiratory obstruction. 1) Strict bed rest, strict isolation. 2) Cleansing throat gargle may be ordered. 3) Liquid or soft diet,gavage or parenteral fluid. 4) Observe for respiratory obstruction (tracheotomy). 5) Use suctioning as needed. 6) O2 therapy. 7) Antitoxin is given against toxin. 8) Toxoid is given to immunized contact. 9) Broad spectrum antibiotic is given against diphtheria bacilli.