Diptheria

exp date isn't null, but text field is

The bacteria responsible for this disease produces a toxin that damages human body tissues and organs. It commonly affects the tonsils and sometimes the skin causing ulcers. It is spread mainly by respiratory droplets from person to person, and less commonly through skin contact.

Infected patients may recover after initial symptoms and signs or develop severe weakness and die within 6-10 days. Complications may develop in the early phase of the disease or weeks later such as abnormal heartbeat and heart failure, damage to valves of the heart, or respiratory obstruction leading to death.  

The disease is now uncommon because of immunisation. However, high immunisation coverage needs to be maintained to keep the disease under control because it has a high mortality rate.

Note: All cases of diphtheria should be reported to the District Disease Control Officer.

Cause

  • Corynebacterium diphtheriae 

Symptoms

  • Sore throat
  • Loss of appetite
  • Slight fever
  • Dysphagia
  • Difficulty in breathing with or without stridor

Signs

  • Greyish white membrane or patch in the throat and on tonsils within 2-3 days of the onset of symptoms. Membrane may bleed, become greyish green or black. 

Investigations

  • Throat/nasal swabs for culture for index case and close contacts
  • Repeat swabs after antibiotic treatment course (treatment may need to be extended).

TreatmentTreatment Objectives

  • To neutralise the effect of circulating antitoxins before they become fixed to the tissues 
  • To provide supportive care respiratory and feeding where indicated
  • To eradicate the organism from the pharynx
  • To prevent spread 

Non-pharmacological treatment

  • Bed rest
  • Feeding by nasogastric tube for patients who cannot swallow
  • Strict isolation of suspected patients

Pharmacological treatment 

All patients clinically diagnosed with diphtheria

Evidence Rating: [C]

  • Diphtheria antitoxin, IV infusion (following an intradermal test dose of 0.1 ml of 1 in 10 dilution of antitoxin in Sodium Chloride 0.9%)

Adults

10,000 to 20,000 units

Children

> 10 years; 10,000-20,000 units

< 10 years; 5,000-10,000 units

Note: Reactions are common so resuscitation facilities should be available immediately

And

  • Benzyl Penicillin, IV,

Adults

1.2 g 6 hourly for 48 hours

Children and Neonates     

1 month-18 years; 50 mg/kg 6 hourly for 48 hours

Then 

  • Amoxicillin, oral,

Adults

1 g 12 hourly for 5 days

Children

5-18 years; 500 mg 12 hourly for 10 days

1-5 years; 250 mg 12 hourly for 10 days

1 month-1 year; 125 mg 12 hourly for 10 days

Or 

  • Azithromycin, oral,  

Adults

500 mg daily for 5 days

Children 

10 mg/kg body weight daily for 5 days. 

Not recommended for children less than 6 months because of a risk  of pyloric stenosis.

All close contacts

  • Amoxicillin, oral, for 14 days (refer dosing above) 

Or 

For patients who may not tolerate penicillins:

  • Azithromycin, oral, for 5 days (refer dosing above)

Referral Criteria

  • Refer patients with laryngeal obstruction or respiratory paralysis to an ENT specialist.