Diphtheria

Subject: Child Health Nursing

Overview

The bacterial species Corynebacterium is the source of the infectious disease diphtheria, which is most frequently characterized by fever, a sore throat, and the development of an adherent membrane on the tonsils and/or nasopharynx. Other organ systems, like the heart and nervous system, can be negatively impacted by severe infections. Additionally, some diphtheria patients may also develop skin infections. The bacteria's exotoxin is a key factor in causing the more severe symptoms of diphtheria. Diphtheria is brought on by a kind of bacteria called Corynebacterium diphtheria. The most visible and common symptom of diphtheria is a thick, gray coating on the and tonsil.The most visible and common symptom of diphtheria is a thick, gray coating on the and tonsil.Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.

Diphtheria

The bacterial species Corynebacterium is the source of the infectious disease diphtheria, which is most frequently characterized by fever, a sore throat, and the development of an adherent membrane on the tonsils and/or nasopharynx. Other organ systems, like the heart and brain system, can be negatively impacted by severe infections. Additionally, some diphtheria patients may also develop skin infections. The bacteria's exotoxin is a key factor in causing the more severe symptoms of diphtheria.

Epidemiology

Incubation Period: 2-5 days

Source of Infection: The secretion and discharge from an infected person or carrier.

Reservoirs: Human beings

Age: Common in preschool age children

Sex: Both

Environmental Factors: Occur in all season but winter months favor its spread.

Mode of Transmission: Droplet infection infected cutaneous lesions and by objects such as cups, toys etc.

Portal of Entry:

  • Respiratory route: respiratory tract.
  • Nonrespiratory tract : skin, cuts, conjunctiva.

Causes:

A type of bacteria called Corynebacterium diphtheria causes diphtheria. Usually C. diphtheriae multiply on or near the surface of the mucous membranes of the throat. C. diptheriae spreads via three routes:

  • Airborne droplets.
  • Contaminated personal items.
  • Contaminated household items.

In some cases, these toxins can also damage other organs, including the heart, brain, and kidneys. This can lead to potentially life-threatening complications, such as myocarditis, paralysis, or kidney failure.

Signs and symptoms:

The most visible and common symptom of diphtheria is a thick, gray coating on the throat and tonsils. Other common symptoms include:

  • a fever,
  • chills,
  • Swollen glands in the neck,
  • a loud, barking cough,
  • a sore throat,
  • bluish skin,
  • drooling,
  • a general feeling of uneasiness or discomfort.

Additional symptoms may occur as the infection progresses, including:

  • difficulty breathing or swallowing,
  • changes in vision,
  • slurred speech,
  • signs of shock, such as pale and cold skin, sweating, and a rapid heartbeat.

Diagnosis

  • History taking,
  • Physical exam,
  • Culture of throat and nasal smear.

Treatment

Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these medications:

  • An Antitoxin: If doctors suspect diphtheria, the infected child or adult receives an antitoxin. The antitoxin injected into a vein or muscle, neutralizes the diphtheria toxin already circulating in the body.

To ensure that the infected person does not have an allergy to the antitoxin, doctors may perform skin allergy tests before administering the antitoxin. The antitoxin must first be desensitized in allergic individuals. The antitoxin is first administered in small doses, and the dosage is then gradually increased by doctors to achieve this.

  • Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.
  • Observed: for reduction in constitutional symptoms and toxemia
  • Supportive treatment includes:
    • Keep a child in bed rest for 2-3 weeks to reduce cardiac complications.
    • Regular monitoring of heart rate and rhythm to reduce cardiac complication.
    • Provide easily digestible high-calorie foods.
    • Give symptomatic treatment
    • Treatment of complication on time.

Prevention

  • Isolation of patient.
  • Disinfection of all articles contaminated by discharge.
  • Immunization of DPT should be given.
  • Chemoprophylaxis 40-50mg/kg/day of oral erythromycin for seven days.

Nursing Care

Diphtheria patients must be treated in isolation rooms closed. Health care workers should wear special dresses (aprons) and masks should be replaced every turn of duty or at any time when dirty. Instead, the keeper of the patient must also wear an apron to prevent transmission to the outdoors. Hand-washing equipment should be provided: disinfectant, soap, washcloth, or towels are always dry, clean water, if there is also a place to soak faucet cutlery filled with disinfectant. The risk of complications of airway obstruction, myocarditis, pneumonia. Patients with diphtheria, although mild illness needs to be hospitalized because of potentially life-threatening complications are caused by pseudomembranous and exotoxin released by the diphtheria bacillus.

Airway Obstruction

This disorder occurs because of edema of the larynx and trachea, and the pseudomembranous. Symptoms of blockage are hoarseness and stridor inspiration. When more severe shortness of breath occurs, cyanosis, muscle retraction looks, sounds stridor:

  • Give oxygenation.
  • Lay half sitting.
  • Call the doctor.
  • Install an infusion (if not already installed).
  • Contact the parents let the situation of children and the dangers that can occur.

Myocarditis



Myocarditis is a condition that is typically diagnosed between the second and third week after exposure to the exotoxin released by the diphtheria bacillus and absorbed by the heart. Continuous observation is required to identify myocarditis symptoms, and the patient should rest for at least 3 weeks or until two consecutive normal ECG results are obtained. Pulse, respiration, and temperature were carefully monitored throughout the course of the treatment.

If no ECG equipment:

Monitoring the pulse is very important and should be done every hour and recorded on a regular basis. If there is a change in pulse rate continues to drop (bradycardia) should immediately contact a doctor. Treatments other than vital signs and general condition:
Patients should not be a lot of moves, but recumbency must often be changed, for example, every 3 hours to prevent complications of bronchopneumonia (hypostatic pneumonia).
Keep the skin on the body to prevent pressure sores (remember, the patient bed rest for 3 weeks, can not wake up).

The Complications of the Nervous

The complications of the nerve can occur in the first week and the second. If the soft palate nerve (nerve swallow) with the patient's symptoms when drinking water / milk will come out through the nose. If this occurs:

  • How to give a drink to be careful, while the patient is seated.
  • If the patient is eating a liquid that is slightly thicker and given little by little.

Complications in Renal

During the diphtheria patients in care, the state of the urine, in addition, to be aware of color, too much is normal or not.
Impaired nutrient inputs. Impaired nutrient inputs diphtheria patients, in addition to the pain caused by swallowing, as well as anorexia. If the child is willing to swallow him to want to eat little by little and give a liquid or pureed diet solution and give more milk. If the patient does not eat at all or very little, or in a state of shortness of breath, infusion needs to be installed. After 2-3 days, then shortness of breath have decreased before the infusion was stopped trying to eat by mouth and apbila children have to eat infusion is stopped. Give drink frequently to maintain oral hygiene and help smooth elimination

REFERENCE

Healthline. 2005. 2017 <http://www.healthline.com/health/diphtheria#ReadThisNext8>.

Mayo Clinic. 1998. 2017 <http://www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/dxc-20300514>.

Mayo Clinic. 1998. 2017 <http://emedicine.medscape.com/article/215100-overview>.

MedicineNet. 1996. 2017 <http://www.medicinenet.com/diphtheria_facts/article.htm>.

Medscape. 1994. 15 march 2016 <http://emedicine.medscape.com/article/215100-overview>.
Things to remember
  • The bacterial species Corynebacterium is the source of the infectious illness diphtheria, which is most frequently characterized by fever, a painful throat, and the formation of an adherent membrane on the tonsils and/or nasopharynx.
  • Other organ systems, like the heart and brain system, can be negatively impacted by severe infections.
  • Additionally, some diphtheria patients may also have skin infections. The bacteria's exotoxin is a key factor in creating the more severe symptoms of diphtheria.
  • Diphtheria is brought on by a kind of bacteria called Corynebacterium diphtheria.
  • The tonsil and tonsil have a thick, gray coating, which is the most obvious and typical sign of diphtheria.
  • Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.
Questions and Answers

Causes:

Diphtheria is brought on by a kind of bacteria called Corynebacterium diphtheria. The disease is typically spread from person to person or when in contact with objects like cups or used tissues that have the bacteria on them. If you are close to someone who has diphtheria and they cough, sneeze, or blow their nose, you could also contract the disease. An infected person can still spread the bacterial infection for up to six weeks after the initial infection, even if they don't exhibit any diphtheria symptoms or signs.

Your nose and throat are typically infected by the bacteria. Toxins are harmful substances that the bacteria release once you are infected. Your bloodstream is spread by the toxins, which frequently result in the formation of a heavy, gray coating in the:

  • Nose
  • Throat
  • Tongue
  • Airway

These toxins can occasionally harm not only the kidneys but also the kidneys, brain, and heart. This may result in complications that could be fatal, like myocarditis, paralysis, or kidney failure.

Signs and symptoms:

The tonsils and throat have a thick, gray coating, which is the most obvious and typical sign of diphtheria. Other typical signs include:

  • The fever
  • Chills
  • Neck glands that are enlarged
  • A barking, loud cough
  • An upset stomach
  • The color blue
  • Drooling
  • An overall sensation of unease or discomfort

As the illness worsens, more signs and symptoms like:

  • Breathing or swallowing challenges
  • Alterations to vision
  • Muddled speech
  • A rapid heartbeat, pale and cold skin, and other symptoms of shock

The bacterial species Corynebacterium is the source of the infectious disease diphtheria, which is most frequently characterized by fever, a painful throat, and the development of an adherent membrane on the tonsils and/or nasopharynx. Other organ systems, like the heart and brain system, can be negatively impacted by severe infections. Additionally, some diphtheria patients may also have skin infections. The bacteria's exotoxin is a key factor in creating the more severe symptoms of diphtheria.

Treatment:
A serious disease is diphtheria. With these drugs, doctors treat it swiftly and aggressively:

  • An antitoxin: An antitoxin is administered to the afflicted kid or adult if doctors suspect diphtheria. The diphtheria toxin that is already present in the body is neutralized by the antitoxin that is injected into a vein or muscle. To ensure that the infected person does not have an allergy to the antitoxin, doctors may perform skin allergy tests before administering the antitoxin. The antitoxin must first be desensitized in allergic individuals. The antitoxin is first administered in small doses, and the dosage is then gradually increased by doctors to achieve this.
  • Additionally, medications like erythromycin or penicillin are used to treat diphtheria. Antibiotics aid in the body's destruction of microorganisms, hence removing illnesses. Diphtheria patients are no longer contagious for more than a few days thanks to antibiotics.
  • Reduced constitutional symptoms and toxemia were noted.
  • Supportive care consists of:
    • For two to three weeks, keep a youngster on bed rest to prevent heart problems.
    • Regular heart rate and rhythm monitoring helps to prevent cardiac complications.
    • Provide calorie-dense foods that are simple to digest.
    • Administer symptomatic therapy
    • Timely treatment of the complication.

Prevention:

  • Patient isolation
  • Cleaning up any items contaminated by the spill
  • DPT vaccination ought to be administered.
  • Chemoprophylaxis for seven days with oral erythromycin at a dose of 40–50 mg/kg/day.

Nursing care:
Patients with diphtheria must receive treatment in locked isolation rooms. Apron-style clothing is required for healthcare personnel, and masks should be changed after each shift or whenever they become soiled. Instead, in order to stop transmission to the outside world, the patient's caretaker must also don an apron. If there is a location to soak faucet cutlery filled with disinfectant, hand-washing supplies like soap, disinfectant, washcloths, and towels should also be available. the potential for pneumonia, myocarditis, and airway obstruction problems. Despite having a mild illness, diphtheria patients must be hospitalized due to potentially fatal complications brought on by the exotoxin and pseudomembranous toxins released by the diphtheria bacillus.

Airway obstruction

The edema of the larynx, trachea, and pseudomembranous contribute to this condition. Hoarseness and stridor inspiration are indications of obstruction. If you have more severe shortness of breath, cyanosis, or muscle retraction:

  • Provide oxygen.
  • Lay partially seated.
  • Phone the doctor.
  • Establish a fusion
  • Inform the parents of the children's situation and any potential hazards.

 

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