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2. Respiratory diseases
Diphtheria
D iph th eria is a bacterial infection d ue to Corynebacterium diphtheriae, ch aracterized by
local proliferation (m ost com m only E N T ) of th e bacteria, and system ic d iffusion of th2e
d iph th eria toxin th roug h th e bod y.
T ransm ission is by d irect contact w ith an infected person.
Clinical features
– Incubation period : 3 to 5 d ays
– L ocal sig ns:
• febrile tonsillitis w ith pseud om em branes ( g rey, toug h and v ery sticky false
m em branes) som etim es accom panied by sig ns of serious illness: h ig h fev er
(g reater
th an 3 9 °C ), olig uria, cerv ical oed em a, enlarg ed cerv ical lym ph g land s and sig ns
of
h aem orrh ag e (cerv ical or th oracic purpura, g ing iv al bleed ing , epistaxis).
• laryng itis, m ost com m only second ary to th e tonsillitis. R isk of d eath by
Cas. pdhipyhxthiaetrioiane..
• oth er local sig ns: rh initis (often unilateral); second ary infection of a skin lesion w ith
– G oefnpeartaiel nstigs.nTs hd ueesetoatrhe emtooxrine:serious w h en appear early (from th e 5 d ay).
• m ycocard itis: clinically d etectable arrh yth m ias or card iac cond uction d efects in 2 5 %
th
• neuropath ies m ay occur 1 to 3 m onth s after th e onset of th e d isease: paralysis of th e
soft palate, respiratory m uscles, lim bs and accom m od ation.
• m ore rarely: pneum onia, renal failure w ith olig o-anuria and h aem aturia.
Laboratory
C onfirm ation is m ad e by isolating th e toxic strain of C. diphtheriae from a th roat sw ab.
Treatment (at h ospital lev el)
– Strict isolation.
– TB resartemd keanmt w eith oadnt.itoxin serum : d o not w ait for bacteriolog ical confirm ation.
F or diphtheria antitoxin d eriv ed from h orse serum , ad m inister accord ing to th e
1
D oses are g iv en as a function of th e sev erity of illness, and th e d elay in treatm ent:
Dose in units Administration route
L aryng itis or ph aryng itis 2 0 0 0 0 to 4 0 0 0 0 D epend s on th e v olum e to be
ad m inistered : IM or for v olum es
R h inoph aryng itis 84 00 00 00 00 atond6 0 0 0 0 g reater th an 2 0 0 0 0 units IV infusion
Serious form s or if treatm ent up to 1 0 0 000 in 2 0 0 m l 0 .9 % N aC l, ov er one h our
is started m ore th an 4 8 h ours
after onset of sym ptom s
Besredka method: inject 0.1 ml SC and wait 15 minutes. If there is no allergic reaction (no erythema at the injection
site or a flat erythema of less than 0.5 in diameter, inject a further 0.25 ml SC. If there is no reaction after 15 minutes
1
inject the rest of the product IM or IV depending on the volume to be administered.
55
Diphtheria
D iph th eria is a bacterial infection d ue to Corynebacterium diphtheriae, ch aracterized by
local proliferation (m ost com m only E N T ) of th e bacteria, and system ic d iffusion of th2e
d iph th eria toxin th roug h th e bod y.
T ransm ission is by d irect contact w ith an infected person.
Clinical features
– Incubation period : 3 to 5 d ays
– L ocal sig ns:
• febrile tonsillitis w ith pseud om em branes ( g rey, toug h and v ery sticky false
m em branes) som etim es accom panied by sig ns of serious illness: h ig h fev er
(g reater
th an 3 9 °C ), olig uria, cerv ical oed em a, enlarg ed cerv ical lym ph g land s and sig ns
of
h aem orrh ag e (cerv ical or th oracic purpura, g ing iv al bleed ing , epistaxis).
• laryng itis, m ost com m only second ary to th e tonsillitis. R isk of d eath by
Cas. pdhipyhxthiaetrioiane..
• oth er local sig ns: rh initis (often unilateral); second ary infection of a skin lesion w ith
– G oefnpeartaiel nstigs.nTs hd ueesetoatrhe emtooxrine:serious w h en appear early (from th e 5 d ay).
• m ycocard itis: clinically d etectable arrh yth m ias or card iac cond uction d efects in 2 5 %
th
• neuropath ies m ay occur 1 to 3 m onth s after th e onset of th e d isease: paralysis of th e
soft palate, respiratory m uscles, lim bs and accom m od ation.
• m ore rarely: pneum onia, renal failure w ith olig o-anuria and h aem aturia.
Laboratory
C onfirm ation is m ad e by isolating th e toxic strain of C. diphtheriae from a th roat sw ab.
Treatment (at h ospital lev el)
– Strict isolation.
– TB resartemd keanmt w eith oadnt.itoxin serum : d o not w ait for bacteriolog ical confirm ation.
F or diphtheria antitoxin d eriv ed from h orse serum , ad m inister accord ing to th e
1
D oses are g iv en as a function of th e sev erity of illness, and th e d elay in treatm ent:
Dose in units Administration route
L aryng itis or ph aryng itis 2 0 0 0 0 to 4 0 0 0 0 D epend s on th e v olum e to be
ad m inistered : IM or for v olum es
R h inoph aryng itis 84 00 00 00 00 atond6 0 0 0 0 g reater th an 2 0 0 0 0 units IV infusion
Serious form s or if treatm ent up to 1 0 0 000 in 2 0 0 m l 0 .9 % N aC l, ov er one h our
is started m ore th an 4 8 h ours
after onset of sym ptom s
Besredka method: inject 0.1 ml SC and wait 15 minutes. If there is no allergic reaction (no erythema at the injection
site or a flat erythema of less than 0.5 in diameter, inject a further 0.25 ml SC. If there is no reaction after 15 minutes
1
inject the rest of the product IM or IV depending on the volume to be administered.
55
