Diphtheria
A preventable bacterial disease that affects the tonsils, throat, nose, or skin that was once widespread and greatly feared. Through the 1920s diphtheria killed 13,000 babies and children in the United States each year and made another 150,000 sick. It is most common in low socioeconomic groups where people live in crowded conditions. Unimmunized children under age 15 are likely to contract the disease.
Today the conquest of diphtheria is one of the greatest success stories of modern vaccination. In 1992 only four people in the United States were reported to have diphtheria, and by 1993 and 1994 no cases were reported. This does not mean that the disease has been eliminated.
Many Russian children did not get vaccines, so a serious outbreak began in Moscow in 1990; by 1992 there were 4,000 cases in the Russian federation and 24 deaths in Moscow. The problem has gotten worse since then, spreading throughout Russia with 1,100 deaths in 1994. Most of the victims are adults, but the outbreak has spread because many children had not been receiving their vaccines and adults who had been vaccinated were no longer immune.
Travelers to these areas must have completed a series of the vaccine and must have had a booster within the previous five years. There is no risk if the traveler is fully immunized.
In this country, confirmed cases of diphtheria must be reported to and investigated by the local and state health departments.
Cause
Diphtheria is caused by a bacterium (Corynebacterium diphtheriae) found in the mouth, throat, and nose of an infected individual; it is easily transmitted to others during coughing or sneezing, or through close contact with discharge from nose, throat, skin, eyes, and lesions. However, the bacteria do not travel very far through the air, and they infect only humans. The infection can also be spread by carriers, those who have the bacteria but have no symptoms.
Untreated patients who are infected can be contagious for up to two weeks, but not usually more than a month. Recovery from the disease does not always confer immunity.
Symptoms
Symptoms usually appear within two to five days of being exposed. There are two types of diphtheria; one type involves the nose and throat, and the other involves the skin.
Diphtheria usually develops in the throat, causing fever, red sore throat, weakness, and headache. There may be swelling and a gray membrane that completely covers the throat. This membrane can interfere with swallowing and talking and causes an unpleasant, distinct odor; if the membrane covers the windpipe, it can block breathing and suffocate the patient. Other symptoms include slight fever and chills. In the skin variety, skin lesions may be painful, swollen, and red.
Diagnosis
A sample of the nose or throat discharge is cultured; results are provided within eight hours.
Treatment
Diphtheria is a preventable and treatable disease, but if treatment is inadequate or not begun in time, a powerful toxin may be produced by the bacteria and spread throughout the body. This poison may cause serious complications.
Intensive hospital care and prompt treatment with diphtheria antitoxin offer the best hope for cure. The antitoxin neutralizes the toxin if it has not yet invaded cells but is still circulating in the blood. Antibiotics (penicillin or erythromycin) can help destroy the bacteria and decrease infectiousness in the respiratory secretions. Patients are kept isolated and in bed for 10 days to two weeks and are fed a liquid or soft diet. Secretions in nose and throat must be suctioned; tube feeding may be necessary if swallowing is impossible. A tracheotomy may be necessary if the breathing muscles are paralyzed.
A person is infectious from two to four weeks, or until after two to four days of antibiotic treatment. Anyone with a confirmed case must be isolated until negative results are obtained from two cultures from the nose and throat taken 24 hours apart, after completion of antibiotic treatment.
Complications
If the bacteria has time to produce the toxin, its complications can include bronchopneumonia, heart failure, or paralysis in the throat, eye, and breathing muscles. Severe paralysis of the breathing muscles or diaphragm can be fatal. The toxin will inflame the heart muscle (myocarditis), which can lead to heart failure and death. About one out of every 10 patients with diphtheria will die.
Prevention
Diphtheria vaccine is almost always given to infants in a combination with acellular pertussis and TETANUS (DTaP), given as a shot at ages two, four, six, and 15 months and once more as a booster before entering school at ages four to six.
All infants should be immunized; boosters throughout life will prevent resurgence. The vaccine is made of a toxoid (weakened form of the toxin) that stimulates the immune system to make antibodies against the toxin. However, this immunity wanes; a booster is required every 10 years.
The toxoid comes in two strengths; children under age seven need a higher concentration to develop immunity. Older patients should get the lower concentration, since it has fewer side effects yet will still boost immunity.
Anyone exposed to diphtheria must receive a vaccine booster (DTP, DT, or Td) if one has not been given within five years. Exposed people must have a throat culture and be under observation for one week; anyone with a positive culture (even without symptoms) needs seven days of antibiotics.
Anyone with a high fever or serious illness should not get a vaccination until recovered, but children with mild colds and low fevers should be vaccinated.
Common side effects of the vaccine and booster include slight fever and irritability in the first 24 hours with redness, swelling, or pain at the injection spot. Giving acetaminophen at the time of the shot may prevent a fever. A fever more than one day after the shot requires a call to the physician.
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wtf!! does this really exist?
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