Infectious diseases with tonsillitis. Diphtheria

1. Infectious diseases with tonsillitis. Diphtheria Lecturer GorishnaIvannaLubomyrivna

2. Plan of the lecture • Definition of Diphtheria • Etiology • Transmission • Pathogenesis • Classification and clinical presentation • Complications • Diagnostic tests • Differential diagnose • Treatment • Prevention

3. Diphtheria is Diphtheria is an acute toxicoinfection caused by toxigenic strains of Corynebacterium diphtheriae, characterized by a local lesion consisting of a membrane. The constitutional symptoms are due to exotoxin circulation, which has a special affinity for nerve tissue, heart muscle and kidneys.

4. ETIOLOGY • Corynebacterium species are aerobic, nonencapsulated, non-sporeforming, mostly nonmotile, gram-positive bacilli. • Sensitive to high temperature and disinfection • Stabile to freezing and dryness • Three biotypes – • mitis • gravis • intermedius

5. Transmission Transmission is from person-to-person (from a patientorcarrier) • through direct contact • or airborne respiratory droplets Thesematerialsincludedischargefromthenose, throat, andlesionsontheskin, eyesandeventhevagina. Contagious index – 10-15% Seasonality – autumn-winter Immunity – instable

6. Incubation period • Short (from one to seven days)

7. Pathogenesis • Entrance for the infection: throat, nose, larynx, sex organs, wound. • Dissemination of the Corynebacterium, production of exotoxin. • Local toxin effects with membranous inflammation. • Toxemia. • Diffuse toxic effects on kidneys, suprarenal glands, cardiovascular system, and peripheral nervous system.

8. Fibrinous inflammation • Diphtheritic (on flat multilayer epithelium) • Crupous (on cylindrical one layer epithelium)

9. Classification of Diphtheria • Diphtheria of the tonsils and pharynx • localized (catarrhal, islet-like, membranous) • spread form • toxic form: • I degree • II degree • III degree • hypertoxic • hemorrhagic form • gangrenous form

10. Diphtheria of the tonsils, localized, membranous (moderate)

11. Diphtheria of the tonsils, localized, membranous (moderate)

12. Diphtheria of the tonsils, spread (moderate)

13. Diphtheria of the tonsils, toxic (severe)

14. Diphtheria of the tonsils, toxic (neck edema)

15. Classification of Diphtheria Diphtheria of the respiratory tract (croup) • Localized croup (laryngitis) • Spread croup • laryngotracheitis • laryngotracheobronchitis • Stages of croup • Catarrhal croup • Stenosis • Compensated • Subcompensated • Decompensated • Asphyxia

16. Classification of Diphtheria • Diphtheria of the nasopharynx(adenoiditis) • Diphtheria of the nose • localized • catarrhal • islet-like • membranous • Spread • toxic • Combined form • Rare forms (localized, spread, toxic) • eye • ear • skin • genital tract

17. Diphtheria of the nose

18. Diphtheria of the lip

19. Classification of Diphtheria

20. Classification of Diphtheria The course of disease • With complication • Without complication

21. Classification of Diphtheria Bacilli carrying • Transitional carrying • Short time – up to 2 wks • Prolong carrying - more than 1 mo • Chronic carrying – more than 6 mo

22. Complications • early: • Toxic shock syndrome; • DIC syndrome • Acute adrenal insufficiency; • Renal insufficiency • Respiratory insufficiency • Plural organs insufficiency • (in the end of 1st to 2nd week) nephritis; myocarditis; peripheral cranial nerves palsies; • late (on the 3rd to 7th week): myocarditis; peripheral spinal nerves palsies.

23. Death may occur from • Toxemia toward the end of the firth week • Cardiac failure from toxic myocarditis (second week of illness) • Respiratory failure due to peripheral neuritis affecting the vagus nerve (third to seventh week)

24. Diagnostic tests • used to confirm infection combine isolation of C diphtheriae on cultures with toxigenicity testing. • Bacteriologic culturing is essential to confirm the diagnosis of diphtheria. • Toxigenicity testing: Perform toxigenicity testing using the Elek test to determine if the C diphtheriae isolate produces toxin. • Polymerase chain reaction

25. Differential diagnose • Diphtheria of the pharynx must be differentiated from scarlet fever, acute bacterial tonsillitis, infectious mononucleosis; • diphtheria of the upper respiratory tract– with viral croup caused by parainfluenza, measles, chickenpox, and influenza viruses.

26. Bacterial tonsillitis (follicular)

27. Bacterial tonsillitis (lacunar)

28. Bacterial tonsillitis (lacunar)

29. Bacterial tonsillitis (necrotizing)

30. Bacterial tonsillitis (membra-nose) in patient with scarlet fever

31. Candid's tonsillitis

32. Infectious mononucleosis

33. Infectious mononucleosis

34. Infectious mononucleosis

35. Infectious mononucleosis

36. Infectious mononucleosis

37. Infectious mononucleosis

38. Perytonsillitis

39. Perytonsillar abscess

40. Mumps

41. Viral croup: • Acute development • Stenosis of1st-2nddegree, • Absence of gradual development, • Absence of aphonia, loud voice • Other clinical signs (rash, rhinitis, pharyngitis) • Moderate or severe intoxication, • Edema of the sub vocal space, • Negative bacterial culture

42. Treatment • Absolute bed regime (2-3 wks) • Diphtheritic antitoxin therapy • Antibacterial therapy • BENZYLPENICILLIN Na 50-100 000 lU/kg/day • Erythromycin 40-50 мg/кg/day • Roxitromycin 5-8 mg/kg • Rifampicin 10-15 мg/кg/day • Antiseptic fluids locally • Desensitization (suprastinum) • Vitamins B-group, C • Disintoxication therapy (50-100 ml/kg/day) • In case of severe form corticosteroids therapy prednisolone 2-3 mg/kg/day hydrocortizone 5-10 mg/kg/day

43. Administration of Antitoxin for Treatment of Diphtheria

44. Administration of Antitoxin for Treatment of Diphtheria

45. In case of toxic shock syndrome: • - Immediately intravenous infusion of DAT with prednisone intravenously 30-50 mg before DAT; • - Prednisone 10-20 mg/kg/day in equal doses 2-4 times per day; • - Detoxication, correction of acid-base stability and electrolytes; • - Dopamine, trental, corglicon.

46. In case of diphtheria of the larynx(except DAT): • - Inhalation of antiedematous drugs (2% NaHCO3, hydrocortisone, euphyllin, and mucolithics); • suctioning of membranes and mucus; • inhalation of oxygen; • in the III stage of stenosis – intubation; • In case of spread croup, combined with diphtheria of pharynx – tracheotomy.

47. Carriers’ treatment: • Erythromycin 40-50 мg/кg/day • Roxitromycin 5-8 mg/kg • Rifampicin 10-15 мg/кg/day • Antiseptic fluids locally • Vitamins B-group, C • Immune modulators in case of chronic site of infection, • Tonsillectomy, adenotomy in case of chronic carrying.

48. Patients discharge • healthy; • Patient should be isolated until three consecutive throat swabs take 24 hrs apart after stopping treatment, are negative • Mild and moderate in 14-21 days; • Severe – in 30-60 days.

49. Prevention specific • Immunization by DTP vaccine from 3 months age 3 times in 30 days interval (3, 4, 5 months), revaccination in 18 months (DTP), 6, 14, 18 years (DT), later – every 10 years.

50. Prevention nonspecific • Close contacts who were previously immunized longer then 5 years before should receive booster dose of diphtherial toxicoid • Antibiotic (erythromycin, rifampin) orally for 7 days • Revealing, sanation of healthy infected persons, • contacts’ examination for 10 days, • disinfection of epidemic focus.