Alan R. Tumbelaka
Division of Infectious Diseases & Tropical Pediatrics, FKUI
Diphtheria
Epidemiology
RSHS
RSWS
RSK
RSU PMH
Tahun
Kasus
*m%
Kasus
*m%
Kasus
*m%
Kasus
*m%
Kasus
*m%
1991
22
50,0
28
10,7
70
8,6
32
21,9
1992
25
32,0
26
7,7
12
34
5,9
19
26,3
1993
19
26,3
18
12
16
62,5
1994
16
18,8
12
10
10
13
46,2
1995
12
25,0
11,1
14,3
1996
28,6
11
14
42,9
Etiology
Corynebacterium diphtheriae
Corynebacteria diphtheriae
Diphtheria
Figure 24.6
Pathogenesis of Diphtheria
Encounter Corynebacterium diphtheriae
encountered only from other people (carriers)
Entry respiratory droplets; organism
colonizes pharynx
Spread
Multiplication
Evasion of host immune response
adhesins; toxin may kill phagocytes
contributing to pseudomembrane
Damage inflammation; circulating toxin
Transmission aerosolized droplets; fomites
Pathogenesis
Clinical manifestations
Immunity
: (+)
1.
2.
-
Toxin
Laboratory
mild albuminuria
founded as thorax-hialyn sediment ,
erythrocyte, leukocyte
Diagnosis
1. Clinical manifestations.
2. Direct preparation / positive culture of
throat swab.
3. Immunization history
Differentials diagnosis
Nasal diphtheria
Corpus alienium
Syphilis congenital
Faucial diphtheria
Fever
general conditions
regional lymph node
direct preparation / culture
Laryngitis diphtheria
laryngitis acute / laryngo tracheitis
corpus alienum
Complications
Cardiac Sign
Myocarditis
Cardiac decompensation
Dyspnea, cyanosis
Irritability
Stridor inspiratory
Retraction
- epigastrium
- intercostals
- suprasternal
Treatment
1.
General
- isolation , good nursing
- observation of the complications
- bed rest total
2.
Specific
- A.D.S 100.000 UI
- Antibiotic : PP 50.000 UI/KgBW.
Treatment
Prognosis
Depends on :
1. Age
2. Stadium
3. Localization
4. Bacteria pathogenicity (mitis has lowervirulency)
Prognosis
5. Antitoxin
1st
2nd
3rd
> 4th
Attention
1. Totally bed rest (luminal 5 mg/KgBw,
largactil 2mg/KgBw)
2. Throat swab
3. ECG each week
4. Urinary and hematological examination
weekly
5. Pulse, respiratory, defecation
6. Airway obstruction
BCG
HepB
Polio
DTP
1
0
3
1
Tifoid
HepA
4
1
Campak
Hib
MMR
12
5
2
4
1
2
Ulangan tiap 3 th
2x interval 6-12 bln