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Diphtheria

  • Diphtheria

    Diphtheria is an acute infection caused by the bacteria Corynebacterium diphtheriae. Diphtheria spreads through respiratory droplets (such as from a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms. The most common and visible symptom is a thick, gray coating on your throat and tonsils. Other common symptoms include: difficulty breathing, swollen lymph nodes in the neck, chills, fever, a loud, barking cough, bluish skin, sore throat, drooling, general feeling of uneasiness or discomfort

  • Diphtheria

    Pathophysiology

    Infected patients and asymptomatic carriers can transmit C diphtheria via respiratory droplets, nasopharyngeal secretions, and rarely fomites. In the case of cutaneous disease, contact with wound exudates may result in the transmission of the disease to the skin as well the respiratory tract C diphtheria adheres to mucosal epithelial cells where the exotoxin, released by endosomes, causes a localized inflammatory reaction followed by tissue destruction and necrosis. The toxin is made of two joined proteins. The B fragment binds to a receptor on the surface of the susceptible host cell, which proteolytically cleaves the membrane lipid layer enabling segment A to enter. Molecularly, it is suggested that the cellular susceptibility is also due to diphthamide modification, dependent on human leukocyte antigen (HLA) types predisposing to more severe infection. The diphthamide molecule is present in all eukaryotic organisms and is located on a histidine residue of the translation elongation factor 2 (eEF2). eEF2 is responsible for the modification of this histidine residue and is the target for the diphtheria toxin

  • Diphtheria

    Treatment

    The first step is an antitoxin injection. If you are allergic to the antitoxin (previous allergic reactions to diphtheria immunizations or any drug preparations containing horse products), inform your doctor and he can give you small doses of the antitoxin and gradually build up to higher amounts. After the diphtheria antitoxin, your doctor will prescribe antibiotics like erythromycin and penicillin. Antibiotics help clear up the infection. During treatment, your doctor may have you stay in the hospital to avoid passing on your infection. People you might have exposed to the C. diphtheriae bacteria will want to receive a booster vaccine or antibiotics.

  • Diphtheria

    Epidemiology

    Since the introduction and widespread use of diphtheria toxoid in the 1920s, respiratory diphtheria has been well controlled, with an incidence of approximately 1000 cases reported annually. Before vaccination, at least 200,000 cases occurred annually in the United States. According to the World Health Organization (WHO), diphtheria epidemics remain a health threat in developing nations. The largest epidemic recorded since widespread implementation of vaccine programs was in 1990-1995, when a diphtheria epidemic emerged in the Russian Federation, rapidly spreading to involve all Newly Independent States (NIS) and Baltic States. This epidemic caused more than 157,000 cases and 5000 deaths according to WHO reports. Disproportionately high rates of death were observed in individuals older than 40 years, and 5,000 deaths were reported. This epidemic accounted for 80% of cases reported worldwide during this time period. From 1993-2003, a decade long epidemic in Latvia resulted in 1359 reported cases of diphtheria with 101 deaths. The incidence fell from 3.9 cases per 100,000 cases in 2001 to 1.12 cases per 100,000 populations in 2003. Most cases were registered in unvaccinated adults. From 1995-2002, 17 cases of cutaneous diphtheria due to toxigenic strains were reported in the United Kingdom. A sero-epidemiological study among children in Northern Norway and North-Western Russia was performed in order to evaluate protection against diphtheria and how differences in vaccination programmes affect immunity. A total of 664 sera, 400 from Norwegian and 264 from Russian children, were examined for antibodies against diphtheria, using an in vitro toxin neutralisation method. The Russian children studied had satisfactory protection in all age groups examined. The Norwegian children had poor protection against diphtheria from the age of 7 years until they received the booster dose at the age of 11.

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