Diphtheria

 

* Toxic infection caused by Corynebacterium diphtheriae (Klebs-Löffler bacillus).

Gram positive bacillus; the packet group matches (or pins or Alphabet Letter) is suggestive.

* The strains carrying the gene Tox (transmitted by a bacteriophage) produce a toxin.

Cell damage are related to nuclease action of the toxin.

* The pharyngitis are very contagious (direct air transmission).

Throat of a child diphtheria

Throat of a child diphtheria

* Malignant diphtheria: often secondary to angina but occurs when the local signs of angina and fever disappeared.

– Early Marfan Syndrome: 7d after initiation of angina;begins with vomiting and paralysis of the veil (nasal reflux).

The key symptom is myocarditis.

The risk of cardiac arrest persists 8 weeks.

– Late Syndrome Genet & Mézard (35th day); begins with a paralysis of accommodation, paresis of sailing, followed by an ascending polyneuropathy with respiratory illness that requires assisted ventilation.

Paralysis regresses without sequelae from the 52nd day.

– Laryngeal diphtheria (croup) and faint voice hoarse cough and dyspnea with laryngeal inspiratory bradypnea, draw and wheezing.

* NSF: neutrophilia.

* Culture (mid Löffler) and testing Elek (appearance of the toxin) confirms the diagnosis.

* Emergency treatment => serum therapy (anti-toxic serum).

Corynebacterium diphtheriae or Klebs-Löffler bacillus

Corynebacterium diphtheriae or Klebs-Löffler bacillus

Penicillin G is the reference antibiotic (spectacular action on false membranes).

Isolation is required.

Croup -> corticosteroids.

The relay of serum therapy is provided by the anatoxithérapique vaccine (J1, J3, J15).

* Prophylaxis of contacts: subjects unvaccinated contacts must be protected by a serum therapy emergency while a first toxoid injection is performed.

Healthy carriers should be screened and treated (penicillin, macrolide).

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