Diptheria - Dr. Deoshlok Sharma

DIPHTHERIA-
DEF: It is an acute infection and communicable disease caused by Coryne Bacterium Diphtheria characterised by a formation of pseudomembrane most commonly in the region of pharynx.
Aetiology: Caused by a gram positive bacillus, Coryne Diphtheria. Three groups of organisms-Gravis, Intermedius and Mitis.

Age: Mostly children (1 to 15 years)
Season: Common in cold months.
Climate: More in temperate zone.
Sex: Both, predisposing factors—An operation about the nose and throat, low socio-economic status, etc.
Pathology: The disease takes the form of a typical lesson with a severe general toxaemia. The local lessonis a membranous exudates which usually occurs in the throat, causing faucial diphtheria, Less often it is situated either in the nose (causing nasal diphtheria) or in the larynx (causing laryngeal diphtheria), Combined jesions may occur, in cases, skin diphtheria may be present. Although the organisms remain in the membrane, the produce a very powerful toxin which causes a general toxaemia. The toxin particularly attacks the heart muscle (myocardium), causing an acute myocarditis, and the nervous system, causing various forms of paralysis.

Types Diphtheria: 1. Tonsillar or facucial diphtheria. 2. Laryngeal (primary tracheo-bronchial and mixed). 3. Pharyngeal. 4. Naso-pharyngeal. 5. Nasal. 6. Haemorrhage or wound or skin. 8. Also involving conjunctivae, ears umbilicus, genitals etc.

Clinical Features: Incubation period –1 to 7 days.
Faucial or Tonsillar Type – Onset is sudden.1. Temp.99 to 101F. 2.Toxic appearance. 3. Malaise and weakness and headache may be present. 4. Store throat, swallowing is painful and continuous salivation. 5. Pharynx congested and dull red and form oropharyngeal pseudomembrane which is thick, elevated, grayish white in colour. 6. Tonsils enlarged.7. Pulse-tachycardia. 8. Urine may show albuminuria. 9. Blood shows leucocytosis (with polymorphonuclear preponderance). 10. Throat swab test- positive for G.D.(K.L.B.).
D/D: 1. Acute streptococcal tonsillitis. 2.Vincent’s angina, etc.

Laryngeal Type: Symptoms –1. Croupy cough. 2. Store throat. 3. Difficulty in swallowing. 4. Hoarseness of voce. 5. Dyspnoea in paroxysmal attacks.
On examination – 1.Anixious and pale. 2. Slight temperature. 3. Quick pulse. 4. Restlessness. 5. Cyanois (central type). 6. Intercostal recession. 7. Membrane extending to trachea or main bronchi. 8. Lungs reveals diminished air entry. 9. Schick test- positive. 10. Throat swab examination revele K.L.B.(C.D.).
Differential Diagnosis: 1.Acute laryngitis in measles. 2. Forgein body. 3.Acute laryngo-tracheo-bronchitis(croup).

Nasal Type (Diphthria): Sings and symptoms – 1. Watery or mucous nasal discharge; usually blood stained. 2. Membrane in the posterior part of the nose; may be visible in the nostrils. 3. Small follicular sports on the upper lip under the nose.
Differential Diagnosis: 1. Acute tonsillitis. 2. Vencent’s angina. 3. Streptococcal store throat 4. Ifectious mononucleosis. 5. Catarrhal Laryngitis. 6. Agranulocytosis, pancytopenia. 7. Thrush, etc.

Complications or Sequelae of Diphtheria: 1. Peritonsillar abscess. 2. Myocarditis – early and late. 3. Peripheral nerve paralysis. 4. Acute laryngeal obstruction. 5. Pneumonia (other respiratory troubles). 6. Allergic shock. 7.Supra-renal haemorrhage leading to shock and collapse. 8. Otitis media, epistaxis, purpuric sports, etc.

Treatment: 1. Preventive- 1. Isolation. 2. Regular gargling with saline or Phytolacca M.T. 3. Immunization.
II Curative- 1. Bed rest with minimum movement. Initially, only one pillow is allowed; a second pillow is then given gradually, he/she is allowed to sit up. 3. Liquid diet; if feeding by mouth is not possible; intravenous glucose. 4. Anti-diphtheritic serum should be administered as possible (unless the patient is sensitive).5. Treatment of complcations.

Homoeopathic Remedies:
Belladonna: In forming stage. Great dryness of fauces; tonsil bright red and swollen. Very restless, feels drowsy, yet cannot sleep Congestion to head, with throbbing of carotids; eyes injected; delirium.
Phytolacca: Fauses and tonsils highly inflamed and covered with darkcoloured pseudo-membrane. Excessive fetor of breath. Deglutition almost impossible. Great prostration. When rising up in bed, gets faint and dizzy.

Arsenicum—Great anguish, extreme restlessness and fear of death. Fetid breath and viscid, foul discharge from the nostrils. Constant desire for cold drinks but can take only little. Great prostration, all worse about midnight.
Merc. Iod. Rub: Pseudo-membranous deposits on tonsils, uvula, velum palati and pharynx. Tongue coated, thick, yellow, dirty. Tonsils much swollen, with great difficulty in swallowing. Offensive breath. Expectoration of touch.

Biochemic Remedies.
Calcarea fluor. – When the affection has gone to the windpipe through mismanagement, give this remedy and Calcarea Phos. Alternatively.
Calcarea phos. – Diphtheritic exudation spreading to the trachea. Such a complication is very rare when the Tissue Remedies are used exclusively. A white speak or patch remains after the main exudation has come off.
Kali phos. – In the well-marked, malignant, gangrenous condition, patient exhausted, prostrate. Also for the after effects of diphtheria, such as weakness of sight, nasal speech or paralysis in any part of the body, squinting, etc. The putrid character is well marked, as seen by the putrid-smelling odor from mouth.
Natrum mur. – Diphtheria, if the face be puffy and pale with heavy drowsiness; watery stools, flow of saliva or vomiting of watery fluid. Dryness of the tongue, stertorous breathing, etc. The use of Natrum mur. Must be discontinued with the disappearance of these symptoms.
Natrum phos. –Diphtheritic throat falsely so called (not true), when the tonsils are covered with a yellow, creamy coating, and the back part of the roof of the mouth looks creamy-yellow; the coating of the tongue is moist, creamy or gold colored.
Natrum sulph. –In diphtheria as an intercurrent remedy where there is vomiting of green matter or water, and the peculiars welling up of mucus from the stomach.

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