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  1. Caused by corynebacterium diphtheriae
  2. Incubation period :2-5 days
  3. Secretions from infected person or carrier. Q
  4. Portal of entry respiratory tract.
  5. Patient infective till 2-4 weeks.
  6. Preschool children commonly involved.
  7. Pathology mainly due to a lysogenic B-phage that carries gene encoding for toxin (tox+ve) Q
  8. Acute onset illness with toxemia.
  9. Local manifestations
    1. Nasal                          
    2. Faucial: Most common
    3. Laryngotracheal.                  
    4. Rarely skin and conjunctiva. 
  10. Bull Neck  due to tender enlargement of cervical LN along with involvement of adjacent tissue .
  11. Diagnosis:
    1. Based on identification of diphtheria bacilli from the site of lesion. Metachromatic granules in bacilli arranged in Chinese letter pattern using ALBERT STAIN. Q
    2. Demonstration of bacilli not adequate for diagnosis. Culture necessary for confirmation .
  12. Complications:
    1. Myocarditis: end of 1st week.
    2. Palatal palsy: 2nd week
    3. Ocular palsy (3rd week) loss of accommodation with intact pupillary constriction.
    4. Generalized polyneuritis 3-6 weeks.
    5. Renal complications: oliguria and proteinuria. 
  13. Treatment:
    1. ​Antitoxin mainstay of treatment
      To be given as early as possible.





Combined type/delayed diagnosis

Severe disease

Carrier /contact

10,000-20,000 units im or iv

20,000-40,000 units im or iv.

20,000-30,000 units im or iv.

40,000-60,000 units im or iv.

80,000-120,000 units im or iv.

not required

  1. Initiated before confirmation of disease.
    1. Antibiotics: procaine penicillin 3-6 lac unit im 12hourly till oral (penicillin V or Erythromycin).
    2. Treatment till 3 negative cultures at 24 hours intervals.
    3. Bed rest for 2-3 weeks.
    4. Carnitine is recommended for myocarditis 
  2. Prevention  
    1. Isolation of patient till 3 cultures –ve .people in close contact observed carefully for symptoms, cultured for corynebacterium and given chemoprophylaxis with Erythromycin for 7 days.
    2. Immunized asymptomatic contacts: booster .
    3. UN immunized asymptomatic contacts: immunization for age.

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