2. DIPHTHERIA References :
Krugman’s Infectious Diseaseof Chlidren Nelson text book of Pediatrics
Nelson Essentials of Pediatrics
Abstract Diphtheria is a preventable acute disease caused by Corynebacterium Diphtheria.
Diphtheria is acquired by contact with ill person with the disease or with an asymptomatic carrier of organism. The incidence increase among school age
children during the first few month of the school year has been reported. Diphtheria usually develops after a short incubation period of 2 days with a range of 1 to 5
days. For clinical purposes, the disease my be classified by the anatomic location as a nasal diphtheria, tonsilar and pharyngeal diphtheria, laryngeal diphtheria,
cutaneus diphtheria and unusual type of diphtheria. The diagnosis of diphtheria is confirmed by the demonstration of diphtheria bacilli cultured from material obtained
from the site of infection. Diphtheria antitoxin must be given promptly and in adequate dosage. Penicillin and erythromycin are effective against most strains of
diphtheria bacilli. Supportive therapy is needed for several cases and complication.
Preventive therapy by immunization with diphtheria toxoid.
Self Assessment
1. Explain the etiology of diphtheria 2. How the pathogenesis of diphtheria ?
3. Mention the sign and symptom that we could find in patient suffered from
diphtheria based on the location of the infection 4. Explain how to diagnosis diphtheria
5. Mention the differential diagnosis of diphtheria based on the anatomic site of involvement
6. Explain some severe complication caused by the effect of diphtheria toxin 7. Explain the management of diphtheria
3. TETANUS References :
Krugman’s Infectious Diseaseof Children Nelson text book of Pediatrics
Nelson Essentials of Pediatrics
Abstract Tetanus is an acute, spastic paralytic illness caused by tetanus toxin; the neurotoxin
produced by Clostridium Tetani. Tetanus occurs after induced spores germinate, multiply and produce tetanus toxin at infected injury site. Tetanus toxin binds at the
neuromuscular junction and enter the motor nerve by endocytosis. Clinical manifestation of tetanus is trismus, headache, restlessness, often followed
by stiffness, difficulty chewing, dysphagia and neck muscle spasm. Because tetanus toxin does not affect sensory nerve, the patient remains conscious. The seizures are
Udayana University Faculty of Medicine, DME, 2017
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characterized by sudden, severe tonic contractions of the muscle. Diagnosis is established clinically with typical is an unimmunized patient who was injured or born
within the preceding 2 week who presents with trismus, other rigid muscle and a clear sensorium. Management of tetanus requires eradication of C. tetani and the
wound environment conductive to its anaerobic multiplication, neutralization of tetanus toxin, control of seizures and respiration, palliation and provision of
meticulous supportive care. Penicillin G remains the antibiotic of choice for C. tetani, erythromycin and tetracycline for patient 8 yr old or older are alternatives for
penicillin allergic patients. Muscle relaxants for relaxation and seizure control. Active immunization for prevent is tetanus toxoid usually combine with diphtheria
and pertusis vaccine.
Self assessment
1. How is the characteristic of Clostridium tetani ? 2. Explain about portd’entrée of the bacteria
3. How is the pathogenesis of stiffness caused by the effect of toxin in
Tetanus ? 4. Mention the degree of tetanus and explain it
5. Mention the differential diagnosis of Tetanus 6. How is the management of patient with Tetanus ?
7. Explain some ways to prevent Tetanus
4. MEASLES References :
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