Thursday, April 27, 2017


Understanding Diphtheria

Diphtheria is a bacterial infection that generally attacks the mucous membranes of the nose and throat, and can sometimes affect the skin. The disease is highly contagious and includes serious potentially life-threatening infections if not treated promptly.
Diphtheria is caused by the bacterium Corynebacterium diphtheriae and generally has an incubation period (the time span since bacteria enter the body until symptoms appear) 2 to 5 days. Symptoms that indicate this disease include:
  • The formation of a thin layer of gray that covers the throat and tonsils.
  • Fever and chills.
  • Sore throat and hoarseness.
  • Difficult breathing or rapid breathing.
  • Swollen lymph glands in the neck.
  • Limp and tired.
  • Runny nose. Initially liquid, but gradually become thick and sometimes bloody.
Diphtheria can sometimes invade the skin and cause ulcers . The ulcers will heal within a few months, but will usually leave marks on the skin.
Immediately consult a doctor if you or your child shows any of the above symptoms. The disease should be treated promptly to prevent complications.
According to the World Health Organization (WHO), there are at least 7,321 cases of diphtheria recorded worldwide by 2014. Among these figures, Indonesia contributed 394 cases. By 2015, the incidence of diphtheria in Indonesia has increased to 502 cases. However, the Ministry of Health of the Republic of Indonesia stated that 37 percent of cases occur in patients who have not received diphtheria immunization.
In Indonesia, diphtheria is one of the diseases that prevention has been incorporated into the government's mandatory immunization program. Diphtheria immunization combined with pertussis (whooping cough) and tetanus is referred to as DPT immunization 3. The coverage of this immunization itself in Indonesia is quite extensive, ie, 90-100 percent.

Diphtheria transmission process

The spread of diphtheria bacteria can occur easily and generally is through the air when a person sneezes or coughs. In addition, there are a number of other ways of transmission that need to be watched, such as through:
  • Items that have been contaminated by bacteria, for example toys or towels.
  • Direct touch on ulcers due to diphtheria in the patient's skin. Transmission is common in people living in densely populated environments and their hygiene is not maintained.
Diphtheria bacteria will produce toxins that will kill healthy cells in the throat, thus eventually becoming a dead cell. These dead cells will form a gray (membrane) membrane in the throat. In addition, the resulting toxin also has the potential to spread in the bloodstream and damage the heart, kidneys, and nervous system.
Sometimes, diphtheria may show no symptoms so that the sufferer does not realize that he or she is infected. If not properly treated, they have the potential to transmit the disease to those around them, especially those who have not been immunized.

Diagnosis and Treatment of Diphtheria

To establish the diagnosis of diphtheria, initially the doctor will ask you a few things about the symptoms experienced by the patient. Doctors can also take samples from the mucus in the throat, nose, or ulcers to be examined in the laboratory.
If a person is suspected of contracting diphtheria, the doctor will begin treatment immediately, even before any laboratory results. The doctor will advise him to undergo treatment in the isolation room at the hospital. Then step treatment will be done with two types of drugs, namely antibiotics and antitoksin.
Antibiotics will help the body to kill bacteria and cure the infection. The dose of antibiotic use depends on the severity of the symptoms and the length of the patient suffering from diphtheria.
Most patients can get out of the isolation room after taking antibiotics for 2 days. But it is very important for them to continue to complete the consumption of antibiotics as recommended by doctors, ie for 2 weeks.
Patients will then undergo a laboratory examination to see whether there is bacterial diphtheria in the bloodstream. If diphtheria bacteria is still found in the patient's body, the doctor will continue the use of antibiotics for 10 days.
While antitoxin serves to neutralize toxins or diphtheria toxins that spread in the body. Before giving antitoxin, your doctor will check whether the patient has an allergy to the drug or not. In the event of an allergic reaction, your doctor will give you a low-dose antitoxin and slowly increase it while you look at the patient's condition.
For patients who have difficulty breathing due to gray membrane barrier in the throat, the doctor will recommend the process of removal of the membrane. While diphtheria patients with symptoms of ulcers on the skin is recommended to clean boils with soap and water thoroughly.
In addition to patients, people who are nearby are also advised to see a doctor because the disease is very easy to spread. For example, families who live in a house or medical personnel who handle diphtheria patients.
Doctors will advise them to undergo tests and provide antibiotics. Sometimes diphtheria vaccine is also re-supplied if needed. This is done to increase protection against this disease.

Risk of Diphtheria Complications

Treatment of diphtheria should be done immediately to prevent the spread as well as serious complications, especially in children sufferers. It is estimated that 1 in 5 sufferers and elderly people over 40 years died from complications of diphtheria.
If not treated quickly and appropriately, toxins from diphtheria bacteria can trigger some potentially life-threatening complications. Some of these include:
  • Respiratory problems . Cells that die from toxins produced by diphtheria bacteria will form a gray membrane that can inhibit breathing. Membrane particles can also fall into and enter the lungs. This has the potential to trigger an inflammatory reaction in the lungs so that its function will decrease drastically and cause respiratory failure.
  • Heart damage . In addition to the lungs, diphtheria toxin has the potential to enter the heart and cause inflammation of the heart muscle or myocarditis. These complications can cause problems, such as irregular heartbeat, heart failure , and sudden death.
  • Nerve damage . Toxins can cause people having difficulty swallowing problems, urinary tract problems, paralysis or paralysis of the diaphragm, and swelling of the nerves of the hands and feet. This paralysis will make the patient unable to breathe requiring respirator or respirator. Diagfragm paralysis may occur suddenly at the onset of symptoms or weeks after the infection heals. Therefore, people with diphtheria who have complications are generally recommended to stay in the hospital for up to 1.5 months.
  • Hypertensive diphtheria . This complication is a very severe form of diphtheria. In addition to the same symptoms as ordinary diphtheria, hypertensive diphtheria will trigger severe bleeding and kidney failure.

Prevention of Diphtheria with Vaccination

The most effective preventive measure for this disease is with the vaccine. Prevention of diphtheria is included in the DPT vaccine. The vaccine includes diphtheria, tetanus, and pertussis or whooping cough .
The DPT vaccine is included in 5 mandatory immunizations for children in Indonesia. The vaccine is administered 5 times at 2 months, 4 months, 6 months, one half year and five years.
Such vaccinations can generally protect children against lifelong diphtheria. But for those who have not received this vaccine at infancy, there is a similar vaccine called Tdap that can be given at the age of 12 years.
Patients with recovered diphtheria are also advised to receive the vaccine because it remains at risk for re-contracting the same disease.

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