1. Diphtheria.Pertussis.Tetanus

2. Diphtheria
 Caused by Corynebacterium
diphtheriae
 An aerobic gram-positive bacillus
 Man-to-man transmission
 Incubation period- 2-5 days
 Primarily a disease of children
 75% children immune by 10 years
 Involves respiratory mucous membrane

3. Clinical manifestation
 Tonsillopharyngeal, laryngeal, nasal &
tracheobronchial involvement
 s/s- fever with systemic toxicity, sore throat,
dysphagia, hoarseness, rhinorrhea, cough, Cxal LNE
 Characteristic pseudomembrane over tonsils, that
bleeds on attempt to remove
 Complication- local or toxin mediated
 Respiratory obstruction
 Myocarditis- arrythmias &/or heart failure
 Polyneuritis- IX/X Cr. n., proximaldistal weakness, distal paresthesias
 Pneumonia

4. Management
 Diagnosis- mostly empirical, based on s/s
± pseudomembrane
 Diphtheria antitoxin- horse antiserum
 IV infusion over 60 mins
 20,000100,000 units, depending on severity
 Watch for serum sickness
 Antibiotics- macrolide or penicillin
 Macrolide or Rifampicin for carriers
 Vaccination- toxoid- DPT/DT/Td

5. Pretussis- whooping cough
 Caused by Bordetella pertussis
 A gram-negative coccobacillus
 Man is the only host
 Transmitted by airborne respiratory
secretions from an infected individual
 No carrier state
 Incubation period- 7-10 days

6. Clinical manifestation
 3 stages- clasically
 Catarrhal- non-specific URTI, most infectious, x 1-2 wk
 Paroxysmal- bouts of severe cough (whoop),
more at night, x 2-4 wk
 Convalescent- less intense cough, not infectious, 3-4 wk
 In adults- prolonged bronchitis
 Complications-
 Pneumonia, commonly due to secondary bacterial infection
 Seizures, encephalopathyFND
 Otitis media
 Hemorrhage, due to severe cough

7. Management
 Diagnosis-
 Markedly increased TLC, with lymphocytosis
 B. pertussis from nasopharyngeal swab
 Treatment-
 Supportive care
 Antibiotics early- macrolide or co-trimoxazole
 Prophylaxis with macrolide for contacts
 Vaccination-

Adsorbed whole-cell vaccine, part of DPT

8. Tetanus
 A neurologic disorder, characterised by
increased muscle tone & spasms
 Caused by tetanospasmin, a toxin produced
by Clostridium tetani
 C. tetani- a motile anaerobic gram-positive
bacillus with a terminal spore
 Sporadic disease, caused by contamination
of wound with spores, that germinate under
suitable conditions, to produce neurotoxin
 Infectionsymptom- ~7 days

9. Clinical manifestation
 Progressive skeletal muscle involvement
 Trismus, dysphagia
 Rigid abdomen, stiff proximal limb muscles (hands/feet- spared)
 Facial grimace
 Arched back- opisthotonus
 Paroxysmal painful generalized spasms
 Complications-
 Sympathetic overactivity
 Pneumonia
 Fractures
 Asphyxia

10. Management
 Diagnosis- clinical
 Treatment-
 Supportive care
 Wound care
 Antibiotic- Penicillin or Clindamycin
 Antitoxin- Tetanus immunoglobulin
 Diazepam & neuromuscular blockade with mech. vent.
 Course- 4-6 weeks, with complete recovery
 Prognosis- early disease with short course
has poor prognosis
 Vaccine- DPT in children & Td in adults