Transmission : Droplet and contact: intimate contact with a patient or carrier :Discharge from respiratory tract, eyes and skin lesions :2-6 weeks transmissible without treatment, communicable <4days after appropriate antibiotics
Toxic myocardiopathy :10-25% of cases, : occurs in the 2nd-3 rd week :Responsible for 50-60% of death :Correlates directly with the extent and severity of exudative local oropharyngeal disease : Tachycardia, prolong PR interval, ST-T change, V-tach, congestive heart failure
Toxic neuropathy : Acutely or 2-3 weeks after onset :local paralysis of soft palate :Weakness of posterior and facial nerve :Dysphagia, aspiration :Cranial neuropathy occur in the 5 th week :Symmetric polyneuropathy occur in 10 days to 3 months
Antitoxin : DAT IV after sensitivity test for reaction, desensitization Pharyngeal or laryngeal lesions,48 hr. duration or less, 20,000-40,000 U Nasopharyngeal lesions, 40,000-60,000 U Extensive disease of 3 or more days duration or diffuse swelling of the neck,80,000-120,000 U of antitoxin Skin lesions only:20,00-40,000U
Standard and droplet precautions for patients and carriers with pharyngeal diphtheria until 2 cultures from both the nose and the throat are negative Contact precautions for patient with cutaneous diphtheria until 2 cultures of skin lesions are negative
Care of close contact :Surveillance 7 days for evidence of disease : Culture for C. diphtheriae : Antimicrobial prophylaxis: erythromycin40-50 mg/kg 7days or single dose benzathine pen. G (1.2mU for patient BW>=30kg.,0.6mU for patient BW <30kg.)
Care of close contact :Follow up pharyngeal culture from carrier at 2 weeks after completion of therapy, if culture is positive 10 days course of erythromycin should be given, and follow up culture :Immunization of carriers
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