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Course: PEDIATRICS
TOPIC: DIPHTHERIA

Definition
•Diphtheria is an acute infectious disease of the tonsils, pharynx, larynx or nose and occasionally other mucus membranes and skin caused by corynebacterium diphtheriae characterized by pseudo grayish white membrane.

•Diphtheria is a serious infection caused by strains of bacteria called Corynebacterium diphtheriae that make toxin. It can lead to difficulty breathing, heart rhythm problems, and even death.

Incubation Period
• 2-7 days

Cause
•Mycobacterium diphtheriae

Types
•Anterior nasal diphtheria
•Faucial diphtheria (pharyngeal)
•Tracheolaryngeal diphtheria
•Malignant diphtheria
•Cutaneous diphtheria

Pathophysiology
The microorganism enters the upper respiratory tract and produces exotoxins which are then absorbed causing tissue necrosis and inflammatory response. The toxin is transported to other parts of the body through blood and the lymphatics. In the heart it causes myocarditis, kidneys acute tubular necrosis and nervous tissue causes damage.

Signs and symptoms
Depends on the site and extent of the damage caused by the toxins.

Pharyngeal Diphtheria
•Tonsillar and pharyngeal inflammation
•Moderate fever
•Horsenesd of voice
•Unproductive cough
•Painful dysphagia
•Anorexia
•Malaise
•Sore throat

Laryngeal Diphtheria
•Dyspnea
•Cyanosis
•Respiratory obstruction
•Irritability
•Toxemia is less laryngeal disease
•There is use of accessory muscles of respiration

Nasal Diphtheria
•Purulent bloodstained nasal discharge
•The discharge crusts around the external nares
•Moderate fever

Malignant Diphtheria
•Onset is more acute
•Fever
•Tachycardia
•Low BP
•Cervical adenitis produces the classic bull neck
•Patient may bleed through the node, mouth and skin

Complications
•Laryngeal obstruction or paralysis
•Myocarditis
•Peripheral neuropathy
•Rarely encephalitis
•Kidney disease

Prevention
•Active immunization
•All contacts to have throat swabs taken
•Prophylaxis with erythromycin

Medical Management
AIMS
•To isolate the causative organism
•To relieve signs and symptoms
•To prevent complications

History Taking
•I will do history taking which will reveal painful dysphagia
Physical Examination
•I will do physical examination which will reveal difficulties in breathing on inspection

Laboratory Tests
•Throat swab to isolate causative organism

Treatment
•Total bedrest is advised.

Anti-toxin therapy
20000'-80000iu
Antibiotics
•X-pen 1/4-1mu qid 5/7
Other drugs

Analgesics
•Paracetamol 100-500mg tds 3/7
•oxygen therapy Incase of dyspnea 2-5l/min
5% or 10% dextrose for energy.

Nursing Care

AIMS
•To prevent spread of infection
•To alley anxiety
•To promotion nutrition

EPROPHENEMA

COURSE: PEDIATRICS

TOPIC: NEONATAL SEPSIS

DEFINITIONS

•This is a generalized infection that happens in neonates because of the invasion of bacteria in the blood stream and usually, the meninges are also involved.
•It is a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks.

CAUSATIVE AGENT

•E-coli
•Salmonella Hystolytica
•Staphylococcus
•Haemophilus Influenza
•Pseudomonas

PREDISPOSING FACTORS

Can be divided into two:
a) Infant Complications
b) Maternal complications

Maternal Complications
•Early rupture of membranes
•Prolonged or difficult labour

Infant Complications
•Prematurity
•Skin infections
•Respiratory Distress Syndrome

SIGNS AND SYMPTOMS

•Pallor due to reduced Hemoglobin as a result of haemolysis
•Jaundice due to excessive destruction of red blood cells with an increase in bilirubin
•Fever due to infection in the bloodstream
•Poor feeding due to involvement of the GIT
•Lethargy due to involvement of the central nervous system
•Cyanosis due to reduced oxygen carrying capacity of blood and hemolysis
•Tachypnoea due to low hemoglobin levels and involvement of the lungs
•If the meninges are involved, the following may be seen; high pitched cry, bulging of the anterior fontanelle and convulsions.

MEDICAL MANAGEMENT

AIMS
•To isolate the causative organism
•To relieve signs and symptoms
•To prevent complications

INVESTIGATIONS

HISTORY TAKING
•I will do history taking which will reveal early rupture of membranes.
•I will do history taking which will reveal poor feeding
•I will do history taking which will reveal the baby having convulsions.

PHYSICAL EXAMINATION
•I will do physical examination which will reveal jaundice on inspection
•I will do physical examination which will reveal bulging of the anterior fontanelle and convulsions on inspection.

SPECIAL TESTS/LABORATORY TESTS
•Blood for culture and sensitivity to isolate the microorganism
•Lumber puncture to rule out meningeal involvement
•Umbilical Stump Swab to reveal the causative organism.
Chest X-ray to rule out chest infections

TREATMENT

•Gentamycin 20-40mg bid

•paracetamol 100mg tds

In severe cases, blood transfusion may be given after treating the infection to overcome anaemia.

In acute stage, if there is respiratory difficulties, oxygen therapy can be given to promote breathing.

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