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Encyclopedia > Diphtheria
Diphtheria
Classification & external resources
Diphtheria causes a characteristic swollen neck, sometimes referred to as “bull neck”.
ICD-10 A30.
ICD-9 032
DiseasesDB 3122
MedlinePlus 001608
eMedicine emerg/138  med/459 oph/674 ped/596
MeSH D004165

Diphtheria (Greek διφθερα (diphthera) — “pair of leather scrolls”), is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.[1] A milder form of diphtheria can be restricted to the skin. It is caused by Corynebacterium diphtheriae, a facultatively anaerobic Gram-positive bacterium.[2] Image File history File links Download high-resolution version (700x867, 76 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Diphtheria ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... // In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. ... This article needs additional references or sources for verification. ... This article or section contains too much jargon and may need simplification or further explanation. ... The pharynx (plural: pharynges) is the part of the neck and throat situated immediately posterior to the mouth and nasal cavity, and cranial, or superior, to the esophagus, larynx, and trachea. ... Binomial name Corynebacterium diphtheriae Kruse, 1886 Corynebacterium diphtheriae is a pathogenic bacterium that causes diphtheria. ... A facultative anaerobic organism is an organism, usually a bacterium, that makes ATP by aerobic respiration if oxygen is present but is also capable of switching to fermentation under anaerobic conditions. ... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ...


Diphtheria is a highly contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. Once quite common, diphtheria has largely been eradicated in developed nations through wide-spread vaccination. In the United States for instance, between 1980 and 2004 there have been 57 reported cases of diphtheria (and only five cases since 2000)[3] as the DPT (Diphtheria–PertussisTetanus) vaccine is given to all school children. Boosters of the vaccine are recommended for adults since the benefits of the vaccine decrease with age; they are particularly recommended for those traveling to areas where the disease has not been eradicated. Particulates, alternatively referred to as particulate matter (PM), aerosols or fine particles, are tiny particles of solid or liquid suspended in a gas. ... A vial of the vaccine against influenza. ... DPT, (sometimes DTP) is a mixture of three vaccines, to immunize against diphtheria, pertussis, and tetanus. ... Pertussis, also known as whooping cough, is a highly contagious disease caused by the bacterium Bordetella pertussis; a similar, milder disease is caused by B. parapertussis. ... Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibers. ...

Contents

History

One of the first bottles of diphtheria antitoxin (1895), produced by the United States Hygienic Laboratory (now the National Institutes of Health).
One of the first bottles of diphtheria antitoxin (1895), produced by the United States Hygienic Laboratory (now the National Institutes of Health).

Diphtheria was named in 1826 by French physician Pierre Bretonneau. The name alludes to the leathery, sheath-like membrane that grows on the tonsils, throat, and in the nose. The pronunciation /ˌdipˈθiɹˌi.ə/ was originally considered incorrect, but has become the most common way of saying the word, and is accepted as a correct form. While many writers today use the spelling "diptheria" which fits the modern pronunciation, this spelling is rarely found in dictionaries. Image File history File links Antitoxin_diphtheria. ... Image File history File links Antitoxin_diphtheria. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical research. ... The oldest surviving photograph, Nicéphore Niépce, circa 1826 1826 (MDCCCXXVI) was a common year starting on Sunday (see link for calendar) of the Gregorian calendar (or a common year starting on Tuesday of the 12-day-slower Julian calendar). ... Pierre Bretonneau born (Saint-Georges-sur-Cher, 3 April 1778 - died Paris, 1862) was a French medical doctor of the early 19th Century. ... The word sheath has a number of related meanings in English. ... The Palatine tonsils. ... This article does not cite any references or sources. ...


Diphtheria was once a dreaded disease, with frequent large-scale outbreaks. A diphtheria epidemic in the New England colonies between 1735 and 1740 was said to have killed as many as 80% of the children under 10 years of age in some towns.[4]


In the 1920s there were an estimated 100,000 to 200,000 cases of diphtheria per year in the United States, causing 13,000 to 15,000 deaths.[3] Children represented a large majority of these cases and fatalities. One of the most famous outbreaks of diphtheria was in Nome, Alaska; the trip made to get the antitoxin is now celebrated by the Iditarod Trail Sled Dog Race. Aerial view of the harbor in Nome Nome is a city located on the southern Seward Peninsula coast of Norton Sound in the Nome Census Area of the U.S. state of Alaska. ... During the 1925 serum run to Nome, also known as the Great Race of Mercy, 20 mushers and about 150 sled dogs relayed diphtheria antitoxin 674 miles (1,085 km) by dog sled across the U.S. territory of Alaska in a record-breaking five and a half days, saving... For the current race, see 2007 Iditarod The Iditarod Trail Sled Dog Race, usually called the Iditarod, is an annual dog sled race in Alaska, where mushers and teams of dogs cover about 1,150 miles (1,852 km) in eight to fifteen days. ...


Diphtheria was also prevalent in the British royal family during the late 19th century. Famous cases included a daughter and granddaughter of Britain's Queen Victoria. Princess Alice of Hesse (second daughter of Queen Victoria) died of diphtheria after she contracted it from her children in December of 1878 while nursing them. One of Princess Alice's own daughters, Princess May, also died of diphtheria in November of 1878.[5] Members of the Royal Family on the balcony of Buckingham Palace after the Trooping the Colour ceremony The British Royal Family is shared between the Commonwealth Realms; this article focuses on the perspective of United Kingdom. ... “Queen Victoria” redirects here. ... Princess Alice (Alice Maud Mary), (25 April 1843 – 14 December 1878), was a member of the British Royal Family, the third child and second daughter of Queen Victoria. ... 1878 (MDCCCLXXVIII) was a common year starting on Tuesday (see link for calendar). ...


One of the first effective treatments for diphtheria was discovered in the 1880s by U.S. physician Joseph O'Dwyer (1841-1898). O'Dwyer developed tubes that were inserted into the throat, and prevented victims from suffocating due to the membrane sheath that grows over and obstructs airways. In the 1890s, the German physician Emil von Behring developed an antitoxin that did not kill the bacteria, but neutralized the toxic poisons that the bacteria releases into the body. von Behring was awarded the first Nobel Prize in Medicine for his role in the discovery, and development of a serum therapy for diphtheria. (Americans William H. Park and Anna Wessels Williams; and Pasteur Institute scientists Emile Roux and Auguste Chaillou also independently developed diphtheria antitoxin in the 1890s.) The first successful vaccine for diphtheria was developed in 1923. However, antibiotics against diphtheria were not available until the discovery and development of sulfa drugs following World War II. Catholic physician. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... Emil Adolf von Behring (March 15, 1854 - March 31, 1917) was born at Hansdorf, Germany. ... The Nobel Prizes (Swedish: ) are awarded for Physics, Chemistry, Literature, Peace, and Physiology or Medicine. ... William Hallock Park (1863-1939) was an American bacteriologist and Laboratory Director, New York City Board of Health, Division of Pathology, Bacteriology, and Disinfection 1893 to 1936 Biography Park was born on December 30, 1863 in New York City. ... Dr. Anna Wessels Williams ( 1863 - 1954) worked as a bacteriologist at the first municipal diagnostic laboratory in the United States, helped develop the diphtheria antitoxin and was the first woman to be elected chair of the laboratory section of the American Public Health Association. ... The Pasteur Institute (French: Institut Pasteur) is a French non-profit private foundation dedicated to the study of biology, microorganisms, diseases and vaccines. ... Emile Roux Pierre Paul Emile Roux (b. ... Auguste Chaillou (August 21, 1866 - April 23, 1915) was a French biologist and physician who was born in Parennes in the department of Sarthe. ... Sulfonamides, also known as sulfa drugs, are synthetic antimicrobial agents derived from sulfonic acid. ... Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000...


Mechanism

Diphtheria toxin catalyzes the ADP-ribosylation of, and inactivates, the elongation factor eEF-2. In this way, it acts to inhibit translation during eukaryotic protein synthesis. Diphtheria toxin is an exotoxin secreted by Corynebacterium diphtheriae, the pathogen bacterium that causes diphtheria. ... ADP ribose ADP-ribosylation is a posttranslational modification of proteins that involves the addition of one or more ADP and ribose moieties. ... Eukaryotic elongation factors are very similar to those in prokaryotes. ... Translation is the second process of protein biosynthesis (part of the overall process of gene expression). ...


Signs and symptoms

The respiratory form has an incubation period of 2-5 days. The onset of disease is usually gradual. Symptoms include fatigue, fever, a mild sore throat and problems swallowing. Children infected have symptoms that include nausea, vomiting, chills, and a high fever, although some do not show symptoms until the infection has progressed further. In 10% of cases, patients experience neck swelling. These cases are associated with a higher risk of death. Incubation period, also called the latent period or latency period, is the time elapsed between exposure to a pathogenic organism, or chemical or radiation, and when symptoms and signs are first apparent. ...


In addition to symptoms at the site of infection (sore throat), the patient may experience more generalized symptoms, such as listlessness, pallor, and fast heart rate. These symptoms are caused by the toxin released by the bacterium. Low blood pressure may develop in these patients. Longer-term effects of the diphtheria toxin include cardiomyopathy and peripheral neuropathy (sensory type).[6] This article or section does not cite any references or sources. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. ...

A diphtheria skin lesion on the leg.
A diphtheria skin lesion on the leg.

The cutaneous form of diphtheria is often a secondary infection of a preexisting skin disease. Signs of cutaneous diphtheria infection develop an average of seven days after the appearance of the primary skin disease. Image File history File links A_diphtheria_skin_lesion_on_the_leg. ... Image File history File links A_diphtheria_skin_lesion_on_the_leg. ... A secondary infection is an infection by a microorganism subsequent to and simultaneous with an infection by a different microorganism. ...


Diagnosis

The current definition of diphtheria used by the Centers for Disease Control and Prevention (CDC) is based on both laboratory and clinical criteria. The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...


Laboratory criteria

Binomial name Corynebacterium diphtheriae Kruse, 1886 Corynebacterium diphtheriae is a pathogenic bacterium that causes diphtheria. ...

Clinical criteria

  • Upper respiratory tract illness with sore throat
  • Low-grade fever, and
  • An adherent pseudomembrane of the tonsil(s), pharynx, and/or nose.

Case classification

  • Probable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed case
  • Confirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed case

Empirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.


Treatment

The disease may remain manageable, but in more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. In addition, an increase in heart rate may cause cardiac arrest. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit (ICU) and be given a diphtheria anti-toxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation. Lymph nodes are components of the lymphatic system. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... Completed tracheotomy: 1 - Vocal cords 2 - Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal cartilages 5 - Balloon cuff A tracheotomy is a procedure performed by paramedics, emergency physicians and surgeons in order to secure an airway. ... An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...


Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends[7] either:

  • Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
  • Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. ... Penicillin nucleus Penicillin refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Rifampicin (INN) or rifampin (USAN) is an antibiotic drug of the rifamycin group. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ...

Epidemiology

Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend).
Diphtheria cases reported to the World Health Organization between 1997 and 2006 (see description for legend).

Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%.[3] Outbreaks, though very rare, still occur worldwide, even in developed nations. After the breakup of the former Soviet Union in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths. This was so great an increase that diphtheria was cited in the Guinness Book of World Records as "most resurgent disease".
Image File history File links Download high-resolution version (1357x628, 30 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Diphtheria ... Image File history File links Download high-resolution version (1357x628, 30 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Diphtheria ... The Anarchist Black Cross was originally called the Anarchist Red Cross. The band Redd Kross was originally called Red Cross. This article needs to be cleaned up to conform to a higher standard of quality. ...  Member state  Associate member Headquarters Minsk, Belarus Working language Russian Type Commonwealth Membership 11 member states 1 associate member Leaders  -  Executive Secretary Viktor Yanukovych Establishment December 21, 1991 Website http://cis. ... The Guinness Book of Records (or in recent editions Guinness World Records, and in previous US editions Guinness Book of World Records) is a book published annually, containing an internationally recognized collection of superlatives: both in terms of human achievement and the extrema of the natural world. ...


References

  1. ^ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, 299–302. ISBN 0838585299. 
  2. ^ Office of Laboratory Security, Public Health Agency of Canada Corynebacterium diphtheriae Material Safety Data Sheet. January 2000.
  3. ^ a b c Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. (2007). Diphtheria. in: Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book), 10th ed., Washington DC: Public Health Foundation, 59–70. 
  4. ^ Caulfield, Ernest. (1949) "A True History of the Terrible Epidemic Vulgarly Called the Throat Distemper, Which Occurred in His Majesty's New England Colonies between the Years 1735 and 1740." The William and Mary Quarterly, 3rd Ser., Vol 6, No 2. p. 338. See Also: Shulman, Stanford (2004) The History of Pediatric Infectious Diseases (Html by Google) Pediatric Research. Vol. 55, No. 1
  5. ^ Baker, Raegan Princess Alice of Hesse and by Rhine Alexander Palace Time Machine.
  6. ^ Toxic Neuropathies. Neuromuscular Disease Center Washington University, St. Louis, MO USA
  7. ^ The first version of this article was adapted from the CDC document "Diphtheria - 1995 Case Definition" at http://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource.

The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... Shortcut: WP:PD There are many resources available on the net that are in the public domain, and therefore freely usable without restrictions for Wikipedia content. ...

Further reading

  • Holmes RK, Diphtheria and other corynebacterial infections. in Harrison's Principles of Internal Medicine, 16th Ed. (2005)

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