How do we manage diphtheria?
Well, we know this is uncommon because it's vaccine preventable.
We don't see a lot of diphtheria. So these patients are gonna be managed in-patient.
They're going to be given an antitoxin and this is an anti-body.
And this is IM or IV and this is going to help neutralize the toxin that is already circulating.
The patient will receive antibiotics, and this is to kill the remaining diphtheria bacteria.
The focus is on maintaining this patient's airway.
They are a huge risk for airway compromise.
You're gonna provide end organ support because this infection can spread to the heart,
the kidneys and the central nervous system.
This patient is going to be on isolation because remember,
this is spread via droplet and contact so you wanna keep this patient away from others and isolated.
This is a mandatory, notifiable condition to the health department.
This is important in controlling this in a public health setting.
You're gonna treat the household contacts. You need to assess their immune status.
So, evaluate their immunizations.
Look at their vaccine record and a tighter can also be assessed to see if they're protected.
They might receive a throat culture.
These patients are gonna get booster doses of the vaccine and also be placed on prophylactic antibiotics.
The patient with diphtheria will be put on bed rest for 4 to 6 weeks to recover.
And their vaccine will also be boosted because unlike other conditions,
contracting diphtheria does not guarantee lifelong immunity.
How do we take care of this? We prevent it, right? It's easier to prevent.
So we administer pediatric vaccine. These include the DT and the DTaP.
Remember, the DTaP also has pertussis or whooping cough coverage.
In adolescent and adult population, you're gonna administer the TD and a TDaP.
And remember, the TDaP also has the whooping cough coverage.
Vaccination has been very successful at controlling diphtheria.
This is a bacterial toxoid and it's inactivated.
The TDaP booster is recommended in the third trimester of every pregnancy.
Here we can see the normal vaccine schedule.
And you'll see when we're supposed to be giving the DTaP vaccine at the well-child checks.
And then when the -- switches over to the TDaP vaccines.
There are complications to diphtheria because the infection can progress.
The pseudomembrane can occlude the airway or the esophagus
and the patient may require intubation or tracheostomy.
Asphyxia can occur due to the mechanical obstruction.
The pseudomembrane blocks the air from getting through.
The patient can experience circulatory failure.
So, in cases that progress beyond the throat infection, the diphtheria toxin
is gonna spread through the bloodstream and can potentially cause life-threatening complications
that affect other organs such as the heart and kidneys.
This toxin can damage the heart and affect its ability to pump blood.
And can also affect the kidneys ability to clear waste.
It can also cause nerve damage eventually leading to paralysis.
And this can happen in the eyes, the neck, the throat and the respiratory muscles.
The priority in managing these patients involves protecting their airway.
Remember, these toxins can spread. They can infect the heart causing myocarditis.
The kidneys, causing acute renal failure. And the nerves, causing a polyneuropathy.
Patients with severe cases are put in the hospital intensive care unit for close monitoring
and they're gonna be given that diphtheria antitoxin which are the antibodies isolated from horses
who've actually been challenged with the diphtheria toxin.
Unfortunately, the toxin that's already going and bound around in their tissues won't be neutralized.
So it should be given early based on clinical suspicion of your patients and your clinical diagnosis.
Remember, the labs can take a few days to result. 40 to 50% of patients
who do not receive the immunoglobulin will die.