Diphtheria: Clinical Overview, Epidemiology And Clinical Significance Of Its Pathology

Funom Makama By Funom Makama, 1st Apr 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Diseases & Infections

Diphtheria is an acute infectious disease caused by Corynbacterium diphtheria, clinically characterized by a membraneous inflammation at the site of infection and delecterious effects on several tissues particularly on the myocardium and nervous system due to the exotoxin.

Diphtheria Overview

Based on the colonial morphology on tellurite medium, biochemical reactions and hemolytic property, C diphtheria is classified into three main types- gravis, intermedius and mitis. Virulent strains produce an exotoxin which is responsible for producing remote effects. Around 90 to 95% of the gravis and intermedius strains are so. The toxin is a labile protein of molecular weight, 62,000 and it is inactive when released by the bacterium. Action of proteases present in infected tissue is necessary for its activation. Treatment with 0.2 to 0.4% formalin converts the toxin into toxoid. The toxoid is not harmful to the tissues, still it possesses antigenicity and hence it is used for immunization.

Epidemiology

The disease has been almost wiped out from developed countries, but in countries like Ukraine and India, it is still prevalent. Diphtheria is more common in children, though all ages may be affected. The organism is harboured by carriers and cases. The disease is spread by droplets, contaminated vessels shared by children or by direct inoculation into skin abrasions or eyes. Unimmunized children in a partially immunized community are highly susceptible. Untreated cases are infective for more than two weeks. Antibiotic therapy reduces the communicability to 2 to 3 days. During outbreaks, susceptible individuals can be identified by the schick intradermal test, but this method is seldom used in practice.

Pathogenesis and pathology: The organisms gain entry through the respiratory passage, eyes, middle ear, genitalia and the skin. Incubation is 3 to 4 days but it may vary from 2 to 7 days. The exotoxin causes tissue necrosis, which favours further growth of the organism and toxin production. The epithelium degenerates and a sero- fibrinous exudates develops which contains inflammatory cells and fibrin. This forms a bluish white membrane over the involved area. The membrane is adherent and when removed forcibly, it leaves a raw bleeding surface. Site of predilection for the primary lesions is the respiratory tract. Other sites of infection are the nose, ears, conjunctiva, genitalia and skin. Around the membrane there may be necrosis, ulceration or hemorrhage. Sometimes, the membrane may not be evident, but the pharynx may show only hyperemia and edema.

Regional lymph nodes are markedly enlarged. The toxin is absorbed from the primary site and it causes damage to the myocardium, kidneys, adrenal glands, and the cranial and peripheral nerves. Myocardium shows cloudy swelling, fatty change, minute hemorrhages, and round cell infiltration. This may lead to cardiomegaly and conduction disturbances. Kidneys show cloudy welling of the tubular epithelium and interstitial nephritis. The adrenal glands are enlarged with hemorrhages in the cortex. Liver cells show degenerative changes with scattered areas of focal necrosis.

Peripheral nerves may show degeneration of the myelin sheaths and axis cylinders, motor fibers being more affected. The posterior column of the spinal cord may be involved. Rarely cerebral hemorrhage, meningitis and encephalitis have been described. Respiratory obstruction by the membrane or toxic myocarditis may lead to death.

For more Health Articles, visit the following links:
1. Fitness And Exercise From A Doctor’s Perspective: Maintaining The Lifestyle
2. Special Types Of Anemia: Sideroblastic Anemias And Paroxysmal Nocturnal Hemoglobinuria (PNH)
3. Diphtheria: The Health Significance Of Its Clinical Diagnosis And Phases Of Treatment

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author avatar Ptrikha
4th Apr 2014 (#)

Quite a detailed description.

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author avatar Funom Makama
14th Apr 2014 (#)

Thanks a lot Ptrikha

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