A Simple guide to Diphtheria

A Simple guide to Diphtheria
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What is Diphtheria?
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Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.

How is Diphtheria transmitted?
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Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.
It is highly infectious.
Incubation period is 2-4 days.

The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.
Through the blood, the toxin can spreadto the heart, nervous system and kidneys. Infections may also be localised in wounds in the skin,conjunctiva and rarely the vagina.
The infections occur in persons of all ages.

What are the Signs and Symptoms of Diphtheria?
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The incubation peroid is usually 2-4 days after contact with an infected patient.

Symptoms start off with:
1. sudden onset of malaise

2. mild fever

3. sore throat

4. Thick white or grayish tonsillar exudate

5. Membrane may spread to nasopharynx

5. cervical lymphadenopathy

6. difficult breathing

7. respiratory stridor,

8. hoarseness of voice

9. brassy cough

10.dilirium and coma

What are the complications of Diphtheria?
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The worst affected are children below the 1 year old.

Some serious complications are:
1.myocarditis

2.cranial nerve paralysis, especially the soft palate and oculomotor nerves

3.peripheral neuritis

4.laryngeal obstruction

5.death can occur if there is obstruction to breathing.

Serious complications are less with older children or adults.

Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.
When adults get Diphtheria, there is only slight inflammation with little or no exudates.

What are the investigations necessary to diagnose Diphtheria?
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Pharyngeal and nasal swabs for culture in Loeffler medium
Methylene blue stain of membrane

What is the Treatment of Diphtheria?
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Isolation in hospital is necessary.

1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.

2.Antitoxin can be given by intramuscular or intravenous injection

3.Intravenous fluids given for dehydration

4.Tracheostomy if breathing obstruction is bad

5.Oxygen therapy in cases of breathing difficulty

6.Cardiac failure should be treated


Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change

What is the Prevention for Diphtheria?
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Vaccination against Diphtheria is the best prevention .
Since vaccination began, the worldwide incidence of Diphtheria has declined.

Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.

There is also a booster vaccination at 18 months.

What is the prognosis in Diphtheria?
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Death occurs in 10% of cases.

Mortality is highest in children under 10 and adults over 50.

One attack usually confers immunity.

A Simple Guide to Hand, Foot & Mouth Disease

A Simple Guide to Hand, Foot and Mouth Disease
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What is Hand, Foot and Mouth Disease?
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Hand, Foot and Mouth Disease (HFMD) is an infectious disease usually occurring in children which causes ulcers in the mouth and maculopapular rashes(sometimes blisters) on the palms of the hands and soles of the feet.
Because of the locations of the lesions, the illness is thus called Hand, Foot and Mouth Disease.

What causes Hand, Foot and Mouth Disease?
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Hand, Foot and Mouth Disease is caused by the Coxsackie virus and Enterovirus 71.
Of the 2 viruses the enterovirus is more dangerous with some fatalities in severe cases.
Fatalities are usually due to complications involving the heart and nervous system.
It is usually a mild illness with the rash healing in 5 to 7 days.

How is Hand, Foot and Mouth Disease spread?
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HFMD is usually spread through the direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person.

Both adults and children can be affected.

Young children below five years are more prone to the infection.

What are the Symptoms of Hand, Foot and Mouth Disease?
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The symptoms usually start after a prodromal peroid of 3 days with:

1.fever

2.sore throat

3.ulcers in the throat, mouth and tongue

4.rash with vesicles (small blisters-- 3-7 mm) on hands, feet and buttock area.
The rash are typically on the palm side of the hands, the sole side of the feet and very characteristic (maculopapular then vesicle) in appearance.

5.loss of appetite

6.headache and bodyaches in the older child or adult

What is the Treatment of Hand, Foot and Mouth Disease?
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There is no specific cure for an viral infection other than symptomatic relief of symptoms.

Antibiotics is not effective and is not indicated.
Paracetamol can given to treat fever.

Drinking lots of water and fluids is important even though sometimes swallowing may be painful.
More fluid is required when a fever is present.

Rinsing of mouth with salt water may soothe the pain of mouth ulcers.

A soft or liquid diet should be given rather than solid food.

Avoid sour fruits or their juices which can cause pain to the mouth ulcers.

Rest and adequate sleep is also important in the child's recovery.

Parents should also be alert to any change in their child's normal behaviour, e.g. irritation and sleepiness.
Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to hospital.

What is the Prevention for Hand, Foot and Mouth Disease?
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All infected children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport).

All family members should follow good hygiene practices, including frequent hand washing, to limit the spread of the infection.

A Single Attack usually gives lifelong Immunity!

A Simple Guide to Coryza(Common Cold)

A Simple Guide to Coryza( Common Cold )
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What is Coryza(Common Cold)?
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Coryza or Common Cold is one of the most common infections contracted by humans.It is characterised by inflammation of the mucous membranes of the nose and throat, with sneezing, sore throat, and mild coughing.

What causes Coryza (Common Cold)?
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The Common Cold is caused by one of the viral infections of the upper respiratory tract. There are over 200 different viruses which can cause a common cold.

Some of the common viruses include: rhinovirus, respiratory syncytial virus (RSV), coronavirus, parainfluenza.

What are the Symptoms of Coryza(Common Cold)?
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Generally the common cold viruses produces mild but uncomfortable symptoms:

1.Runny nose
2.Sneezing
3.Nasal congestion
4.Tiredness
5.Headache especially around the eyes and forehead
6.Fever low grade rare

Symptoms usually last less than two weeks.

What is the Treatment of Coryza(Common Cold)?
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Usually a common cold runs its course without complications in one to two weeks.
Because there is no cure for a viral infection, treatment is aim at relieving symptoms.

1.Rest is the most important part of treatment. A rested patient will recover faster.

2.Adequate warm Fluids helps to keep the mucus membranes moist to allow infected mucus to flow better and also to replace wet mucus lost during the runny nose.

3.If there is any fever, headaches and pains, paracetamol can be given to relieve symptoms.

4.Oral (tablet or syrup) decongestants may also relieve nasal symptoms.
Antihistamines may be of some benefit in reducing mucus production.

5.Decongestant sprays can relieve block nose temporarily, but should not be used for more than three days. Longer use can lead to rebound congestion with more symptoms of congestion.

6.Antibiotics and vitamin C are not helpful in relieving symptoms of the common cold.

What are the Complications of Coryza(Common Cold)?

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Very rarely young children may develop bronchiolitis, viral pneumonia, and croup.

Some infants less than 3 months of age are particularly susceptible to developing secondary bacterial lower respiratory infections.

Two thirds of people over 60 years who live in the community and develop a rhinovirus infection can be expected to develop a lower respiratory tract illness.

Acute otitis media occurs in 2% of people with a cold.

Bacterial infection of the paranasal sinuses occurs in 0.5% of people with a cold.

People with chronic obstructive pulmonary disease who have a rhinovirus infection are more likely to have a longer duration of illness, a more severe illness, and to cough for longer afterwards than those without lung disease.

What is the Prognosis of Coryza(Common Cold)?

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The median duration of a common cold is a week.

Rarely the commn cold will last up to 2 weeks.

In smokers with a rhinovirus infection the cough is more likely to be troublesome and prolonged.

A Simple Guide to Tonsillitis

A Simple Guide to Tonsillitis
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What is Tonsillitis?
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Tonsillitis is inflammation (swelling) of the tonsils.
The tonsils are lymph nodes in the back of the mouth and top of the throat.
They normally help to filter out bacteria and other germs to prevent infection in the body.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis.
The infection may also be present in the throat and surrounding areas, causing pharyngitis. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue).

What causes Tonsillitis?
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Viral or bacterial infections and low immunity lead to tonsillitis and its complications.
Viral:
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis.
Bacteria:
Bacteria cause 15-30 percent of pharyngotonsillitis cases.
Streptococcus pyogenes is the most common bacteria causing acute Tonsillitis

Who gets tonsillitis?
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Tonsillitis most often occurs in children but rarely in children younger than 2 years.
Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years.
Viral tonsillitis is more common in younger children.
A peritonsillar abscess is usually found in young adults but occur occasionally in children.

What are types of Tonsillitis?
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There are several variations of tonsillitis:
1.acute
2.recurrent
3.chronic tonsillitis and
4.peritonsillar abscess.

What are the symptoms of tonsillitis?
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The type of tonsillitis determines what symptoms will occur.

Acute tonsillitis:
Patients have a
Ear pain
Fever, chills
Headache
Sore throat - severe, lasts longer than 48 hours
Tenderness of the jaw and throat
Voice changes, loss of voice
Foul breath
dysphagia (difficulty swallowing)
Odynophagia (painful swallowing) and
tender cervical lymph nodes.

Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea.
Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

Recurrent tonsillitis:
This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.

Chronic tonsillitis:
Individuals often have
Chronic sore throat,
Foul breath,
Enlarged tonsils, and
Persistently tender cervical nodes.

Peritonsillar abscess:
Individuals often have
Severe throat pain,
fever, Drooling,
Foul breath,
Trismus (difficulty opening the mouth), and
Muffled voice quality (as if talking with a hot potato in his or her mouth).

What are the signs of Tonsillitis?
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The health care provider will look in the mouth and throat for signs of:

1.enlarged, visible tonsils that are usually reddened with white spots (pus) on them.

2.enlarged and tender lymph nodes of the jaw and neck.

3.Fever and chills.

4.Open-mouth breathing and muffled voice resulting from obstructive enlarged tonsils.

5.neck and jaw stiffness (often found in acute tonsillitis).

6.Signs of dehydration (found by examination of skin and mucosa).

7.Palatal petechiae (pinpoint bleeding spots on the soft palate).

8.Unilateral bulging above and to the side of one of the tonsils in peritonsillar abscess .

A culture of the tonsils may show bacterial infection.
A culture for the streptococcus bacteria (strep) may be taken using a throat swab because it is the most common and most dangerous form of tonsillitis.

What is the treatment of Tonsillitis?
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1.If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.Some health care providers will treat all tonsillitis with antibiotics to prevent the chance of strep-related complications.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.Fluid replacement and pain control are important.

4.Hospitalization may be required in severe cases and when there is airway obstruction.

5. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils (tonsillectomy) is often recommended.

What is the Prognosis of Tonsillitis?
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Tonsillitis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
A tonsillectomy may be recommended if tonsillitis is severe, recurrent, or does not respond to antibiotics.

What are the Complications of Tonsillitis?
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1.Complications of untreated strep tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Dehydration from difficulty swallowing fluids

3.Blocked airway from enlarged tonsils

4.Peritonsillar abscess or abscess in other parts of the throat