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6yo boy with odynopagia dx DIPTHERIA - Coggle Diagram
6yo boy with odynopagia
dx DIPTHERIA
Diphtheria Pathophysiology
adheres to mucosal epithelial cells where the exotoxin, released by endosomes, causes a localized inflammatory reaction followed by tissue destruction and necrosis
The B fragment binds to a receptor on the surface of the susceptible host cell, which proteolytically cleaves the membrane lipid layer enabling segment A to enter.
Fragment A inhibits an amino acid transfer from RNA translocase to the ribosomal amino acid chain, thus inhibiting protein synthesis
DT causes a catalytic transfer of NAD to diphthamide, which inactivates the elongation factor, resulting in the inactivation eEF2, which results in protein synthesis blockage and subsequent cell death
Local tissue destruction enables the toxin to be carried lymphatically and hematologically to other parts of the body. Elaboration of the diphtheria toxin may affect distant organs such as the myocardium, kidneys, and nervous system.
Diphtheria Etiology
caused by the aerobic gram-positive bacteria, Corynebacterium diphtheria.
nonencapsulated, nonmotile, gram-positive bacillus
Diphtheria manifests as either an upper respiratory tract or cutaneous infection
Exotoxins C diphtheria
Mode of action: inactivites proteins synthesis
ADP ribosylation
Exotoxins are encoded in viral bacteriophages, which are transmitted from bacteria to bacteria.
Diphtheria Diagnosed
Cultures
Inoculate tellurite or Loeffler media with swabs taken from the nose, pseudomembrane, tonsillar crypts, any ulcerations, or discolorations.
Bacteriologic testing
Gram stain shows club-shaped, nonencapsulated, nonmotile bacilli found in clusters
Immunofluorescent staining of 4-hour cultures or methylene blue–stained specimen may sometimes allow for a speedy identification.
Toxigenicity
Polymerase chain reaction (PCR) assays for detection of DNA sequence encoding the A subunit of tox+ strain are both rapid and sensitive.
History/Symptoms
incubation period of 2-5 days (range, 1-10 d)
Symptoms initially are general and nonspecific, often resembling a typical viral upper respiratory infection (URI)
Low-grade fever (rarely >103°F) (50-85%) and chills
Malaise, weakness, prostration
Sore throat (85-90%)
Headache
Cervical lymphadenopathy and respiratory tract pseudomembrane formation (about 50%)
Serosanguineous or seropurulent nasal discharge, white nasal membrane
Hoarseness, dysphagia (26-40%)
Dyspnea, respiratory stridor, wheezing, cough
Physical Examination
general
low-grade fever but is toxic in appearance, and also may have a swollen neck
Pharyngeal diphtheria
Patients may present with general symptoms of fever, halitosis, tachycardia, and anxiety.
Tonsils and pharynx: Pharyngeal erythema and edema; thick, gray, leathery membrane variably covers the tonsils, soft palate, oropharynx, nasopharynx, and uvula. Attempts at scraping the pseudomembrane cause bleeding of the underlying mucosa.
Neck: Extensive anterior and submandibular cervical lymphadenopathy imparts a bull's neck appearance. The patient may hold his or her head in extension. It occasionally can also be associated with dysphonia.
Respiratory distress manifesting as stridor, wheezing, cyanosis, accessory muscle use, and retractions
Odynophagia Differential Diagnosis
Reflux Esophagitis
Diphtheria
Pharyngitis
Viral Esophagitis
Odynophagia etiology
most often induced by an infection of the esophagus, particularly in those with acquired immunodeficiency syndrome, radiation-induced esophagitis
Diphtheria Epidemiology
Most deaths occur on days 3-4 secondary to asphyxia with a pharyngeal membrane or due to myocarditis.
The incidence fell from 3.9 cases per 100,000 cases in 2001 to 1.12 cases per 100,000 population in 2003.
younger than 12 years. Infants become susceptible to the disease at age 6-12 month
Diphtheria Treatment
Prehospital Care
assessment of airway patency and cardiovascular stability. Patients should be transported to the nearest hospital
Antibiotics
erythromycin
40-50mg/kgBB/hari
Penicillin V oral
125-250mg
Isolation
2-3 weeks until culture test negative
Anti Difteri Serum (ADS)
IV with D5% 100ml, 1-2 hours
Diphtheria Pharyng Dose: 40.000
Diphtheria Differential Diagnosis
Angioedema
Emergent Management of Pediatric Epiglottitis
Epiglottitis
Oropharyngeal/esophageal candidiasis
Peritonsillar Abscess in Emergency Medicine
Pharyngitis
Retropharyngeal Abscess
Preventing Diptheria
The widespread use of the diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine in childhood has significantly decreased the incidence of diphtheria