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What is diphtheria?
Diphtheria (English: diphtheria) is an acute bacterial infection with pseudomembranous gland, pharynx, larynx, and nose. The disease can appear on the skin, other mucous membranes such as the eye conjunctiva or genitals. This is a disease that is both infectious and toxic and serious damage of the disease is mainly caused by the exotoxin of the diphtheria bacteria - Corynebacterium diphtheria - the scientific name - causes.
The disease was first described by Hippocrates in the 5th century BC. Some documents also suggest the prevalence of diphtheria in ancient Syria and Egypt. Scientists discovered pathogenic bacteria around 1883-1884, and antitoxin was invented in the late nineteenth century.
Diphtheria epidemic situation in Vietnam?
In Vietnam, in the period when diphtheria vaccination has not been implemented under the Expanded Immunization Program, diphtheria often occurs and causes epidemics in most provinces, especially in areas with high population density. According to a report from the Ministry of Health, the incidence of diphtheria has continuously decreased since 1984, corresponding to an increase in the rate of children vaccinated with diphtheria - pertussis - tetanus.
Due to the good implementation of diphtheria vaccination, the rate of diphtheria in Vietnam has gradually decreased from 3.95 / 100,000 in 1985 to 0.14 / 100,000 in 2000. As of 2012, Vietnam controlled The rate of diphtheria falls below 0.01 / 100,000 people, most of them are scattered or small diphtheria outbreaks on the village and commune scale and usually occur in remote areas where the rate is low vaccination.
According to the report of the expanded vaccination program in children under 5 years old, the rate of vaccinated combination vaccines containing diphtheria antigen for many years reached over 90%. Statistics in 2015 show that children under 1 year of age are fully vaccinated (1 dose of tuberculosis vaccine, 3 doses of DPT-VGB-Hib vaccine, 3 doses of polio vaccine, 1 dose of measles vaccine) the rate of 97.2% nationwide, there is no clear difference between big cities and remote areas.
However, at present, the vaccine to prevent diphtheria for adults is only available in the vaccination service, so the protection capacity of the vaccine in the adult community will be low.
What causes diphtheria? How is diphtheria spread?
The causative agent is the bacterium Corynebacterium diphtheriae of the Corynebacteriaceae family. Diphtheria bacteria have 3 types: Gravis, Mitis and Intermedius.
Diphtheria bacteria secrete toxins that damage many organs and organs of the body. Diphtheria bacteria reservoirs are located in sick people and in healthy people carrying the bacteria. This is both a reservoir and a source of disease transmission.
Diphtheria bacteria reservoirs are in sick and healthy people carrying the bacteria. This is both a reservoir and a source of disease transmission. Patients often eliminate bacteria from the onset period, the infectious period can last about 2 weeks or less. Healthy people carry diphtheria bacteria that can range from a few days to 3.4 weeks.
Diphtheria can be transmitted directly from an infected person to a healthy person through inhalation or indirectly by contact with toys or objects contaminated with the secretions of people infected with diphtheria bacteria.
Because diphtheria bacteria are transmitted mainly through the respiratory tract, the speed of spread is very fast, can penetrate through the skin, causing diphtheria skin. After about 2 weeks of infection, the patient is able to infect others.
The disease is easy to meet any object, can it be re-infected after vaccination or not?
Currently, diphtheria has not been eliminated in our country, so people can still get the disease if they have not been vaccinated against the disease and are exposed to pathogens. The Ministry of Health has issued Circular No. 17/2019 / TT-BYT guiding surveillance for 9 dangerous infectious diseases and diseases, including diphtheria.
Subjects susceptible to disease:
Clinical manifestations of diphtheria?
Diphtheria usually starts as a common cold, pharyngitis, tonsillitis, or laryngitis, and it may seem strange that it can also manifest as a skin infection.
Clinical case: Children will be sore throat, nose, larynx. Red throat, painful swallowing. Blue, tired, lymphadenopathy under the jaw causes swelling in the neck area. When he found a fake. Preterm diphtheria is usually ivory white or gray in color sticking around the inflamed tissue, if peeled off will bleed. Case confirmed diagnosis by Isolation of a positive diphtheria bacteria from clinical specimens taken from diseased tissue.
Diphtheria of the larynx is a serious illness in children. Clinical manifestations of local diphtheria toxoid infection are pseudomembranous and systemic manifestations are neurotoxicity, cranial nerve paralysis, peripheral motor neurons and sensory nerves and / or inflammation. myocardium.
People with diphtheria often have serious infections and poisoning. Diphtheria toxin causes muscle paralysis, myocarditis, leading to death within 6 days. The mortality rate is about 5% - 10%.
Common symptoms of diphtheria?
Depending on the location of the bacteria, diphtheria will have different manifestations:
Anterior nasal diphtheria: Patients with runny nose, runny nose mucus sometimes with blood. On examination, the physician can see the white membrane in the septum of the nose. This form of the disease is usually mild because the bacterial toxin is less likely to penetrate the bloodstream.
Diphtheria of the pharynx and tonsils: Fatigue, sore throat, loss of appetite, low fever. After 2-3 days, a clump of necrosis will appear that forms a white, green, chewy pseudo-layer that adheres firmly to the tonsils, or may spread to cover the oropharynx. Often this disease the toxins absorbed into the blood a lot and can cause systemic toxicity. Some patients may experience swelling under the jaw area and swollen neck glands that cause the neck to bulge like a bull's neck. In cases of severe poisoning, the patient will be lethargic, pale, rapid pulse, drowsiness, and coma. Without active treatment, these patients can die within 6-10 days.
Laryngeal diphtheria: This is a rapidly progressive and very dangerous disease. The patient often presents with signs of fever, hoarseness, and his cough. On examination, the doctor can see the pseudomembranous in the larynx or from the oropharynx spreading down. If not managed in time, these false positives can cause airway obstruction, causing respiratory failure and rapid death.
Diphtheria other sites: Usually very rare and mild, diphtheria bacteria can cause ulcers in the skin, mucous membranes such as the eye, vagina or ear canal.
Dangerous complications of diphtheria?
All complications of diphtheria, including death, are the result of the toxin. The most common complications of diphtheria are myocarditis and neuritis.
Myocarditis complications can occur during the full course of the illness or it can occur several weeks after the illness has resolved. When myocarditis occurs early in the early days of illness, the prognosis is often very dark, and mortality is very high.
Neuritis complications often affect motor nerves and usually recover completely if the patient does not die from another complication. Pharyngeal paralysis (curtain curtain) usually appears in the third week of illness. Paralysis of the optic nerve, limb muscle, and diaphragmatic paralysis may occur in week five of illness. Pneumonia and respiratory failure can develop as a result of diaphragmatic paralysis.
Other possible complications such as ocular conjunctivitis or respiratory obstruction may occur in children, especially infants.
Deaths between 5 and 10% can be as high as 20% in children under 5 years old and adults over 40 years old. The death rate of diphtheria seems to have not changed in the past 50 years.
Who will get diphtheria?
Diphtheria can be cured?
Currently, there are drugs to treat diphtheria, however, in the advanced stage, diphtheria can damage the heart, kidneys and nervous system of the patient. Even with treatment, diphtheria can be fatal with a death rate of 3% of people with diphtheria, even higher in children under 15 years of age.
What is diphtheria vaccine? Time, dose injection like?
Diphtheria can be prevented with a vaccination. In Vietnam, there is currently no single vaccine to prevent diphtheria, only vaccines in combination with diphtheria antigens, almost:
In the National Immunization Program (TCMR):
About service vaccines:
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