Tag: Corynebacterium Diphtheria: Clinical manifestation

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Ans. D

Explanation:

Susceptible to diphtheria [Ref. Park 19th/e p 137]



Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Ans. B

Explanation:

Subseceptibles


Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Ans. B

Explanation:

Diptheria

Quiz In Between


Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Ans. C

Explanation:

Post exposure prophylaxis is used in HIV, HBV, Measles, Rabies, Tetanus, H.influenzae and Meningococcus.

Ref: Park, 20th Edition, Pages 139, 189, 240, 283.

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Ans. D

Explanation:

Ans. is ‘d i.e., Schick test


Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Ans. B

Explanation:

Ans. is ‘b’ i.e., Elek’s Gel is a precipitation test 

.  Elek’s is a precipitation test. It is an in vitro test for toxigenicity of the diphtheria bacillus.

.   Selective medium for C. diphtheriae is tellurite blood agar (eg. Mc Leod’s and Hoyle’s media or cystine – tellurite agar – Tinsdale medium).

.  All strains of C. diphtheriae show metachromatic granules on staining.

.  C. diphtheriae is gram (+) ye, nonmotile and non-capsulated.

Based on colonial morphology on tellurite agar and other properties, Mc Leod classified diphtheria bacilli into three bio types – gravis, intermedius and mitis. Gravis causing most serious and mitis the mildest variety of diphtheria.

Quiz In Between


Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e.,Incubation period 2-5 days

.  Diptheria is caused by Gram positive bacilli, Corynebacterium diphtheriae

.   Incubation period of most common form of diphtheria ( faucial/ tonsiliopharyngeal diphtheria) is 2-5 days.

. For chemoprophylaxis erythromycin or penicillin are used.

Previously immunized asymptomatic household contact should receive booster dose of diphtheria toxoid. Those not fully immunized but asymptomatic contacts should receive immunization for their age”.—0.P. Ghai 7th/221 “Lifelong immunity is usually, but not always, acquired after disease or inapparent infection”—health.vic.gov.au> IDAES home > blue book

. So, child recovered from illness is already is immune. No active immunization is required.


Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Ans. C

Explanation:

Ans. is ‘c’ i.e., Isolated ocular palsies 

Complications

o Obstruction of the respiratory tract by pseudomembrane

o Myocarditis

  • Polyneuropathy
  • Post diphtheritic paralysis q Occurs in the 3rd or 4th week

o Palatine and pupillary paralysis is characteristic

Spontaneous recovery is the rule.

  • Pneumonia

o Other less common complications are renal failure, encephalitis, cerebral infarction, pulmonary embolism and bacteremia or endocarditis.


Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Ans. B

Explanation:

Ans. is ‘b’ i.e., 2-5 years 

Diphtheria

o Diphtheria is an acute infectious disease caused by toxigenic strains of corynebacterium diphtheriae.

o Source of infection –> cases or carriers; carriers are common sources of infection, their ratio is estimated to be 95 carriers for 5 clinical cases.

o Infective period              –> 14 – 28 days from the onset of disease.

o Age group                                     —> 1 to 5 years

o Sex                                    –> Both sexes

o Incubation period            –> 2 – 6 days

Quiz In Between


Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e., Positive test means that person is immune to diphtheria 


Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Ans. D

Explanation:

A i.e. Gonococcus; C i.e. Diptheria 

The only organisms known to be able to invade normal corneal epithelium are N. gonorrhoea & Cornybacterium diptheria Q

Quiz In Between



Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment


Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Symptoms
    • Fever
    • sore throat
    • Weakness
    • Malignant or hypertoxic or bull neck appearance
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis:Cardiac damage permanent
    • peripheral polyneuropathy of descending type.
  • Risk
    • Involvement larynx or tracheobronchial tree 
    • Children(because of small airway size).
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 
  • Blurred vision with preserved light reflex.
  • Degenerative changes in adrenal, kidney and liver may occur.
  • Cause of death
    • circulatory failure.

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare
  • Risk factors are 
    • preexisting cardiac abnormalities
    • IV drug abusers
    • alcoholic cirrhosi

Prevention

  • Active immunization by Toxoid
  • Immunization cannot prevent carrier stage.
  • Active immunization –
    • Combined DPT.
  • Perfussis component in DPT increase potency of diphtheria toxoid.
  • Toxoid of diphtheria shows Danysz phenomenon and Ehrlich phenomenon
  • contact isolation is must.

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.

The throat swabs are inoculated on the following culture media:

  • Loefflers serum slope
  • Tellurite blood agar
  • Blood agar

Virulence tests:

  • These tests demonstrate the production of exotoxin by bacteria isolated on culture.

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests
  • Schick test:
  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fades slowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
  • Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing10 kg).
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria

Exam Important

Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis
    • Peripheral polyneuropathy of descending type.
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.
  • The throat swabs are inoculated.
Virulence tests:

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests

Schick test:

  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fadesslowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

 Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin DOC
  • Procaine penicillin G .
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria
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