tailieunhanh - Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 5)

Management Patients in whom diphtheria is suspected should be hospitalized in respiratory isolation rooms, with close monitoring of cardiac and respiratory function. A cardiac workup is recommended to assess the possibility of myocarditis. In patients with extensive pseudomembranes, consultation with an anesthesiologist or an ear, nose, and throat specialist is recommended because of the possibility that tracheostomy or intubation will be required. In some settings, pseudomembranes can be removed surgically. Treatment with glucocorticoids has not been shown to reduce the risk of myocarditis or polyneuropathy. Prognosis Fatal pseudomembranous diphtheria typically occurs in patients with nonprotective antibody titers and in unimmunized patients. . | Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species Part 5 Management Patients in whom diphtheria is suspected should be hospitalized in respiratory isolation rooms with close monitoring of cardiac and respiratory function. A cardiac workup is recommended to assess the possibility of myocarditis. In patients with extensive pseudomembranes consultation with an anesthesiologist or an ear nose and throat specialist is recommended because of the possibility that tracheostomy or intubation will be required. In some settings pseudomembranes can be removed surgically. Treatment with glucocorticoids has not been shown to reduce the risk of myocarditis or polyneuropathy. Prognosis Fatal pseudomembranous diphtheria typically occurs in patients with nonprotective antibody titers and in unimmunized patients. The pseudomembrane may increase in size from the time it is first noted. Risk factors for death include bullneck diphtheria myocarditis with ventricular tachycardia atrial fibrillation complete heart block an age of 60 years or 6 months alcoholism extensive pseudomembrane elongation and laryngeal tracheal or bronchial involvement. Another important predictor of fatal outcome is the interval between local disease development and antitoxin administration. Cutaneous diphtheria has a low mortality rate and is rarely associated with myocarditis or peripheral neuropathy. Prevention Vaccination Sustained campaigns for vaccination of children and adequate boosting vaccination of adults are responsible for the exceedingly low incidence of diphtheria in most developed nations. At present diphtheria toxoid vaccine is coadministered with tetanus with or without acellular pertussis vaccine. DTaP full-level diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed is the currently recommended vaccine for children up to the age of 7 DTaP replaced DTP diphtheria and tetanus toxoids and whole-cell pertussis vaccine in 1997. Tdap is a .