Diphtheria is a bacterial infection that generally attacks the mucous membranes of the nose and throat, and can sometimes affect the skin. The disease is highly contagious and includes serious potentially life-threatening infections.
According to the World Health Organization (WHO), there are 7.097 cases of diphtheria reported worldwide by 2016. Among these figures, Indonesia contributed 342 cases. Since 2011, extraordinary events (KLB) for diphtheria cases have become a problem in Indonesia. Recorded 3,353 diphtheria cases are reported from 2011 to 2016 and this number places Indonesia second after India with the largest number of diphtheria cases. Of the 3,353 people suffering from diphtheria, and 110 of them died. Nearly 90% of infected people, do not have a complete history of diphtheria immunization.
Diphtheria is one of the preventable diseases by immunization and immunization against diphtheria, including into the mandatory Indonesian immunization program. Diphtheria immunization combined with pertussis (whooping cough) and tetanus is called DTP immunization. Before the age of 1 year, children are required to get 3 DTP immunization. The coverage of children who get DTP immunization up to 3 times in Indonesia, in 2016, amounted to 84%. The number decreased when compared with the first DTP coverage, ie 90%.
Causes of Diphtheria
Diphtheria is caused by Corynebacterium diphtheriae bacteria. The spread of these bacteria can occur easily, especially for people who do not get diphtheria vaccine. There are a number of ways of transmission that need to be watched, such as:
Inhalation splashes the patient in the air when the patient sneezes or coughs. This is the most common mode of diphtheria transmission.
Items that have been contaminated by bacteria, for example toys or towels.
Direct touch on ulcer wounds (ulcers) due to diphtheria in the skin of the patient. Transmission is common in people living in densely populated environments and their hygiene is not maintained.
Diphtheria bacteria will produce toxins that will kill healthy cells in the throat, thus eventually becoming a dead cell. These dead cells will form a gray (membrane) membrane in the throat. In addition, the resulting toxin also has the potential to spread in the bloodstream and damage the heart, kidneys, and nervous system.
Sometimes, diphtheria may show no symptoms so that the sufferer does not realize that he or she is infected. If not properly treated, they have the potential to transmit the disease to those around them, especially those who have not been immunized.
Diphtheria Symptoms
Diphtheria generally has an incubation period or time span since bacteria enter the body until symptoms appear 2 to 5 days. The symptoms of the disease include:
The formation of a thin layer of gray that covers the throat and tonsils.
Fever and chills.
Sore throat and hoarseness.
Difficult breathing or rapid breathing.
Swollen lymph nodes in the neck.
Limp and tired.
Cold. Initially liquid, but gradually become thick and sometimes mixed with blood.
Diphtheria also can sometimes attack the skin and cause ulcers (ulcers). The ulcer will heal within a few months, but will usually leave marks on the skin.
Immediately consult a doctor if you or your child shows any of the above symptoms. The disease should be treated promptly to prevent complications.
Diagnosis and Treatment of Diphtheria
To establish a diagnosis of diphtheria, initially the doctor will ask some things about the symptoms experienced by the patient. Doctors can also take samples of mucus in the throat, nose, or ulcers on the skin for laboratory testing.
If a person is suspected of contracting diphtheria, the doctor will begin treatment immediately, even before any laboratory results. The doctor will advise him to undergo treatment in the isolation room at the hospital. Then step treatment will be done with two types of drugs, namely antibiotics and antitoksin.
Antibiotics will be given to kill the bacteria and cure the infection. The dose of antibiotic use depends on the severity of the symptoms and the length of the patient suffering from diphtheria.
Most patients can get out of the isolation room after taking antibiotics for 2 days. But it is very important for them to continue to complete the consumption of antibiotics as recommended by doctors, ie for 2 weeks.
Patients will then undergo a laboratory examination to see whether there is bacterial diphtheria in the bloodstream. If diphtheria bacteria is still found in the patient's body, the doctor will continue the use of antibiotics for 10 days.
According to the World Health Organization (WHO), there are 7.097 cases of diphtheria reported worldwide by 2016. Among these figures, Indonesia contributed 342 cases. Since 2011, extraordinary events (KLB) for diphtheria cases have become a problem in Indonesia. Recorded 3,353 diphtheria cases are reported from 2011 to 2016 and this number places Indonesia second after India with the largest number of diphtheria cases. Of the 3,353 people suffering from diphtheria, and 110 of them died. Nearly 90% of infected people, do not have a complete history of diphtheria immunization.
Diphtheria is one of the preventable diseases by immunization and immunization against diphtheria, including into the mandatory Indonesian immunization program. Diphtheria immunization combined with pertussis (whooping cough) and tetanus is called DTP immunization. Before the age of 1 year, children are required to get 3 DTP immunization. The coverage of children who get DTP immunization up to 3 times in Indonesia, in 2016, amounted to 84%. The number decreased when compared with the first DTP coverage, ie 90%.
Causes of Diphtheria
Diphtheria is caused by Corynebacterium diphtheriae bacteria. The spread of these bacteria can occur easily, especially for people who do not get diphtheria vaccine. There are a number of ways of transmission that need to be watched, such as:
Inhalation splashes the patient in the air when the patient sneezes or coughs. This is the most common mode of diphtheria transmission.
Items that have been contaminated by bacteria, for example toys or towels.
Direct touch on ulcer wounds (ulcers) due to diphtheria in the skin of the patient. Transmission is common in people living in densely populated environments and their hygiene is not maintained.
Diphtheria bacteria will produce toxins that will kill healthy cells in the throat, thus eventually becoming a dead cell. These dead cells will form a gray (membrane) membrane in the throat. In addition, the resulting toxin also has the potential to spread in the bloodstream and damage the heart, kidneys, and nervous system.
Sometimes, diphtheria may show no symptoms so that the sufferer does not realize that he or she is infected. If not properly treated, they have the potential to transmit the disease to those around them, especially those who have not been immunized.
Diphtheria Symptoms
Diphtheria generally has an incubation period or time span since bacteria enter the body until symptoms appear 2 to 5 days. The symptoms of the disease include:
The formation of a thin layer of gray that covers the throat and tonsils.
Fever and chills.
Sore throat and hoarseness.
Difficult breathing or rapid breathing.
Swollen lymph nodes in the neck.
Limp and tired.
Cold. Initially liquid, but gradually become thick and sometimes mixed with blood.
Diphtheria also can sometimes attack the skin and cause ulcers (ulcers). The ulcer will heal within a few months, but will usually leave marks on the skin.
Immediately consult a doctor if you or your child shows any of the above symptoms. The disease should be treated promptly to prevent complications.
Diagnosis and Treatment of Diphtheria
To establish a diagnosis of diphtheria, initially the doctor will ask some things about the symptoms experienced by the patient. Doctors can also take samples of mucus in the throat, nose, or ulcers on the skin for laboratory testing.
If a person is suspected of contracting diphtheria, the doctor will begin treatment immediately, even before any laboratory results. The doctor will advise him to undergo treatment in the isolation room at the hospital. Then step treatment will be done with two types of drugs, namely antibiotics and antitoksin.
Antibiotics will be given to kill the bacteria and cure the infection. The dose of antibiotic use depends on the severity of the symptoms and the length of the patient suffering from diphtheria.
Most patients can get out of the isolation room after taking antibiotics for 2 days. But it is very important for them to continue to complete the consumption of antibiotics as recommended by doctors, ie for 2 weeks.
Patients will then undergo a laboratory examination to see whether there is bacterial diphtheria in the bloodstream. If diphtheria bacteria is still found in the patient's body, the doctor will continue the use of antibiotics for 10 days.
Meanwhile, administration of antitoxin serves to neutralize toxins or diphtheria toxins that spread in the body. Before giving antitoxin, your doctor will check whether the patient has any allergies to the drug or not. In the event of an allergic reaction, your doctor will give you a low-dose antitoxin and slowly increase it while you look at the patient's condition.
For patients who have difficulty breathing due to gray membrane barrier in the throat, doctors will recommend the process of removal of the membrane. While patients with diphtheria symptoms of ulcers on the skin is recommended to clean boils with soap and water thoroughly.
In addition to patients, people who are nearby are also advised to see a doctor because the disease is highly contagious. For example, households who live in a house or medical personnel who handle diphtheria patients.
Doctors will advise them to undergo tests and give antibiotics. Sometimes diphtheria vaccine is also re-supplied if needed. This is done to increase protection against this disease.
Diphtheria Complications
Treatment of diphtheria should be done immediately to prevent the spread as well as serious complications, especially in children. It is estimated that 1 in 5 sufferers and elderly people over 40 years died from complications of diphtheria.
If not treated quickly and appropriately, toxins from diphtheria bacteria may trigger some potentially life-threatening complications. Some of them include:
Respiratory problems. Cells that die from toxins produced by diphtheria bacteria will form a gray membrane that can inhibit breathing. Membrane particles can also decay and enter the lungs. This has the potential to trigger an inflammatory reaction in the lungs so that its function will decrease drastically and cause respiratory failure.
Heart damage. In addition to the lungs, diphtheria toxin has the potential to enter the heart and cause inflammation of the heart muscle or myocarditis. These complications can cause problems, such as irregular heartbeat, heart failure, and sudden death.
Nerve damage. Toxins can cause people having difficulty swallowing problems, urinary tract problems, paralysis or paralysis of the diaphragm, and swelling of the nerves of the hands and feet. Paralysis of the diaphragm will leave the patient unable to breathe and thus requires a respirator or respirator. Diagfragm paralysis may occur suddenly at the onset of symptoms or weeks after the infection heals. Therefore, people with diphtheria who have complications are generally recommended to stay in the hospital for up to 1.5 months.
Hypertensive diphtheria. This complication is a very severe form of diphtheria. In addition to the same symptoms as ordinary diphtheria, hypertensive diphtheria will trigger severe bleeding and kidney failure.
Prevention of Diphtheria with Vaccination
The most effective preventive measure for this disease is with the vaccine. Prevention of diphtheria is incorporated in the DTP vaccine. The vaccine includes diphtheria, tetanus, and pertussis or whooping cough.
DTP vaccine is included in mandatory immunization for children in Indonesia. Provision of this vaccine is done 5 times when the child aged 2 months, 3 months, 4 months, one and a half years, and five years. Furthermore, can be given a booster with a similar vaccine (Tdap / Td) at the age of 10 years and 18 years. Td vaccine can be repeated every 10 years to provide optimal protection.
If DTP immunization is late given, the given pursuit immunization will not repeat from the beginning. For children under 7 years who have not immunized DTP or immunized incomplete, can still be given immunization with the schedule according to your doctor's recommendation. But for those who are 7 years old and not yet complete do the DTP vaccine, there is a similar vaccine named Tdap to be given.
Such protection can generally protect the child against life-long diphtheria.
