COMMUNICABLE DISEASES

COMMUNICABLE DISEASE
Is any disease that can be transmitted directly or indirectly from one person to another

INFECTION
Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body. It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion)

FACTORS AFFECTING RISK OF INFECTION

AGE HEREDITY LEVEL OF STRESS NUTRITIONAL STATUS CURRENT MEDICAL THERAPY PRE-EXISTING DISEASE IMMUNIZATION STATUS

IMMUNITY
THE QUALITY OF BEING INSUSCEPTIBLE TO OR UNAFFECTED BY A PARTICULAR DISEASE.

TYPES OF IMMUNITY
INNATE = within the HOST Immune System ACQUIRED = inoculation and disease Active Passive

 IMMUNE SYSTEM PROTECTION AGAINST ANTIGEN OR DISEASES BY A SYSTEM OF ANTIBODY PRODUCTION ANTIBODY PRODUCED BY LYMPHOCYTES IN RESPONSE TO ANTIGEN. ANTIGEN TRIGGERING AGENT OF THE IMMUNE SYSTEM

 IMMUNOGLOBULINS IgG MOST PREVALENT ANTIBODY 80%, PRODUCE LATER IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS THE PLACENTA IgA FOUND IN COLOSTRUM , TEARS, SALIVA, SWEAT IgM PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL IMMUNIZATION IgE ALLERGIC REACTION IgD UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLS

IMMUNIZATION
A PROCESS BY WHICH RESISTANCE TO AN INFECTIOUS DISEASE IS INDUCED OR AUGMENTED. ACTIVE AND PASSIVE IMMUNIZATION EPI Hepa b 3 shots, 0-1-6 mo, im, 0.5 ml, vas. lateralis Bcg 1 at birth, id, 0.05 ml, right arm Bcg 2 at 6 y/o, id, 0.1 ml, left arm Dpt 3 shots, 6 weeks old, 4 weeks interval im, 0.5 ml, vas. lateralis Opv 3x, same with dpt, oral gtts, 2-3 months Measles 1x, 9 mo, sq, 0.5 ml, right arm

 Active Immunity ANTIBODIES ARE PRODUCED BY THE BODY IN RESPONSE TO INFECTION. ANTIGEN IS INTRODUCED, LONG DURATION EXAMPLE: NATURAL ACTIVE = DISEASE ARTIFICIAL ACTIVE = VACCINES ARTIFICIAL ACTIVE ANTIGENS (VACCINES OR TOXOIDS) ARE ADMINISTERED TO STIMULATE ANTIBODY PRODUCTION. REINFORCED BY BOOSTER DOSE TO INCREASE IMMUNITY. KILLED VACCINES PERTUSSIS VACCINE, TYPHOID VACCINE LIVE VACCINES ATTENUATED, WEAKENED SABIN, MEASLES TOXOID INACTIVATED BACTERIAL TOXIN-TETANUS, DIPHTHERIA

 PASSIVE IMMUNITY ANTIBODIES ARE PRODUCED BY ANOTHER SOURCE. ANTIBODIES ARE INTRODUCED, SHORT DURATION Example: NATURAL PASSIVE = MOTHER ARTIFICIAL PASSIVE = GLOBULINS

ARTIFICIAL PASSIVE IMMUNE SERUM (ANTIBODY) FROM ANIMAL OR HUMAN IS INJECTED. PROVIDE IMMEDIATE PROTECTION (DIPHTHERIA ANTITOXIN, TETANUS ANTITOXIN) SKIN-TESTING IS A MUST.

CONDITIONS BEFORE AN INFECTION DEVELOPS Sufficient number of microorganisms Virulence of microorganisms Resistance of the of the host Immunity of the host Cycle of infection must be completed

Infection Cycle
Infectious Agent

Susceptible Host

Reservoir

Portal Of Entry

Portal of Exit

Mode of transmission

Terminologies
ETIOLOGY The study of causation or origination EPIDEMIOLOGY is the study (or science) of the patterns, causes and effects of health and dse conditions in defined populations INCIDENCE Measure of the risk of developing some new condition within a specified measure of time

 PREVALENCE Proportion of the population found to have a condition ENDEMIC

 EPIDEMIC When a certain disease is maintained in a population without the need for external inputs PANDEMIC Is and epidemic of infectious dse that has spread through human populations across a large region (continents/worldwide) SPORADIC Occuring occasionally, singly, or in irregular or random instances

FUNDAMENTALS OF STANDARD PRECAUTION

HANDWASHING GLOVES MASKS, GOGGLES, FACE SHIELDS AIR FILTERS GOWNS ISOLATION STRICT ISOLATION CONTACT ISOLATION RESPIRATORY ISOLATION TUBERCULOSIS ISOLATION ENTERIC PRECAUTION DRAINAGE/SECRETION PRECAUTION BLOOD/BODY FLUIDS PRECAUTION

ISOLATION
It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact. The principle behind isolation technique is to create a physical barrier that prevents the transfer of infectious agents.

Transmission-Based Precautions Airborne Droplets Contact

AIRBORNE PRIVATE ROOM NEGATIVE AIR PRESSURE VENTILATION SAFEGUARDS air from room is not recirculated to other areas DOOR SHOULD BE KEPT CLOSED BARRIER TO SMALL PARTICLES masks HEPA high efficiency particulate air COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT DROPLET PRIVATE ROOM WEAR MASK IF WORKING WITHIN 3 FEET WEAR MASKS UPON ENTRY INTO THE ROOM COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT CONTACT PRIVATE ROOM WEAR GLOVES GLOVES ARE REMOVED BEFORE EXITING FROM THE ROOM HANDS ARE WASHED THOROUGHLY NOTHING IS TOUCHED BEFORE EXITING THE ROOM GOWN IS WORN WHEN ENTERING THE ROOM REMOVE GOWN CAUTIOUSLY BEFORE LEAVING THE ROOM PATIENT CARE ITEMS SHOULD BE RESTRICTED TO SINGLE PATIENT

 OTHER TYPE OF ISOLATION AFB ISOLATION STRICT ISOLATION RESPIRATORY ISOLATION WOUND AND SKIN ISOLATION ENTERIC ISOLATION PROTECTIVE OR REVERSE ISOLATION AFB ISOLATION VISITORS REPORT TO NURSES STATION BEFORE ENTERING ROOM MASKS ARE TO BE WORN IN THE PATIENTS ROOM GOWNS ARE INDICATED TO PREVENT CLOTHING CONTAMINATION GLOVES ARE INDICATED FOR BODY FLUIDS AND NONINTACTSKIN HANDWASHING-after touching the patient or potentially contaminated articles and after removing gloves articles should be discarded, cleaned or sent for decontamination and reprocessing room is to remain closed patient is to wear mask during transport

RESPIRATORY ISOLATION
VISITORS-REPORT TO NURSES STATION BEFORE ENTERING ROOM PRIVATE ROOMnecessary, door must be kept closed GOWNS-gowns not necessary MASKS- must be worn by all persons entering the room if susceptible disease HANDS-must be washed on entering and leaving room GLOVES-not necessary ARTICLES-those contaminated with secretions must be disinfected CAUTION-all persons susceptible to the specific disease should be excluded from the area, susceptibles must wear masks

WOUND AND SKIN PRECAUTIONS

VISITORS-REPORT TO NURSES STATION BEFORE ENTERING ROOM PRIVATE ROOM-desirable GOWNS-must be worn by all persons having direct contact with the patient MASKS- during dressing changes HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with infected area ARTICLES-instruments, dressing, linens

ENTERIC PRECAUTIONS

VISITORS-REPORT TO NURSES STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary FOR CHILDREN ONLY GOWNS- must be worn by all persons having direct contact with the patient MASKS- not necessary HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with patient or articles contaminated with fecal material ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded

PROTECTIVE ISOLATION
VISITORS-REPORT TO NURSES STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary, door must be kept closed GOWNS- must be worn by all persons entering room MASKS- - must be worn by all persons entering room HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with patient

 DIAGNOSTIC TOOLS COLLECTION OF SPECIMEN PRINCIPLES TYPES OF SPECIMEN COLLECTION BLOOD URINE STOOL SPUTUM WOUNDS THROAT LABORATORY TESTS MICROSCOPY CULTURE ANTIBIOTIC SUSCEPTIBILITY TESTING WHITE BLOOD CELL COUNT IMMUNOLOGIC TEST

 DISORDERS CNS DISEASES GIT DISEASES RESPIRATORY DISEASE BLOOD BORNE DISEASES ERUPTIVE FEVER DISEASES CONTACT DISEASE SEXUALLY TRANSMITTED DISEASES TORCHS HIV AND AIDS HEPATITIS

CNS

Tetanus Clostridium tetani MOT = wound setting IP = 3 -21 days IMMUNITY Active = TT Passive = TAT TIG Natural = active none, passive (+)

 Tetanus Wound Infection FATAL INFECTION OF THE CNS TOXINNEUROTOXIN PATHOPHYSIOLOGY: SETTING OF WOUND ---ENTRANCE OF C.T. ---- RELEASES TETANUS TOXIN ---TETANOSPASMIN (CNS), TETANOLYSIN (BLOOD) ---ABSORBED BY MOTOR NERVE ENDINGS ---- SYNAPSE (CONNECTION BETWEEN NEURONS) ---- MYONEURAL JUNCTION ---- ACETYLCHOLINE DISTURBANCE IN THE TRANSMISSION OF NERVE IMPULSE

 Trismus lock jaw Risus sardonicus - maskface Risorius grinsmile is a highly characteristic, abnormal, sustained spasm of the facial muscles that appears to produce grinning

Dx wound and blood extraction (non specific)

3 types of patients w/ skin wounds post exposure prophylaxis (+) immunization as a child w/ boosters but last shot > 10 yrs give TT (-) immunization - TT + TIG/TAT .(+) tetanus TIG/TAT + TT + Abx + wound cleansing + supportive therapy

Management
1. Anticonvulsant, muscle relaxants, antibiotics, wound cleansing and debridement, hyperbaric chamber 2. Active-DPT and tetanus toxoid 3. Passive-TIG and TAT, placental immunity

Rabies

Rabies/Lyssa (Zoonotic) Rhabdovirus/filterable virus MOT = Bite from warm blooded animals Canine (human) and sylvatic (animals) IP = 10 days to several years IMMUNITY Active = rabies vaccine Passive = HRIG, ERIG Natural = active none, passive none

Rabies/Lyssa (Zoonotic) Hydrophobia (fear of choking) Aerophobia (laryngospasm) Bite from warm blooded animals Encephalitis/meningitis/respiratory paralysis
Category of bites I intact skin (lick) II mucosal, non bleeding wounds, abrasions III bleeding bites and above neck, stray dogs, laceration, multiple bites Rabies/Lyssa (Zoonotic) Observe dog for maniachal s/sx Active-rabies vaccine Passive-rabies immunoglobulin Dx History taking Quarantine the dog Staining of brain tissue (dog) (+) Negri bodies

 AFTER THE BITE WASH WITH SOAP AND WATER GIVE ANTIBIOTICS AND ANTITETANUS OBSERVE DOG FOR 14 DAYS, IF IT DIES CONSULT DOCTOR IF DOG SHOWS SUGGESTIVE OF RABIES, KILL THE DOG IMMEDIATELY AND BRING HEAD FOR LAB EXAM (+) NEGRI BODIES SUBMIT FOR IMMUNIZATION WHILE WAITING FOR RESULTS IF DOG IS NOT AVAILABLE FOR OBSERVATION SUBMIT FOR IMMUNIZATION

 Immunization Rabies vaccine (5 shots) IM (2 ml deltoid) 0, 3, 7, 14, 28 days ID (0.1 ml deltoid) 0, 3, 7 days (0.1 ml deltoid 2 shots) 30, 90 days (0.1 ml deltoid single shot) Rabies immunoglobulin (HRIG and ERIG) IM (0.2 x kg) single shot wound 40% deltoid 60% 4 STAGES 1. prodrome - fever, headache, paresthesia, 2. encephalitic excessive motor activity, hypersensitivity to bright light, loud noise, hypersalivation, dilated pupils 3. brainstem dysfunction dysphagia, hydrophobia, apnea 4. death/recovery

Poliomyelitis
Poliomyelitis Infantile Paralysis Polio virus, Legio debilitans Legio brunhilde (fatal) Legio lansing Legio leon MOT = Fecal oral route (common) and droplets IP = 7-12 days IMMUNITY Active = OPV Passive = none Natural = active (+), passive none

 Poliomyelitis Infantile Paralysis Assymetrical paralysis Haynes sign - head drop Pokers sign opisthotonus Landrys sign - ascending paralysis Pandys Test increased in CSF CHON

`
Poliomyelitis Infantile Paralysis I abortive or inapparent II meningitis (non-paralytic) III paralytic (anterior horn of spinal cord) IV bulbar (encephalitis)

Meningitis
Menigococcemia Neisseria meningitides (bacteria) MOT = droplets IP = 1-2 days IMMUNITY = xxx Meningitis Menigococcemia Immunocompetent are susceptible Petechiae (volar/palm of hands) EARLY Opisthotonus MENIGEAL IRRITATION Brudzinski MENINGEAL IRRITATION Kernigs MENINGEAL IRRITATION Increased ICP BRAIN Seizure BRAIN S/sx: Meningococcemia spiking fever, chills, arthralgia, petechial rash Fulminant Meningococcemia (Waterhouse Friderichsen) septic shock; hypotension, tachycardia, enlarging petecchial rash, adrenal insufficiency Meningitis most common; nuchal rigidity, brudzinski, kernigs, Photophobia, confusion Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture Mgmt: antibiotics (Pen G, ceftriaxone), steroids, anticonvulsants, Rifampin for close contacts of meningococcemia

Encephalitis
Arbo virus (arthropod borne virus) MOT = bite from mosquito (St. Louise) IP = xxx IMMUNITY = xxx Encephalitis S/sx: fever, abdominal pain, sore throat, respiratory symptoms, headache, meningeal signs, photophobia, Seizure (lacrosse), SIADH w/ hypoNa (St Louis) Dx: CSF analysis r/o other CNS disease, CT scan, MRI Mgmt: nonspecific; control seizures

Leprosy
Mycobacterium Leprae, Hansens Bacillus MOT = (unknown) may be due to prolonged skin-skin contact (common) or droplets IP = years to decades IMMUNITY Active = BCG Passive = none Natural = none EARLY Skin lesion and paresthesia LATE Lagopthalmos Madarosis Gynecomastia Saddle Nose Contractures Dx: Lepromin Test ID injection Slit Skin Smear Dapsone-Lamprene-Rifampicin Dapsone-dont give to anemic Lamprene-dry skin, hyperpigmentation (lasting) Rifampicin-renal and liver toxicity

 MDT-RA 4073 (home meds) Paucibacillary - 6-9 months 1. Dapsone 2. Rifampicin Multibacillary- 12-24 months 1. Dapsone mainstay; hemolysis, agranulocytosis 2. Clofazimine reddish skin pimentation, intestinal toxicity 3. Rifampicin bactericidal; renal and liver toxicity MDT- two or more drugs RA 4073 (home meds) Paucibacillary.- 6-9 months Multibacillary.- 12-24 months Tuberculoid high resistant, less severe (+LT) Lepromatous most severe, low resistant (-LT) Non - communicable After 1 week of medication Considered cured After completing the course of treatment

Red Tide Poisoning

Pyromidium Bahamense Exotoxin Dinoflagellates Plankton Algae MOT = Ingestion of contaminated bi-valve shellfish IP = within 30 minutes IMMUNITY = xxx Dx gastric siphoning EARLY Circumoral numbness nausea and vomiting LATE Bulbar paralysis and metabolic acidosis Mgmt: emesis/gastric lavage + activated charcoal, supportive

 CLINICAL MANIFESTATIONS: Numbness of the face especially around the mouth vomiting, dizziness, headache tingling sensation, weakness rapid pulse, difficulty of speech (ataxia), dysphagia, respi paralysis, death.

MANAGEMENT AND CONTROL MEASURES: No definite medications induce vomiting (early intervention) drinking pure coconut milk (weakens toxic effect) dont give during late stage it may worsen the condition. Nahco3 SOLUTION (25 GRAMS IN GLASS OF WATER) RESPIRATORY SUPPORT AVOID USING VINEGAR IN COOKING SHELLFISH AFFECTED BY RED TIDE (15X virulence) TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN COOKING. Avoid tahong, talaba, halaan, kabiya, abaniko. When red tide is on the rise.

Botulism
Clostridium Botulinum (bacteria) Endotoxin MOT canned foods Ingestion of contaminated foods) IP = 12-36H canned food, 4-14 days wound IMMUNITY Active = xxx Paiive = botulinum antitoxin Natural = xxx Dx = gastric siphoning EARLY VISUAL DIFFICULTY, DYSPHAGIA, DRY MOUTH LATE VOMITING, CONSTIPATION/DIARRHEA DESCENDING SYMMETRICAL FLACCID BULBAR PARALYSIS

GASTROINTESTINAL DISEASES

Amoebiasis
Entamoeba Hystolitica protozoan (parasite) MOT = 5 Fs, fecal oral route IP = 2-4 weeks IMMUNITY = xxx Dx microscopic stool exam or rectal secretions (tetra nucleated cyst and trophozoites) Diarrhea and constipation (non dysenteric) Blood streaked, diarrhea and watery mucoid, abdl cramps (dysenteric) Extra amoebiasispenile, vagina, spleen, liver, anal, lungs and meninges Mgt: Metronidazole (Flagyl)

Bacillary Dysentery
Shigellosis Shiga bacillus (bacteria) s. dysenterae (fatal) s. flexneri (common in the Philippines) s. boydii s. sonnei MOT = same with amoebiasis IP = 1-7 days IMMUNITY = xxx Dx stool exam Watery mucoid, bloody with pus feces Tenesmus = rectal prolapse Mgt: Chloramphenicol, Tetracycline

Cholera
, El Tor Vibrio Coma (inaba, ogawa, hikojima) Vibrio Cholerae Vibrio El Tor (bacteria) MOT = same with amoebiasis IP = few hours to 5 days IMMUNITY Active = cholera vaccine Passive = none Natural = none

Dx stool exam Rice watery stool with fishy odor Washerwomans appearance Severe dehydration
Mgt: Chloramphenicol

Typhoid Fever
Salmonella typhosa (bacteria) MOT = same with amoebiasis (5 Fs) IP = 1-3 weeks IMMUNITY Active = vaccine Passive = xxx Natural = lifetime immunity Pathophysiology Oral ingestion Bloodstream Reticuloendothelial system (lymph node, spleen, liver) Bloodstream Gallbladder Peyers patches of SI necrosis and ulceration

 Typhoid Fever 1st week step ladder (BLOOD) 2nd week rose spot and fastidial typhoid pyschosis (URINE & STOOL) 3rd week (complications) intestinal bleeding, perforation, peritonitis, encephalitis, 4th week (lysis) decreasing S?SX 5th week (convalescent) Blood (typhi dot) 1st week after Stool and urine 2nd week after Chloramphenicol Rose spot (abdominal rashes) Step ladder fever to fastidial (peak of fever) typhoid psychosis Peyers patches of small intestine May stay in the gallbladder (hiding area)

Hookworm (Roundworm)
Necator Americanus, Ancylostoma Duodenale Skin entry (sole of the feet to blood steam then into the lungs then ascends to the pharynx where it is swallowed and attached into the intestinal mucosa and subsists on the blood of the host) Anemia, abdl cramps, abdl distention, perforation to peritinotis to septicemia IP few weeks to months Dx microscopic exam (stool exam) Pyrantel Pamoate and Mebendazole Note: dont give drug
without (+) stool exam members of the family must be examined and treated also.

 Nursing Consideration FOLLOW-UP EXAMINATION OF THE STOOL 2 WEEKS AFTER THERAPY NUTRITION COUNSELING AND IRON SUPPLEMENTS FAMILY MEMBERS AND CLOSE CONTACTS SHOULD BE EXAMINED AND TREATED FOR PARASITES EDUCATE PUBLIC ABOUT DANGERS OF CONTAMINATED SOIL IMPORTANCE OF WEARING SHOES DEWORMING

Ascariasis (Roundworm)
Ascaris Lumbricoides MOT ingestion of food contaminated by ascaris lumbricoides GIT to LUNGS and other ORGANS MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall towards lung where larvae grow and coughed up intestine larvae mature and passed out in feces Sx:Coughing, wheezing and hemoptysis IP same with hookworm Drug: same with hookworm Dx same with hookworm

Tapeworm Taenia Saginata (cattle) Taenia Solium (pigs) MOT fecal oral route (ingestion of food contaminated by the agent) Dx: Stool Exam S/Sx diarrhea, abdominal discomfort, anemia Pinworm Enterobiasis (nocturnal animation/alive) Vermicularis Enterobius MOT fecal oral route S/sx Itchiness at the anal area (eggs of the agent causes the itchiness) Dx tape test at night time (agents release their eggs during night time) Thread worm storgyloidiasis Whip worm trichoniasis voracious eating abdominal pain weight loss Flat worm - paragonimiasis

Schistosomias
,Snail Fever, Takayama Blood fluke Schistosoma japonicum S. hematobium S. mansoni MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate the liver, from liver to intestines Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny snail)-cercaria Itchiness at the site RUQ pain (hepatomegaly) Intestine infiltration-abdl cramps, diarrhea with blood Praziquantel Dx (stool exam) KEY POINTS! Egg miracidium snail cercaria- human Itchiness liver intestines Praziquantel PREVENTION Samar and Leyte

Mumps
Mumps virus/filtrable virus MOT = droplets and airborne HIGHLY CONTAGIOUS IP 12-16 days IMMUNITY Active = MMR Passive = mumps Ig Natural = active =lifetime Unilateral or bilateral parotitis Ice collar Stimulating foods cause severe pain Bilateral orchitis and oophoritis Active spermatogenesis Sterility Steroids Supporter

SEE YOU 2MRW!

RESPIRATORY DISEASES

Diphtheria
Corynebacterium diphtheriae Klebsloefflers bacillus (bacteria) MOT = droplets and airborne HIGHLY CONTAGIOUS IP 2-5 days IMMUNITY Active = DPT Passive = DAT Natural = xxx Dx = throat swab, MOLONEY, SCHICK S/Sx:Pseudomembrane, Bullneck Penicillin or erythromycin Resp Acidosis with hypoxemia Cx: myocarditis, septicemia

Nursing Considerations:
OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL F&E RESUSCITATION PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN ATTENTION TO NASOPHARYNGEAL DISCHARGE ANTIBIOTICSPENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN

 S/sx: sore throat, fever, Bull-neck (Pseudomembrane- gray exudate, foul breath, massive swelling of tonsils and uvula, thick speech, cervical lymphadenopathy, swelling of submandibular and anterior neck), obstruction of respiratory tract Dx: Schick test - susceptibility to diphtheria toxin Moloney - sensitivity to diphtheria toxoid Throat swab (K tellurite and Loefflers coagulated blood serum) Mgmt: Diphtheria antitoxin (Skin test), Penicillin,erythromycin, rifampicin, clindamycin

 Diphtheria KEY POINTS! Highly contagious Pseudomembrane and bullneck Immunization best intervention PREVENTION Obstruction and myocarditis Isolation technique