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Diphtheria, Pertussis, And Tetanus: Evidence-Based Management Of Pediatric Patients In The Emergency Department

February 2017

Abstract

Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

Keywords: diphtheria, pertussis, tetanus, whooping cough, Corynebacterium diphtheriae, Bordetella pertussis, Clostridium tetani, pseudomembrane, infectious disease, bacterial infection, vaccine-preventable disease, vaccine, vaccination, DTP, DTaP, Tdap, diphtheria antitoxin, DAT, tetanus immune globulin, TIG, muscle spasms, magnesium sulfate, postexposure prophylaxis, PEP, National Notifiable Disease Surveillance System

POINTS

  • Cases of diphtheria, pertussis, and tetanus should be immediately reported to the state Department of Health or United States Centers for Disease Control and Prevention (CDC).
  • The pseudomembrane site of diphtheria is a source of toxin production that can spread via the bloodstream to other tissues in the body. The extent of the membrane is an indicator of the severity of the illness.

PEARLS

  • Emergency clinicians should be able to recognize the clinical presentations of diphtheria, pertussis, and tetanus. In suspected cases, treatment should not be delayed while awaiting confirmatory testing.
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