Makogwaro (Diphtheria)

Lokacin kwanciyar cuta: Kwanaki 2–5

Diphtheria na makogwaro (pharyngeal — mafi yawa):

• Ciwon makogwaro mai matsakaici

• Dan zazzabi (37.5–38.5°C)

• Farin/toka-toka (greyish-white membrane) a kan tonsils/pharynx — mai mannewa sosai, yana zubar da jini idan aka yi kokarin cirewa

• Kumburin glandin lymph a wuya — "wuyan bijimi" (bull neck)

• Mummunan wari a baki

• Muryar hanci (nasal voice)

Diphtheria na na'ura ta numfashi (laryngeal):

• Muryar sautin karfe (stridor/croup)

• Wahalar numfashi — gaggawa

• Toshewar hanyar numfashi — na iya kashe cikin sa'o'i

Diphtheria na fata (cutaneous):

• Raunin fata mara warkewa tare da membrane — ya fi yaduwa a yankunan dumi

Matsaloli na guba (toxic complications — za su iya bayyana makonni bayan cutar ta warke):

• Kumburin zuciya (toxic myocarditis): matsalar da ta fi kashe mutane, tana iya bayyana kwanaki 10–14 bayan cutar

• Lalacewar jijiyoyi (polyneuropathy): gurguwar muƙamuƙi, wahalar hadiya, raunin ƙafafu

• Rashin aikin koda (nephrotoxicity)

The risk of diphtheria is primarily determined by vaccination status and proximity to endemic or outbreak settings. The following factors increase the likelihood of infection and/or severe disease:

Risk factors for infection:

• Incomplete or absent vaccination: The dominant risk factor globally. In the 1990s outbreak in the former Soviet Union (>150,000 cases, >5,000 deaths), the majority of cases occurred in adults whose childhood vaccine-induced immunity had waned without booster doses.

• Living in or traveling to endemic areas: Regions with DTP3 coverage <80%, particularly sub-Saharan Africa, South Asia, and Southeast Asia

• Crowded living conditions: Military barracks, refugee camps, prisons, homeless shelters — outbreaks propagate rapidly in overcrowded settings with poor hygiene

• Close contact with a case or carrier: Household contacts of a diphtheria case have a secondary attack rate of 2–5% even in partially immunized populations

• Low socioeconomic status and poor hygiene: Both respiratory and cutaneous diphtheria are diseases of poverty

Risk factors for severe disease and death:

• Age: CFR is highest in children <5 years (up to 20%) and adults >40 years (up to 20–30%). The relatively lower CFR in older children and young adults (3–5%) reflects both immune maturity and lower membrane burden.

• Delayed antitoxin administration: Every day of delay after day 2 of illness increases mortality. Antitoxin given on day 1 is associated with ~1% CFR; by day 4+, CFR exceeds 15%.

• Extensive membrane: Membrane involving the larynx, trachea, or extending across the entire pharynx carries higher risk of airway obstruction and systemic toxicity.

• Bull-neck (severe cervical edema): Indicates massive toxin production and correlates with higher rates of myocarditis and neuropathy.

• Biotype: C. diphtheriae biotype gravis has historically been associated with more severe disease, though this correlation is not absolute.

Populations at increased risk in high-income countries:

• Adults aged >50 years (waning immunity, inadequate booster uptake — serological studies show 30–60% are below protective antibody levels)

• Immigrants and refugees from low-coverage countries

• Homeless populations (cutaneous diphtheria)

• Healthcare workers in contact with cases

Matsaloli — sun fi hatsari idan ba a ba da antitoxin da sauri ba:

• Kumburin zuciya (Toxic myocarditis): Babban sanadin mutuwa. Yana bayyana kwanaki 10–14. ECG: block na zuciya, arrhythmias. A lokacin barkewar Najeriya, mutuwar kwatsam saboda matsalar zuciya ta faru a wasu yara da suke kamar sun warke.

• Lalacewar jijiyoyi (Polyneuropathy): Gurguwar muƙamuƙi (mako 3–6), wahalar hadiya (hatsarin shaƙewa), raunin ƙafafu da hannaye (mako 6–10). Yawanci ana warkewa cikakke.

• Toshewar hanyar numfashi: Membrane na iya toshe hanyar numfashi — mutuwa idan ba a yi tracheostomy ba

• Cutar koda (Nephrotoxicity)

Mutuwa: 5–10% baki daya; ya fi girma idan ba a ba da antitoxin da wuri ba. A lokacin barkewar Najeriya 2022-2023: kashi na mutuwa ~3.6% (CFR) amma ya fi girma a yankunan da ba su da isassun kayan aikin lafiya.