What is diphtheria?

The characteristic symptom of respiratory diphtheria is a greyish white membrane (pseudomembrane) covering the tonsils and pharynx. The membrane tends to be difficult to remove and in doing so the area bleeds easily.

Symptoms

The most common symptoms are:

• Fever, feeling generally unwell and respiratory obstruction.
• Neurological and cardiac complications in the most serious cases. These complications can lead to death.

Who does diphtheria affect?

Thanks to vaccination, there have been no cases diagnosed in Spain for over thirty years. In 2015, however, there was one case in a child who had not been vaccinated.

Diphtheria is transmitted through respiration or close physical contact with an infected person or a healthy person carrying the bacteria but who has never shown symptoms.

The incubation period is two to seven days and it can be spread from seven days before symptoms appear up to two or three weeks afterwards. 

Diagnosis

Diagnosis is confirmed via microbial culture of clinical samples (swabs from the nasal mucosa, pharynx or pseudomembranes).

Typical treatment

Diphtheria antitoxin medication and an antibiotic such as penicillin G procaine must be given as soon as possible (in the first 48 hours after showing symptoms, without waiting for the laboratory diagnosis).

Prevention

Vaccination is the main measure to prevent diphtheria and is effective in 95% of cases. It must be periodically boosted as the effects of the vaccination do not last for ever.

Epidemiological monitoring and prophylaxis are essential to control the bacteria and to avoid secondary cases.

What is the effect of burns?

When burns are extensive and cover 15% of an adult’s body or 10% of a child or a person over 50 years old, they are called “minor burns”. When they occur, a high number of pro-inflammatory molecules are released from the burn and reach the rest of the body through circulation of the blood. During the acute stage, the permeability of the blood vessel membranes and of the body's cells is increased, which results in changes to the distribution of liquid in the body and the depression of cellular function.

To tackle the burn, a few days later the body initiates a generalised inflammatory response via a notable increase in catabolism processes in order to obtain energy resources. It also initiates a hyperdynamic response that transfers these resources to the injured areas. If the burn does not heal quickly, the inflammatory response may consume the body's resources, exhaust the patient, cause organ failure and, ultimately, death. 

Once healed, however, there may be lasting functional and aesthetic consequences due to scarring or retraction. This is the case with hypertrophic and keloid scars; thickened areas of scar tissue that limit the mobility of joints, retraction of the eyelids, microstomia, and others.

Symptoms

Burns are graded depending on their severity and they also look different: 

• First-degree burns: painful and with reddening of the skin (erythema), but the skin is not broken.
• Superficial second-degree burns: very painful due to blisters with red and watery skin underneath.
• Deep second-degree burns: may or may not include blistering, and appear dry and whitish. May also be less painful.
• Third-degree burns: look like scar tissue, leathery appearance, dry, sunken and dark in colour. In this case, there is no sensitivity to pain.

Who do burns affect?

Burns are a common, serious and debilitating traumatic injury that mainly results from accidents in the workplace, the home or traffic accidents. The Spanish Society of Family and Community Medicine estimates that three out of every thousand people a year suffer burns requiring medical attention. Primary care centres (CAPs) deal with most cases, but 15-20% will require admission to hospital.

Diagnosis

Diagnosis is clinical and treatment must be carried out by highly specialised professionals as this is  not a common pathology.

Typical treatment

Depending on the degree of the burn, treatment may be:

• First-degree: hydrating creams.
• Superficial second-degree: if there are no complications they can be left to heal by themselves with the application of topical treatment.
• Deep second-degree and third-degree: require skin grafts as they need at least three weeks to heal by themselves. There may also be functional and aesthetic complications.
• Extensive burns: require specific life support in a Burns Unit.

Prevention

Most burns are avoidable and therefore the main tools for prevention are education and legislation in society.

What is Chagas disease?

Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.

Symptoms

Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:

• Acute: there are no symptoms and this means it goes undetected or is confused with other diseases. After an incubation period of 7-10 days, the acute phase resembles a case of flu, so it usually goes unnoticed.
• Chronic: in 30-40% of cases the disease results in cardiac and/or gastrointestinal complications which may be serious and therefore require specific treatment.

Who is affected by Chagas disease?

This disease affects six to seven million people, but 60 million are estimated to be at risk of infection.  There are 11,000 cases in Catalonia.

Diagnosis

• In the acute phase (mainly in babies) the disease is diagnosed by detecting the parasite in the blood. Microscopy and molecular techniques (PCR) are used for this.
• In the chronic phase (when acquired in childhood), the disease is diagnosed by detecting antibodies in the serum. In this phase of the disease, molecular techniques work in cases where the disease has been reactivated or as a marker of the failure of a specific treatment.

Typical treatment

There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.

Prevention

Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.