Pathology of diphtheria (白喉) – patient education and translation

 Figure caption: Diphtheria is caused by the Gram-positive bacillus  Cornebacterium diphtheriae , which releases a toxin that causes severe necrosis of the respiratory mucosa. Primarily affecting the nasopharynx, aggressive necrosis of the ciliated pseudostratified columnar epithelium ulcerates and a dense pseudomembrane forms. Complications arise three-fold: first,  C. diphtheriae   multiplies on the surface of this membrane – diphtheria is highly contagious via exposure from inhalation or physical contract with the infected – coughing is often a symptom, which release airborn secretions of diphtheria. Secondly, as the nasopharynx is highly vascularized, it provides a pathway for the diphtheria toxin to cause further systemic complications such as loss of motor function and heart failure. Lastly, the psudomembrane posesa physical threat, as it can potentially dislodge and cause asphyxiation. Diphtheria should be treated with antitoxin to counter the exotoxin released by   C. diphtheriae  , as well as erythromycin to eliminate the bacteria itself. Preventative measures (immunization) have proven extremely effective.

Figure caption: Diphtheria is caused by the Gram-positive bacillus Cornebacterium diphtheriae, which releases a toxin that causes severe necrosis of the respiratory mucosa. Primarily affecting the nasopharynx, aggressive necrosis of the ciliated pseudostratified columnar epithelium ulcerates and a dense pseudomembrane forms. Complications arise three-fold: first, C. diphtheriae multiplies on the surface of this membrane – diphtheria is highly contagious via exposure from inhalation or physical contract with the infected – coughing is often a symptom, which release airborn secretions of diphtheria. Secondly, as the nasopharynx is highly vascularized, it provides a pathway for the diphtheria toxin to cause further systemic complications such as loss of motor function and heart failure. Lastly, the psudomembrane posesa physical threat, as it can potentially dislodge and cause asphyxiation. Diphtheria should be treated with antitoxin to counter the exotoxin released by C. diphtheriae, as well as erythromycin to eliminate the bacteria itself. Preventative measures (immunization) have proven extremely effective.

DESCRIPTION:

The objective of this project is to visualize the pathology of diphtheria. While immunization has proven extremely effective against diphtheria in industrialized (Western) countries, this illustration is intended for an audience in areas where endemic diphtheria has not been eradicated and the Tetanus and Diphtheria (Td) vaccine is not readily available. The illustration aims to increase awareness of a preventable disease.

Obstacles include lack of medical knowledge, quarantine procedures, and foremost, English literacy. A brief description introduces the viewer to the infection and how its distinct pseudomembrane forms. Two illustration styles create a visual distinction that implies a change in magnification – from overview to molecular progression. Children under five have a higher fatality risk (~20%), so including a 'quick checklist' helps identify characteristic symptoms. The work is intended as a full-colour printed poster, with additional versions translated in English, Chinese, Malay, and Korean. As a result, additional considerations due to translations – such as layout (due to reading language flow) – need to be addressed.

AWARDS:

Award of Merit 2015, Association of Medical Illustrators | Student Instructional Anatomical/Pathological

Technical:

Adobe Photoshop, Illustrator, InDesign

Audience:

Lay audience – non-English primary language

Supervisors (Scientific):

Dr. J Wong

SUPERVISORS (TECHNICAL):

Dr. S Wall

 


PROCESS WORK:

1. Tissue cube study of respiratory mucosa – showing three cubes visualizing the necrosis of the ciliated pseudostratified columnar epithelium. The necrosis and dead cells transforms and creates the pseudomembrane.
2. Landscape study – a different way of visualizing the same epithelial layer, also featuring the exposed capillary bed due to epithelium necrosis.