DIPHTHERIA

A B B D E F G And K L M N O U R C T Y P X C H W E I

Diphtheria - an acute infectious disease with an airborne pathogen transmission mechanism; characterized by fibrinous inflammation in the oropharynx, respiratory tract, rarely in other organs, toxic lesions of the heart and nervous system. In recent years, on the territory of Russia in connection with incomplete vaccination observed increase in the incidence of diphtheria.

Pathogen - toxigenic diphtheria bacillus (Corynebacterium diphtheriae). The source of infection is the causative agent of diphtheria patient or carrier toxigenic Corynebacterium diphtheria. Germs are transmitted by coughing, sneezing, talking with droplets of saliva, sputum, mucus pathogen into the environment. Infection can occur through a variety of subjects infected patients (eg, linen, dishes, toys). The patient becomes infectious in the last days of the incubation period, and continues to provide it during the entire period of illness before the release of the pathogen.

The clinical picture. The incubation period lasts from 2 to 10 days, frequently 5 days. There are diphtheria oropharynx, respiratory tract, eye, vulva, skin, wounds, ear.

Diphtheria oropharynx is the most common form. It is a localized, widespread and toxic. The localized form is characterized by mild symptoms of intoxication and shows a moderate increase in temperature, a slight health disorder, poor appetite, weakness. The tonsils are enlarged, slightly bloodshot. The soreness when swallowing small or absent. By the end of 1-bedroom or 2 nd day on the tonsils appears grayish white filmy coating with well-rounded edges. The film is difficult to remove, in its place the mucous membrane bleeds. The water does not dissolve plaque and sinks.

When common form of toxicity is more pronounced, the body temperature rises to 38 - 39 ° C, more dense raids. Not only do they cover the surface of the tonsils, but also go to the mucous membrane of the tongue and palatine arches.

When toxic form of acute onset, marked severe pain when swallowing, bright hyperemia throat, high temperature (40 ° C), headache , chills, vomiting , sometimes pain in the stomach. On the tonsils first appear small spider or gelatinous raids. Then the attacks are becoming more dense and quickly spread to the soft and hard palate, there is swelling of the mucous membrane of the throat and subcutaneous tissue of the neck. Prevalence subcutaneous tissue edema corresponds to the severity of intoxication: I degree - swelling extends to the middle of the neck, II degree - to the clavicle, III degree - below the clavicle. Characterized sugary sweet breath and muffled, sometimes snoring breath. Submandibular lymph nodes are enlarged. Slurred speech with a nasal tone. There have been changes in the heart and kidneys, the nervous system is affected. Frequent hemorrhagic manifestations - nosebleeds, bleeding in the skin, blood soaking raids.

Diphtheria airways (diphtheria croup) occurs mainly in children aged 1 to 3 years. The disease begins with a slight increase in body temperature. Characterized by hoarseness, turning into Athos, rough barking cough , effects of stenosis of the upper respiratory tract (noisy breathing with inspiratory indrawing of compliant places of the chest). At laryngoscopy on the mucous membrane of the larynx and trachea found filmy raids. All these symptoms increase gradually over 2 - 3 days without the expressed intoxication. Asthma first brief. Then, stenotic breathing constantly observed; the child becomes restless, marked cyanosis of the lips, face and limbs skin. If this time is not to provide emergency assistance may come blackout, pulse is weakening, blood pressure falls, often occur cramps . When inactive, and delayed treatment of a child may die from asphyxiation.

Diphtheria of the nose. Hard to nasal breathing, there are serous fluid first, then sanies from the nose, excoriating the skin around the nostrils. In the nasal mucosa detected film or surface erosion. This form is rarely accompanied by severe intoxication. Marked tendency to a prolonged duration.

Complications arise primarily from a toxic form of diphtheria and late begun treatment. These include myocarditis , polyneuropathy, paralysis manifested (the soft palate, the eye muscles, the muscles of the limbs and trunk), sensitivity disorders and nephrotic syndrome. Often in severe forms of diphtheria develops pneumonia , usually caused coccal flora.

Diagnosis is based on clinical data and confirm the results of bacteriological examination. Material from the throat and nose, take a sterile cotton swab on the border between the affected area and a healthy mucous membrane, it is better on an empty stomach or 2 hours after a meal. When you select a pathogen determine its toxigenicity.

Treatment is carried out in a hospital. The main therapeutic measures is the introduction of antitoxic diphtheria serum. Serum is administered according to the modified method of Alexandre Besredka: first subcutaneously administered 0.1 ml, 30 min - 0.2 ml and 1 to 1.5 hours - the rest of the dose intramuscularly (into the upper outer quadrant of the buttocks or the front thigh muscles). In severe cases the serum is administered intravenously. Serum was dosed in International Units (ME). The amount of drug depends on the severity of the disease and the period that has elapsed since the start: 10 000-20 000 ME with a localized form of up to 80 000 - 100 000 ME. Usually serum is injected once. When toxic form shown detoxification therapy: intravenous plasma gemodeza combined with a 10% solution of glucose, vitamins, cocarboxylase, corticosteroids. Effective use of plasmapheresis. In diphtheria of the respiratory tract, threatening suffocation, performed tracheal intubation or tracheostomy. Antibiotics are prescribed to children with croup, complicated by pneumonia, otitis media, and others. Caused by other bacterial flora.

Of great importance is well-organized treatment and care. The patient must comply with bed rest. In the early days of acute changes in his throat give digestible liquid and semi-liquid food.

Prevention is defined by the right organization and proper conduct of preventive vaccinations. To detect toxigenic Corynebacterium diphtheria highlighters to single persons are subject to bacteriological examination, re-entering the child care facilities (children's home, boarding school, special institutions for children with CNS disease, sanatorium for children with tuberculous intoxication), children and adults neuropsychiatric hospitals.