DIPHTERIA - an acute infectious disease with an airborne mechanism of transmission of the pathogen; characterized by fibrinous inflammation in the oropharynx, respiratory tract, less commonly in other organs, toxic damage to the heart and nervous system. In recent years, in Russia due to incomplete vaccination, an increase in the incidence of diphtheria has been observed.
The causative agent is toxigenic diphtheria bacillus (Corynebacterium diphtheriae). The source of the pathogen is a patient with diphtheria or a carrier of toxigenic corynebacterium diphtheria. The causative agents of infection are transmitted by coughing, sneezing, talking along with droplets of saliva, sputum, mucus, the pathogen enters the environment. Infection can also occur through various objects infected with the patient (for example, linen, dishes, toys). The patient becomes contagious in the last days of the incubation period and continues to be throughout the entire period of the disease until released from the pathogen.
The clinical picture. The incubation period lasts from 2 to 10 days, usually 5 days. There are diphtheria of the oropharynx, respiratory tract, eyes, external genitalia, skin, wounds, ear.
Oropharyngeal diphtheria is the most common form. It is localized, widespread and toxic. The localized form is characterized by mild symptoms of intoxication and is manifested by a moderate increase in temperature, a slight disturbance in well-being, poor appetite, and weakness. Tonsils enlarged, slightly hyperemic. Soreness when swallowing is slight or absent. Toward the end of the 1st or 2nd day, a grayish-white membranous coating with clearly defined edges appears on the tonsils. The film is removed with difficulty, in its place the mucous membrane bleeds. Plaque does not dissolve in water and sinks.
With a common form, intoxication is more pronounced, body temperature rises to 38 - 39 ° C, plaque is more dense. They not only cover the surface of the tonsils, but also pass to the mucous membrane of the palatine arches and tongue.
In a toxic form, the onset of the disease is acute, severe pain when swallowing, vivid hyperemia of the throat, high fever (up to 40 ° C), headache , chills, vomiting , and sometimes abdominal pain are noted. On the tonsils initially appear a small cobwebby or gelatinous raids. Then the raids become more dense and quickly spread to the soft and hard palate, swelling of the mucous membrane of the throat and subcutaneous tissue of the neck occurs. The prevalence of edema of the subcutaneous tissue corresponds to the severity of intoxication: I degree - edema extends to the middle of the neck, II degree - to the clavicle, III degree - below the clavicle. A sugary sweet breath and choked, sometimes snoring breathing are characteristic. The submandibular lymph nodes are enlarged. Speech is slurred with a nasal tinge. Changes in the heart and kidneys are noted, the nervous system is affected. Hemorrhagic manifestations are frequent - nosebleeds, hemorrhages in the skin, impregnation of bloody blood.
Diphtheria of the respiratory tract (diphtheria croup) occurs mainly in children aged 1 to 3 years. The disease begins with a slight increase in body temperature. The hoarseness of the voice, which turns into aphonia, a rough barking cough , the phenomena of stenosis of the upper respiratory tract (noisy breathing with retraction when inhaling compliant places of the chest) is characteristic. With laryngoscopy, membranous deposits are found on the mucous membrane of the larynx and trachea. All these symptoms increase gradually over a period of 2 to 3 days without pronounced intoxication effects. Attacks of suffocation at first brief. Then stenotic breathing is observed constantly; the child becomes restless, there is cyanosis of the lips, face and limbs. If emergency aid is not provided at this time, dimming of consciousness may occur, the pulse weakens, blood pressure drops, and convulsions often occur. With delayed and inactive therapy, the child may die from asphyxiation.
Diphtheria of the nose. Nasal breathing is difficult, first there are liquid serous, and then bloody-purulent discharge from the nose, corroding the skin near the nostrils. Films or surface erosion are found on the nasal mucosa. This form is rarely accompanied by severe intoxication. A tendency to a protracted course is noted.
Complications arise mainly with the toxic form of diphtheria and late treatment. These include myocarditis , polyneuropathy, manifested by paralysis (soft palate, eye muscles, muscles of the limbs and trunk), sensitivity disorders and nephrotic syndrome. Often with severe forms of diphtheria, pneumonia develops, usually caused by coccal flora.
The diagnosis is established on the basis of clinical data and confirmed by the results of bacteriological studies. Material from the throat and nose is taken with a sterile cotton swab at the border between the affected area and a healthy mucous membrane, preferably on an empty stomach or 2 hours after eating. When the pathogen is isolated, its toxigenicity is determined.
Treatment is carried out in a hospital. The main therapeutic measure is the introduction of antidiphtheria antitoxic serum. Serum is administered according to the modified method of Unlimited: first, 0.1 ml is injected subcutaneously, after 30 minutes - 0.2 ml, and after 1-1.5 hours - the remaining dose intramuscularly (in the upper outer quadrant of the buttock or in the front muscles of the thigh). In severe cases, serum is administered intravenously. Serum is dosed in international units (ME). The amount of drug administered depends on the severity of the disease and the period that has elapsed since its inception: from 10,000 to 20,000 ME in a localized form to 80,000 to 100,000 ME. Typically, serum is administered once. In the toxic form, detoxification therapy is indicated: intravenous administration of plasma, hemodesis in combination with a 10% solution of glucose, vitamins, cocarboxylase, and corticosteroids. The use of plasmapheresis is effective. With respiratory tract diphtheria, threatening suffocation, tracheal intubation or tracheostomy is performed. Antibiotics are prescribed for children with croup complicated by pneumonia, otitis media, etc., due to another bacterial flora.
Properly organized regimen and care are of great importance. The patient must comply with bed rest. In the early days, with acute changes in the throat, he is given digestible liquid and semi-liquid food.
Prevention is determined by the correct organization and the correct conduct of preventive vaccinations. In order to identify the emitters of toxigenic corynebacterium diphtheria, persons newly enrolled in children's institutions (an orphanage, boarding school, special institutions for children with central nervous system damage, sanatoriums for children with tuberculosis intoxication), children's and adult neuropsychiatric hospitals are subject to a single bacteriological examination.