Diphtheria

Diphtheria - an acute infectious disease with airborne transmission mechanism; characterized croupous or diphtheritic inflammation of the mucous membrane in the gate of infection - in the call, nose, larynx, trachea, rarely in other organs and general intoxication.

Etiology, pathogenesis. Pathogen - toxigenic diphtheria bacillus, gram-positive, stable in the environment. Pathogenic action due to the exotoxin. Non-toxigenic Corynebacterium nonpathogenic. Diphtheria bacillus vegetates on the mucous membranes of the throat and other organs, where a lobar or diftoriticheskoe inflammation with the formation of the films. Exotoxin produced by the causative agent is absorbed into the blood and causes a general intoxication with myocardial damage, peripheral and autonomic nervous system, the kidneys, the adrenal glands.

Symptoms within. The incubation period is from 2 to 10 days. Depending on the localization process are distinguished diphtheria pharynx, nose, throat, eyes, and others.

Diphtheria throat. There are localized, common and toxic diphtheria throat. At the localized form are formed filmy fibrinous raids on the tonsils. Zev moderately hyperemic, pain when swallowing is expressed moderately or weakly, regional lymph nodes are enlarged slightly. Total intoxication is not expressed, the reaction temperature is moderate. A variation of this form is ostrovchataya diphtheria throat, where the raids on the tonsils have the form of small plaques, often located in the gaps. When common form of diphtheria throat fibrinous raids transferred to the mucous membrane of the tongue and palatine arches; intoxication is expressed, the body temperature is high, the more significant and the response of regional lymph nodes. Toxic diphtheria is characterized by a sharp increase in the tonsils, significant swelling of the mucous membrane of the throat and the formation of thick off-white attacks, directed from the tonsils to soft and even hard palate. Regional lymph nodes significantly increased, their surrounding subcutaneous tissue edema. Swelling of the neck subcutaneous tissue reflects the degree of intoxication. When toxic diphtheria I degree swelling extends to the middle of the neck, with the II degree -up clavicle, with III degree-below the collarbone. The general condition of patients with severe, marked a high temperature (39-40 gr. C), weakness, anorexia, and sometimes vomiting and abdominal pain. There is a pronounced disorders of the cardiovascular system. A variation of this form is sub-toxic diphtheria throat, where the symptoms are less pronounced than for toxic diphtheria 1 degree.

Diphtheria larynx (diphtheria, or true, cereals) in recent years is rare, characterized lobar inflammation of the mucous membrane of the larynx and trachea. progressive course of the disease quickly. In the first bluetongue (disfonicheskoy) stage lasts 1-2 days, there is a rise in body temperature, usually moderate, increasing hoarseness, cough, initially "barking", then loses its sonority. In the second (stenotic) growing stage symptoms of stenosis of the upper respiratory tract: noisy breathing, inspiratory pressure of the auxiliary respiratory muscles, inspiratory indrawing of compliant places of the chest. The third (asphyxial) stage manifests a pronounced disorder of gas exchange - cyanosis, loss of pulse at the height of an inspiration. sweating, anxiety. If time x0 provide medical care, the patient dies of asphyxia.

Diphtheria of the nose, conjunctiva, external genitalia lately almost not observed.

Characterized complications, mostly due to toxic diphtheria II and III level, especially at late begun treatment. At an early stage of the disease can increase the symptoms of vascular and cardiac weakness. Myocarditis is detected more often in the 2nd week of the disease and is characterized by impaired myocardial contractility and conduction system. Regression of myocarditis is relatively slow. Myocarditis - one of the causes of death in diphtheria. Mono and polyradiculoneuritis appear sluggish peripheral paresis and paralysis of the soft palate, the main external muscles, limbs, neck and torso. Danger to life are paresis and paralysis of the laryngeal, respiratory intercostal muscles, diaphragm and innervation of the heart failure devices. There may be complications due to secondary bacterial infections (pneumonia, otitis, etc.).

Confirmation of the diagnosis is the selection of gene-methoxy diphtheria sticks. Differentiate need from angina, infectious mononucleosis, "false croup" filmy adenoviral conjunctivitis (eye in diphtheria).

Treatment. The main method of therapy - perhaps the earliest in / m introduction of diphtheria serum in appropriate doses (Table 12.).

In milder forms of diphtheria serum was administered once, in severe intoxication (particularly in toxic forms) - for a number of days. To avoid anaphylactic reactions intracutaneous test performed with diluted (1: 100) serum in the absence of over 20 minutes the reaction is administered 0.1 ml of whole serum and 30 minutes later - the entire treatment dose.

When toxic forms a whole detoxification performed also nonspecific pathogenetic Therapy: Intravenous drip infusion preparations of protein (plasma albumin), and neokompensana, gemodeza combined with 10% glucose solution; introduced prednieolon, kokarboksilaeu vitamins. Bed rest in toxic form of diphtheria, depending on its severity should be observed 3-8 weeks.

When diphtheria croup needed rest and fresh air. Recommended sedatives (phenobarbital, bromides, chlorpromazine - do not induce a deep sleep). Weakened laryngeal stenosis contributes to glucocorticoids. Apply (if tolerated) steam-oxygen inhalation in tents cameras. A good effect can exert suction mucus and respiratory films using electric pumps. Given the incidence of pneumonia in croup (especially in infants), prescribe antibiotics. In severe stenosis (stenosis at the transition of the second stage to the third) have resorted to nasotracheal (orotracheal) intubation or tracheostomy bottom.

When diphtheria bacteria carrying recommend ne-orally tetracycline or erythromycin with a simultaneous appointment of ascorbic acid; treatment duration of 7 days.

Prevention. Active immunization - the basis of a successful fight against diphtheria. Immunization is carried out for all children (including contraindications) adsorbed pertussis-diphtheria-tetanus vaccine (DPT) and diphtheria-tetanus toxoid (Td). Primary vaccination is carried out starting at 3 months of age three times in 0.5 ml of vaccine with an interval of 1.5 months; a booster dose of the same vaccine - 1.5-2 years after the vaccination course. At the age of 6 and 11 years old children only revaccinated against diphtheria and tetanus Td toxoid (a drug with a reduced number of antigens). Patients with diphtheria are subject to compulsory hospitalization. The patient's apartment after his isolation is carried out final disinfection. Convalescents discharged from the hospital provided a negative result of bacteriological research on double toxigenic diphtheria bacilli; in institutions are allowed after prior double bacteriological examination. Bacillicarriers toxigenic diphtheria daddies (children and adults) are allowed to attend detskie institution where all children are vaccinated against diphtheria, 30 days after the establishment of bacteria.