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Diphtheria: symptoms, treatment in children and adults


Today, a disease like diphtheria has become more and more common. This is due to the fact that immunization of the population through mandatory vaccination is low due to the frequent rejection of young mothers. Because of this, it is necessary for everyone to know the symptoms of diphtheria in order to promptly consult a doctor and receive appropriate treatment.

Diphtheria is an acute infectious disease, which mainly affects children and young people. Failure to provide timely medical care can be fatal, mainly due to the suffocation of a person by films formed in the throat.

Such a disease as diphtheria has been known to mankind since ancient times. According to the surviving historical evidence, scientists who lived in the period of antiquity, described the clinic of this pathology in some detail. Among the doctors who studied diphtheria, one of the main places is occupied by Hippocrates and Galen. However, this nosological name of the disease did not receive immediately. Among his interesting synonyms, which currently have only historical significance, the most interesting is the "hangman's noose." The current name of the disease was obtained only in the 19th century, when it became clear to French scientists that suffocation by films is the main cause of death in diphtheria (from the Greek word “diphthera” - a membrane, film).

Causes of diphtheria

The causative agent of diphtheria is a bacterium belonging to the class of corynebacteria that are Gram-positive microorganisms. This microbe was first discovered and described in preparations made from diphtheria films in 1883. However, the pioneer of this type of corynebacteria is Friedrich Löffler, who managed to cultivate this microbe in the laboratory. Somewhat later, two well-known microbiologists A. Yersen and E. Roux identified diphtheria toxin, which made vaccination possible.

The causative agent of diphtheria has the form of "dumbbells" and in the preparation is arranged in pairs in the form of a letter V. Corinebacterium does not form a spore, and therefore quickly dies in the environment. The capsule of this microorganism is also absent.

How does the infection occur?

Human infection occurs by inhalation, airborne droplets. The source of infection is a sick patient or carrier of pathogenic flora, in which the maximum concentration of a microbe is noted in the mucous membranes of the respiratory tract. Of particular danger are persons who carry the disease in asymptomatic form. Also dangerous are those patients who recover from diphtheria. It is believed that the release of bacteria from the mucous membranes of the respiratory tract by the convalescent can last up to 15-22 days after the reduction of (or complete disappearance) of clinical symptoms. Occasionally, infection can occur through contact, through infected household items or dirty hands. In this case, diphtheria of the skin or mucous membranes occurs. Casuistic foodborne infections rarely occur, which are caused by the active colonization of food products such as butter or milk by the diphtheria pathogens.

Who can get diphtheria?

Susceptibility to diphtheria corynebacteria is so high that anyone can become infected with almost 100% probability. After immunization or a previous illness, a person develops a lifelong immunity that prevents re-infection. As for newborns, maternal antibodies reliably protect their bodies during the first six months of life.

It is interesting! Diphtheria refers to those diseases that reflect the level of culture of human society. UN researchers have shown that diphtheria outbreaks occur only in those countries in which people refuse vaccination. With the observance of all the rules of immunization, this disease can be completely overcome.

Mechanisms of disease development

As mentioned above, the causative agent of the described pathology enters the body, overcoming the protective barriers of the mucous membranes (oral cavity, eyes, digestive tract). Further, active reproduction of corynebacteria occurs in the entrance gate region. After that, the pathogenic agent begins to actively produce toxic substances for the body that cause disruption of the work of many organs and tissues. In addition, these toxins cause necrosis of mucosal epithelium cells (necrosis), followed by the formation of a fibrinous film. It is firmly attached to the surrounding tissues in the tonsils, and it is not possible to remove it with a spatula during the examination of the patient. As for the more distant parts of the respiratory tract (trachea and bronchi), here it is not so tightly welded to the underlying tissues, which allows it to separate and plug the lumen of the airways, leading to suffocation.

The part of the toxin that has entered the bloodstream can cause pronounced swelling of the tissues in the chin area. Its degree is an important differential diagnostic character, allowing to distinguish diphtheria from other pathologies.

Symptoms of diphtheria

Diphtheria photo Symptoms of the described pathology differ significantly depending on the path that the pathogen has entered the body. It should also be borne in mind that there are asymptomatic and oligosymptomatic forms of the disease, the signs of which in the early stages are extremely difficult to recognize.

In the classical form of the disease (oropharyngeal diphtheria), which is registered in 90-95% of cases, the person has the following symptoms:

- suddenly the body temperature rises, symptoms of intoxication appear: severe headache, fatigue, weakness. A child is naughty and can refuse to eat;

- due to the toxic effect of corynebacterium toxins on the circulatory system, a generalized spasm of small vessels develops. Clinically, it manifests itself as a pale skin, sometimes with a marble tinge. In addition, an increase in cardiac activity may develop, but blood pressure may drop to critical numbers;

- characterized by severe sore throat. On examination, the tonsils are red, somewhat swollen, and thick, off-white films are found on their surface. If you try to separate them with a spoon or spatula, you will find a bleeding surface under them. However, it is not possible to clean the surface of the tonsils with a simple "mechanical" method, since within 20-24 hours, new films are formed at the place of the removed films. Interestingly, unlike other raids that can be found on the tonsils, diphtheria films have their own characteristics. Even Zemstvo doctors noticed that if they were placed in a tank with water, they would quickly sink;

- lymph nodes, which are located in the submandibular region, significantly increased. If you try to palpate them, the patient will feel severe pain.

In most cases, raids in diphtheria are limited to the tonsils and do not go beyond them. If they are found in other parts of the oral cavity, then they are talking about a common form of the disease, which has a very unfavorable prognosis.

The subtoxic variant of diphtheria differs from the forms of the disease described above. It is characterized by a greater severity of local and general signs of the disease, as well as the appearance of a new symptom - swelling of the subcutaneous fatty tissue of the neck, which can sometimes be one-sided.

Of particular danger is the toxic variant of oropharyngeal diphtheria, which in most cases develops in adults. It may be due to an untreated local version of the disease, and may occur almost immediately after infection. Its manifestations are as follows:

  • very high body temperature (39 0 С and higher), significant chills and sweating;
  • sore throats are extremely pronounced, sometimes they can be arching;
  • disorders of the nervous system are manifested by strong agitation, sometimes by hallucinations, delusional ideas;
  • rarely there is a strong spasm of the respiratory muscles;
  • skin is pink, only with agonal form of the disease can pallor of the face be noted;
  • blood pressure is low, heart rate is high;
  • tonsils and mucous membranes pharynx bright red, sometimes with a purple hue. In severe inflammation of the palatine glands, they may be so swollen that they almost completely close the entrance to the larynx.

Depending on the severity of the chin and neck edema, these stages of toxic form of diphtheria are distinguished:

  • Stage 1: swelling reaches approximately half of the neck;
  • Stage 2: Edema reaches the level of the clavicles;
  • Stage 3: edema descends below the collarbone.

Hypertoxic variant diphtheria is diagnosed relatively infrequently. In most cases, they are affected by persons whose body is weakened by any concomitant pathologies (HIV infection, diabetes, etc.). In terms of its clinical manifestations, it resembles the toxic form of the disease, but in this case, complications of the internal organs, for example, DIC, are characteristic. With untimely medical care, the patient may die as early as 1 day from the onset of the onset of clinical signs.

Diphtheria of the nose belongs to the local variants of the disease. It is characterized by the following clinical signs: the symptoms of intoxication are mild, breathing through the nose is difficult, discharge mucous or bloody. When viewed in the nasal mirror, you can see that there are erosions on the mucous membrane, as well as membranous deposits, which are easily removed. Quite often, this variant of diphtheria is combined with damage to the mucous membrane of the eyes or larynx.

Diphtheria croup is a type of disease described in the works of many classics of Russian literature. Remember, with what dedication Zemstvo doctors sucked fibrinous films from the throats of young children! There are two forms of this pathology:

  • localized Its synonym is laryngeal diphtheria;
  • common. This form is characterized by lesions of areas of fibrinous necrosis of the lower parts of the broncho-pulmonary system.

Diphtheria croup develops according to certain laws. There are three main stages of the disease, which successively replace each other:

  • Dysphonic. Characterized by impaired voices: he becomes hoarse, a rough, hacking cough appears. These symptoms persist in a patient for up to 7 days.
  • Stenotic. The voice becomes barely audible, and the cough is almost silent. The patient's skin is pale, he is restless, rushing about in bed or around the room. Breathing is so difficult that the pliable areas of the chest inhale are drawn in.
  • Asfix. The skin becomes bluish tinge, blood pressure drops to almost zero. Pulse barely detectable. Breathing is frequent, superficial. With the extinction of consciousness may appear convulsions .

Very important is the fact that the described stages of diphtheria croup are most pronounced in children. As for adults, they have the only manifestations of this form of the disease may be “hoarseness” and a hacking cough.

Diphtheria eye is extremely rare. It can manifest itself either by a simple reddening of the mucous membranes, or by the formation of characteristic films.

Diagnosis of diphtheria

In order to establish the presence of a disease such as diphtheria in a patient, the following examination program must be performed:

  • collection of complaints (many of them are listed above), familiarization with the history of the disease;
  • examination of the patient with the mandatory measurement of blood pressure, pulse rate;
  • thermometry;
  • consultation of the ENT doctor with the implementation of laryngoscopy. This research method aims to detect films in the larynx and edema of its mucous membranes;
  • seeding a smear from tonsils on nutrient media. At the same time, in patients with a characteristic clinical picture of the disease, as well as in those who communicated with patients and bacteria carriers, the diagnosis is confirmed even when negative seeding results are obtained;
  • clinical blood test. For diphtheria is characterized by an increase in the number of leukocytes, an increase in ESR, a decrease in the number of platelets.

How to treat diphtheria?

It should be remembered that the conduct of therapeutic measures in case of diphtheria on an outpatient basis is prohibited! All patients are subject to mandatory hospitalization.

The main drug aimed at eliminating the causative agent of infection is anti-diphtheria serum, the mode of administration of which is determined by the age and severity of the patient's condition. Before administering this drug, a skin test must be performed to detect if the patient is allergic. When receiving positive results from the introduction of serum refuse.

The second direction of therapy is detoxification of the body and replenishment of water and electrolyte balance. This leads to a decrease in the concentration of toxins in the blood, improving the activity of the cardiovascular system. Both colloidal and crystalloid solutions are used. If blood pressure is unstable, glucocorticosteroid hormones can be used (for example, prednisone).

With the defeat of the larynx, which threatens edema and subsequent asphyxia, inhalations are performed using vasoconstrictor and antihistamine drugs (suprastin). In addition, intravenous hormones (prednisone, hydrocortisone).

If it is impossible to correct the respiratory disorders therapeutically, the patient is transferred to the intensive care unit, where he is provided with round-the-clock monitoring. If necessary, the patient is connected to the ventilator.

Discharge from the hospital is carried out only on the condition that you get double negative results of seeding mucus from the nose and throat. If positive results are obtained, the patient remains in the hospital even in the absence of any signs of the disease. After discharge, you can immediately start working in an organized team.

In persons who are recognized as bacteria carriers, antibiotic therapy is carried out to rehabilitate the foci of infection. Used drugs such as clindamycin and cephalothin.

Diphtheria prevention

As mentioned above, the main way to prevent this disease is active immunization of the population. To do this, children are given DPT according to the vaccination schedule. As for adults, they are administered every 10 years the vaccine ADS-M.

| September 30, 2014 | | 18,423 | Uncategorized
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Christina Masden: Trey parker wouldnt immigrate because the pedo stuff he loves is banned in every other anglo country. Isnt that right, boogie tillmon parker?

Rora Rora: Can you answer this question for me .. which one is true Considering susceptibility and resistance in diphtheria A.there is no maternal immunity B.inapparent infection give life long immunity C.antitoxic immunity protect aganist systemic disease. D.antitoxic immunity protect aganist local infection. E.toxoid give prolong immunity.

Solomon Kelsie McQueen: As a kid in the Sixties I have known a couple of kids who got diphtheria. I remembered this girl and her family whose house was quarantined because of it. Her little brother who was always sick was complaining about his throat was hurting; he was still attending class until his parents got a doctor to make a house call(yes...they did it back then.) and the next day the lady from the health department of our town was going around our neighborhood warning us to stay away that house and we had to get immunized. That winter four kids got it...one died.

strawberry lemon Duncil: Hi my only baby boy brother died in diphtheria hes only 7 years old he died in october 29 2018😭 Hes my only close in our family