Diphtheria: symptoms, treatment in children and adults
- Causes of diphtheria
- How does the infection occur?
- Who can get diphtheria?
- Mechanisms of disease development
- Symptoms of diphtheria
- Diagnosis of diphtheria
- How to treat diphtheria?
- Prevention of diphtheria
Today, such a disease as diphtheria began to occur more and more often. This is due to the fact that immunization of the population through mandatory vaccination is low because of the frequent refusal of young mothers to conduct it. Because of this, the symptoms of diphtheria need to be known to everyone, in order to call a doctor in a timely manner and receive appropriate treatment.
Diphtheria is called an acute infectious disease, which is overwhelmed mainly by children and young people. If you do not provide timely medical assistance, it can lead to death, mainly due to strangulation of people with films formed in the throat.
Such a disease as diphtheria was known to humanity since ancient times. According to the surviving historical evidence, scientists who lived in antiquity described the clinic of this pathology in sufficient detail. Among the doctors involved in the study of diphtheria, one of the main places is occupied by Hippocrates and Galen. However, this nosological name of the disease was not immediately obtained. Among his interesting synonyms, which currently have only historical significance, the most interesting is the "hangman's loop". The disease got its modern name only in the 19th century, when it became clear to French scientists that the main cause of death in diphtheria is strangulation with films (from the Greek word "diphthera" - membrane, film).
Causes of diphtheria
The causative agent of diphtheria is a bacterium belonging to the class of corynebacteria, which belong to the Gram-positive microorganisms. This microbe was first discovered and described in preparations made from diphtheria films in 1883. However, the discoverer of this type of corynebacterium is Friedrich Loeffler, who managed to cultivate this microbe in the laboratory. A little later, two well-known microbiologists A. Yersen and E. Roux isolated diphtheria toxin, which made it possible to carry out vaccination.
The causative agent of diphtheria is in the form of "dumbell" and in the preparation it is located in pairs in the form of the letter V. The corne-bacterium does not form a spore, and therefore quickly perishes in the environment. The capsule in this microorganism is also absent.
How does the infection occur?
Human infection occurs by inhalation, by airborne droplets. The source of infection is a sick patient or carrier of pathogenic flora, in which the maximum concentration of the microbe is noted in the mucous membranes of the respiratory tract. Particularly dangerous persons are those who suffer the disease in an asymptomatic form. Also those patients who recover from diphtheria are also dangerous. It is believed that the release of convalescent bacteria from the mucous membranes of the respiratory tract can continue until 15-22 days after the reduction (or complete disappearance) of clinical symptoms. Occasionally, infection can occur through contact - through infected objects of everyday life or dirty hands. In this case, diphtheria of the skin or mucous membranes occurs. Casually, foodborne infections that are caused by active colonization by pathogens of food diphtheria, such as oil or milk, rarely occur.
Who can get diphtheria?
The susceptibility to corynebacteria of diphtheria is so high that anyone can become infected with almost 100% probability. After immunization or the transferred disease in a person, life-long immunity is formed, which prevents re-infection. With regard to newborn babies, maternal antibodies reliably protect their body during the first six months of life.
It is interesting! Diphtheria refers to those diseases that reflect the level of culture of human society. Researchers from the United Nations have shown that outbreaks of diphtheria occur only in those countries in which people refuse to vaccinate. Under all immunization rules, this disease can be completely defeated.
Mechanisms of disease development
As already 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 region of the entrance gates. After that, the pathogenic agent begins to actively develop toxic substances for the body, which cause disruption of many organs and tissues. Among other things, these toxins cause necrosis of the epithelial cells of the mucous membranes (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 clog the lumen of the airways, leading to strangulation.
That part of the toxin that has got into the blood can cause a pronounced edema of the tissues in the chin area. Its degree is an important differential diagnostic feature, which makes it possible to distinguish diphtheria from another pathology.
Symptoms of diphtheria
Symptoms of the pathology described differ significantly depending on the pathway that the pathogen has entered the body. It should also be taken into account that there are asymptomatic and low-symptom forms of the disease, the signs of which in the early stages of recognition are extremely difficult.
With the classical form of the disease (diphtheria of the oropharynx), which is recorded in 90-95% of cases, the person has such symptoms:
- suddenly the body temperature rises, symptoms of intoxication appear: severe headache, fatigue, weakness. The child is naughty and may refuse to eat;
- Because of the toxic effect of the toxins of the corynebacteria on the circulatory system, a generalized spasm of small vessels develops. Clinically, this is manifested by the pallor of the skin, sometimes with a marble shade. In addition, there may be an increase in heart activity, but blood pressure may drop to critical numbers;
- characterized by severe pain in the throat. When examined, the tonsils are red, somewhat swollen, dense films of dirty white are found on their surface. If you try to separate them with a spoon or a spatula, a bleeding surface will appear beneath them. However, it is not possible to clean the surface of the tonsils with a simple "mechanical" method, since new ones are formed in the course of 20-24 hours without the site of the removed films. Interestingly, unlike other raids that can be found on tonsils, diphtheria films have their own characteristics. Still zemskie doctors have noticed, that if them to place in a tank with water they quickly will be drowned;
- lymph nodes that are in the submaxillary region, significantly increase. If you try to palpate them, then the patient will feel severe pain.
In most cases, the raids in diphtheria are limited to the area of the tonsils and do not go beyond them. If they are found in other areas of the oral cavity, then talk about a common form of the disease, which has an extremely unfavorable prognosis.
The subtotypic variant of diphtheria differs from the above forms of the disease. It is characterized by greater severity of local and general signs of the disease, as well as the appearance of a new symptom - edema of the subcutaneous fatty tissue of the neck, which can sometimes be one-sided.
Especially dangerous is the toxic variant of the oropharyngeal diphtheria, which in most cases develops in adults. It can be a consequence of an untreated local variant of the disease, but it can occur almost immediately after infection. Its manifestations are as follows:
- Very high body temperature (39 0 C and above), significant chills and sweating;
- Pains in the throat are expressed extremely strongly, sometimes they can have a bursting character;
- Disorders of the nervous system are manifested by intense excitement, sometimes hallucinations, delusions;
- Seldom there is a strong spasm of respiratory musculature;
- The skin is pink, only with the agonal form of the disease can the pallor of the face be noted;
- Arterial pressure decreased, heart rate high;
- Tonsils and mucous membranes of the pharynx of bright red color, sometimes with a purple hue. With pronounced inflammation of the palatine glands, they can be swollen enough to close the entrance to the larynx almost completely.
Depending on the severity of the edema of the chin and neck, these stages of the toxic form of diphtheria are distinguished:
- Stage 1: edema reaches approximately half of the neck;
- Stage 2: edema reaches the level of the clavicles;
- Stage 3: edema descends below the clavicles.
Hypertensive diphtheria is diagnosed relatively infrequently. In most cases, they are ill individuals whose body is weakened by any concomitant pathologies (HIV infection, diabetes, etc.). On clinical manifestations, it resembles the toxic form of the disease, but in this case, complications from internal organs, for example, DIC-syndrome, are characteristic. If untimely medical care is provided, the patient may die as early as 1 day after the onset of clinical signs.
Diphtheria of the nose refers to local variants of the disease. It is characterized by the following clinical signs: symptoms of intoxication are poorly expressed, breathing through the nose is difficult, separable mucous or bloody. When viewed in the nasal mirror, you can see that there are erosions on the mucous membrane, as well as filmy coatings that can be 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 kind of disease described in the works of many classics of Russian literature. Remember, with what selflessness zemskie doctors sucked fibrinous films from the throat of small children! There are two forms of this pathology:
- Localized. Its synonym is diphtheria of the larynx;
- Common. This form is characterized by involvement of fibrinous necrosis of the underlying parts of the broncho-pulmonary system.
Diphtheria cereal develops according to certain patterns. There are three main stages of the disease, which consistently replace each other:
- Dysphonic. Characterized by impaired voice: it becomes hoarse, there is a rough coughing cough. These symptoms persist for up to 7 days.
- Stenotic. The voice becomes barely audible, and the cough - almost soundless. The patient's skin is pale, he is restless, rushes in bed or around the room. Breathing is so difficult that the pliable areas of the chest are inhaled by inhalation.
- Asphyxiating. The skin acquires a cyanotic shade, blood pressure drops almost to zero. Pulse barely felt. Breathing is frequent, superficial. As the consciousness fades, cramps may appear.
Very important is the fact that the described stages of diphtheria croup are most pronounced in children. As for adults, their only manifestations of this form of the disease can be "hoarse voices" and a coughing cough.
Diagnosis of diphtheria
In order to establish the presence of a disease such as diphtheria in a patient, it is necessary to perform the following program of examinations:
- Collection of complaints (many of them are listed above), familiarization with the history of the disease;
- Examination of the patient with mandatory measurement of blood pressure, heart rate;
- Consultation of an ENT doctor with laryngoscopy. This method of investigation is aimed at detecting films in the larynx and edema of its mucous membranes;
- Sowing a smear from the tonsils on nutrient media. At the same time, in patients with a typical clinical picture of the disease, as well as those who communicated with patients and bacterial carriers, the diagnosis is confirmed even when negative results are obtained;
- clinical blood test. 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 holding of therapeutic measures for diphtheria in outpatient settings is prohibited! All patients are subject to mandatory hospitalization in the hospital.
The main medicinal product aimed at eliminating the causative agent of infection is the antidiphtheria serum, the mode of administration of which is determined by the age and severity of the patient's condition. Before entering this medication it is necessary to conduct a skin test that detects the patient's allergy. If positive results are obtained from the introduction of serum, they 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 (eg, prednisolone) can be used.
When the larynx is affected, which threatens with swelling and subsequent asphyxia, inhalations are performed using vasoconstrictive and antihistamines (suprastin). In addition, intravenously injected hormones (prednisolone, hydrocortisone).
If the breathing disorder can not be corrected in a therapeutic way, 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.
An extract from the hospital is made only on condition of receiving double negative results of sowing mucus from the nose and throat. If positive results are obtained, the patient remains in the hospital even if there are no signs of the disease. After discharge, you can immediately start working in an organized team.
Prevention of diphtheria
As already mentioned above, the main way to prevent this disease is active immunization of the population. For this, children are given DTP according to the schedule of vaccinations. As for adults, they are introduced every 10 years with the ADS-M vaccine.
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