Diphtheria is an acute infectious disease characterized by common intoxication and the formation of fibrinous films or raids on the mucous membranes of the throat, nose, larynx and skin.
The causative agent of diphtheria is the diphtheria bacillus (Figure 1). Very closely related to the diphtheria bacillus by morphological features are pseudodipteria bacilli, Hofmann's sticks, conventionally grouped together, diphtheria. Dipteroids are distributed on the body surface, on the mucous membranes of the nasopharynx, respiratory tract, eyes. Most microorganisms belonging to the diphtheria group are non-pathogenic to humans.
The source of infection is a patient with diphtheria or a healthy carrier. Infection is transmitted by airborne droplets. In view of the persistence of the pathogen, infection can occur through various objects. The patient becomes contagious already in the last days of the incubation period and continues to be during the whole period of the illness, and sometimes even longer. An increase in the number of cases of diphtheria is observed in the autumn-winter period. At the site of diphtheria, a foci of fibrinous inflammation arises, from which the toxin is released into the body. The process involves nearby lymph nodes, which increase in size. There is swelling of the surrounding subcutaneous tissue.The
The most susceptible children aged 1 to 7 years. Children of the first months of life have passive antitoxic immunity , which is transmitted through the placenta and is supported in part by breast-feeding.
Diphtheria susceptibility can be detected by the Schick reaction (intradermal administration of a specially prepared diluted diphtheria toxin in an amount of 0.1 ml containing 1/40 dose, deadly to guinea pig). The appearance of reddening and infiltration of the skin with a diameter of at least 1 cm (positive reaction) indicates susceptibility. After the transferred diphtheria, specific immunity is acquired, but its resistance is less than with other childhood infections.
The incubation period is 2-10 days. Depending on the entrance gate infection there is a wide variety of clinical forms of the disease. The most common form is the pharyngeal diphtheria, which is localized (Figure 13), widespread and toxic (Figure 14). The localized form is characterized by a slight increase in body temperature, little expressed intoxication. Tonsils enlarged, often hyperemic. Soreness when swallowed is small or absent. By the end of the first or on the second day a typical dirty-gray filmy coating is formed. The film is removed with difficulty, in its place the mucous membrane is bleeding.
With the widespread form of diphtheria, intoxication is more pronounced, the temperature is higher, the raids are more dense. They not only lining the surface of the tonsils, but also pass to the mucous membrane of palatine arches, tongue and pharyngeal wall.The
The early manifestations of the toxic form of diphtheria are high fever (up to 40 ° C), headache, chills, vomiting , abdominal pain, inconspicuous cobweblike or gelatinous small raids. The next day the raids are compacted and rapidly spread, there is swelling of the mucous membrane of the throat and subcutaneous fat of the neck. At an intoxication of I degree the edema extends up to the first cervical fold, II degree - up to a clavicle, III degree - below a clavicle. Characteristic sugary sweetish smell from the mouth and compressed, sometimes snoring breath. Speech is vague with a nasal hue. Other manifestations of intoxication are also growing - defeat of the heart, kidneys, paralysis.
The causative agent is Lefler's wand. Infection is transmitted from a patient or a carrier by a drip. The incubation period is 3-7 days.
There are diphtheria of the nose, pharynx, larynx.
Diphtheria of the nose most often occurs in infancy. Distinguish catarrhal and pleated forms. The catarrhal form is characterized by the appearance of a prickly discharge from the nose, nasal congestion. Sometimes there are cracks on the wings of the nose. The temperature is subfebrile.
The membranous shape of the diphtheria of the nose is characterized by the appearance of inflammation in the anterior sections of the nose with plaques.
Diphtheria of the pharynx is characterized by the appearance of a grayish-white coating on the tonsils, which turns into arches, the vitreous edema of the tongue and the soft palate. The plaque appears frequently on the first day of the disease, it is difficult to remove, leaving at the same time droplets of blood. Cervical and submandibular glands swell. The temperature can be elevated or subfebrile, even normal. Pain in swallowing is weak at first.
With diphtheria of the larynx, there is difficulty breathing, the voice becomes hoarse, barking cough (diptheria croup) appears, films on the mucous membrane of the larynx in the lumen of the glottis.
Diagnostics. Recognition is performed on the basis of typical symptoms (diphtheria raid, swelling of regional lymph nodes) and is confirmed by sowing mucus from the throat, nose and larynx on Lefler's wand. A negative seeding result does not exclude diphtheria in a typical clinical picture.
First aid. Intramuscular injections of antidiphtheria serum from Beside, in mild cases - in doses of 5000-10 000 AE, and in heavy toxic - in doses of 25,000-50,000 AE, with the repetition of this dose in the absence of a noticeable effect after 12-24 hours, cardiac and symptomatic treatment according to indications. If breathing is difficult, ensure strict observation, hospitalization and according to indications - surgical intervention (intubation or tracheotomy).