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Diphtheria: symptoms, treatment, prevention and causes of the disease

All mothers are well aware: babies from 3 months of age are vaccinated against diphtheria. Vaccination, including diphtheria-tetanus toxoid and anti-slush vaccine, is one of the most severe. Is vaccination necessary? Everyone will answer this question in the affirmative if they know what diphtheria is, its symptoms and causes of the disease, prevention and treatment.

Content

Diphtheria: what is it?

Diphtheria (diphtheria) is an acute infectious pathology that in 90-95% of cases affects the oropharynx with the formation of dense fibrinous films on the tonsils. Diphtheria damage to the eyes, skin, genital tract is much less common.

Considered previously a childhood infection, diphtheria has recently been increasingly registered in adolescents and adults. At the same time, severe complications of the disease are increasingly registered.

Diphtheria, photo throat

Diphtheria, photo throat

In ancient times, the disease was called a malignant sore throat, a fatal ulcer of the pharynx, a hangman’s noose. These frightening names accurately described the deadly risk of diphtheria infection in the absence of anti-diphtheria serum and antibiotics.

In the development of the disease the danger is not the pathogen itself, but the potent exotoxin secreted by it. In toxicity, it is inferior only to waste products of pathogens of botulism and tetanus. Thus, the component of diphtheria toxin, hyaluronidase, increases the permeability of the capillary wall and provokes the formation of fibrinogen in the tissues surrounding the site of infection.

Then the necrotoxin that regenerates fibrinogen into fibrin is included in the pathological process. At the same time, on the surface of the site of infection, fibrin films are formed, tightly welded to the surrounding tissues.

And the last, the most dangerous component - actually diphtheria toxin, whose action is aimed at small vessels, myocardium and nerve cells. It is precisely its action that is most responsible for the most severe intoxication and complications in diphtheria.

Causes of diphtheria

Diphtheria is a contagious disease that is transmitted from a person (patient or carrier) to person. Infection with diphtheria from animals is excluded.

The disease occurs during infection with Bacillus Leffler - a gram-positive bacterium of the genus Corynebacterium. During the life of the bacillus can lose the ability to synthesize the toxin, forming non-toxigenic strains.

Infection can be infected by airborne droplets. The danger is presented by patients with diphtheria (the harder the disease is, the more infectious agent the patient releases to the environment), and carriers who do not have external symptoms of infection.

Less commonly, infection occurs through contact (with eye / skin damage) through objects that have been used by a sick person and through contaminated dairy products.

Symptoms of diphtheria by type of disease

Symptoms of diphtheria

The incubation period for diphtheria is 2-10 days. According to the localization of the lesion there are several forms of diphtheria, each of which has distinctive features in the clinical picture.

Oropharyngeal diphtheria is the most common type of lesion with the formation of an inflammatory focus in the oral cavity (tonsils) and pharynx. External manifestations diagnose the following forms of oropharyngeal diphtheria:

Localized diphtheria

It begins with an increase, hyperemia and edema of the tonsils, mild sore throat and temperature rise to 38-39 ° C. The initial picture of catarrhal diphtheria resembles a sore throat, but initially the intoxication is less pronounced. Diphtheria is distinguished from banal tonsillitis by a whistling noise heard on the inhale, a barking cough and problematic breathing.

With the rapid development of the disease in the gaps of the tonsils, fibrinous islets are formed, while the cervical lymph nodes (mobile, practically painless) increase, swelling of the pharyngeal mucosa increases. Swallowing is difficult, although the pain is less intense than with angina.

Quite quickly, the insular form turns into a membranous form - a dense deposit of often white or gray color forms on the tonsils. Removal of diphtheria film with a spatula is difficult, ends with bleeding of the tonsils.

Common diphtheria

Diphtheria plaque spreads over the tonsils, grasping the tongue and the arms. At the same time, intoxication increases, severe weakness, pallor of the skin, headache appear, pain in the throat increases. Also become sensitive cervical lymph nodes, reaching the size of a large bean.

Toxic diphtheria

From the very first hours this form of diphtheria manifests itself extremely violently. There is hyperthermia up to 40 ° C, sore throat and neck. In the throat, on the background of puffiness and hyperemia, a gelatinous cobweb forms in the form of a cobweb, which by 3 days becomes dense, acquires a dirty gray color and completely covers the soft / hard palate, tonsils, bow and tongue.

In toxic diphtheria, the appearance of sukrovichny transparent discharge from the nose is possible, and fibrinous films are often formed on its mucous membrane. Nasal breathing is difficult, nasalness appears in the voice, and a sugary-sweet smell appears from the mouth.

Against the background of visually defined edema of the neck, all groups of lymph nodes increase, forming a painful elastic conglomerate. The development of swelling of the neck distinguish toxic diphtheria:

  • Grade I - swelling spreads to the middle of the neck;
  • Grade II - puffiness reaches the clavicle;
  • Grade III - swelling captures the area below the clavicle.

More pronounced and intoxication symptoms. Severe toxic effects provoke extreme weakness and drowsiness from the very first hours of the disease. High fever and severe intoxication in children with diphtheria cause repeated vomiting, abdominal pain.

Hypertoxic Diphtheria (diphtheria croup)

The most severe form of diphtheria lesion, in which the symptoms of intoxication come to the forefront of the clinical picture. Significant swelling in the throat and large-scale film plaque are accompanied by critical hyperthermia, cyanosis, irregular heartbeat, convulsions and loss of consciousness.

The inflammatory process extends to the larynx, trachea and bronchial tree. At the same time, all the symptoms of diphtheria develop rapidly, and a marked impairment of cardiovascular activity often leads to a fatal outcome of 2-3 days of illness.

This variant of the course of the disease is often observed in case of immunodeficiency and the general weakness of the human body, and it requires the immediate administration of anti-diphtheria serum.

Hemorrhagic diphtheria

It is characterized by multiple hemorrhages (hemorrhages) small in the form of a rash and extensive. Dense bloom due to blood soaking becomes brown. Possible development of bleeding gums, nasal and gastrointestinal bleeding.

Diphtheria other localization

Less commonly diagnosed forms of diphtheria infection occur with less severe symptoms, but no less dangerous in terms of toxic effects. There are the following types of the disease:

  • Diphtheria of the nose - against the background of the absence of intoxication from the nome, serous, bloody mucus with an admixture of pus expires, and the nasal passages are covered with a filmy coating. The wings of the nose, chin, forehead and cheeks are covered with small moist erosions, gradually drying up with the formation of crusts. The localized form is not accompanied by an increase in temperature. With the development of the toxic form and the spread of the disease to the nasal sinuses, pronounced swelling appears on the cheeks and neck.
  • Diphtheria of the eye - the catarrhal form is difficult to distinguish from ordinary conjunctivitis, and when the membranous form is observed, marked conjunctival edema and hard-to-remove whitish-gray films are observed. The toxic form of the disease gives swelling of the entire eye tissue.
  • Diphtheria of the skin - on a hyperemic background, long non-healing ulcers with a dirty-gray bottom are formed, surrounded by a dense infiltrative roller.
  • Diphtheria of the genital organs - characterized by blood flow, painful urination and an increase in the inguinal lymph nodes.

Diagnosis of diphtheria: necessary analyzes

Not always according to the clinical picture (especially in the case of catarrhal diphtheria), an accurate diagnosis can be made. Confirmation of the type of infection is carried out according to the following analyzes:

  • general clinical blood test - gives signs of inflammation, but does not indicate the pathogen;
  • plaque bacterioscopy - identifies Corynebacterium diphteriae of a characteristic type: paired bacterial sticks, located in the letter V, with bulbous thickening at the ends;
  • bacteriological seeding - cultivates colonies of microorganisms, but the study takes time (for the purpose of treatment, do not wait for the response of seeding);
  • serology - detection of specific antibodies in the blood serum (method of phagal antigen, enzyme immunoassay, etc.).

All people who came in contact with the patient are subject to examination for the prevention and subsequent treatment of diphtheria in the detection of bacteriocarrier.

Diphtheria treatment

Diphtheria treatment

The earlier diphtheria is detected and treatment is started, the lower the risk of developing complications: paralysis of the respiratory tract, arms and legs, asphyxia, myocarditis. Treatment is carried out only in the hospital, the patient is placed in a separate box.

Medical complex includes:

  • Anti-diphtheria serum for the inactivation of the toxin - the dose, in / m or / in the method of administration is chosen depending on the severity of the patient's condition.
  • Gargling with antiseptics - soda, decoction of chamomile, eucalyptus.
  • Antibiotics - penicillins, cephalosporins, tetracyclines for 5-7 days.
  • In / in detoxification - Reopoliglyukin, plasma.
  • Symptomatic therapy - antihistamine, Vit. C and group B, with respiratory stenosis - Eufillin, Prednisolone.
  • Plasmapheresis, hemosorption - appropriate in toxic form.
  • Resuscitation - with the development of infectious-toxic shock.

Diphtheria prevention

diphtheria vaccine photo

diphtheria vaccine photo

  1. Vaccination of children according to the age schedule with DTP, Pentaxim, ADS-M vaccines (the temperature after diphtheria vaccination is acceptable for 2-3 days).
  2. Vaccination of health workers, employees of schools, catering enterprises.
  3. Identification of a bacteriocarrier by means of clinical examination.
  4. Inpatient treatment of carriers of toxigenic strains of diphtheria bacillus.
  5. Disinfection at the site of infection.
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