Diphtheria - what is it? Causes, symptoms, prevention

One of the most serious infectious diseases is diphtheria. What is it is known to many. This disease, which affects both adults and children, is difficult not only to treat, but also to diagnose. Vaccination from diphtheria is mandatory and included in the vaccination schedule.

When specific bacteria enter the human body, the rapid development of the disease begins. Diphtheria is acute and requires immediate treatment, otherwise serious complications are possible.

Diphtheria. What is it and how dangerous is the ailment?

This disease affects the mucous membranes of the nasopharynx and oropharynx. In addition, general intoxication develops, the nervous and cardiovascular systems suffer. Inflammation is accompanied by the appearance of fibrin films that resemble a white coating. Diphtheria can have a benign character, without pronounced intoxication.

The danger is that with this disease, laryngeal asphyxia, respiratory tract paralysis, toxic myocarditis or acute adrenal insufficiency may develop, which leads to a lethal outcome. With such a disease as diphtheria, vaccination is the best method of prevention, which allows to avoid if not the disease, then at least its complications.

Causes

The causative agent is Leffler's bacillus, which is very resistant to external influences. In standard conditions, the resistance persists for two weeks, in water or milk - three weeks, at low temperatures - about five months. During the boiling or treatment with chlorine, the causative agent perishes within one minute.

You can get infected by airborne droplets from a person with diphtheria or from a healthy bacterial carrier. When ingested on the mucous membranes of the nasopharynx, lightning multiplication of the diphtheria bacillus takes place. In this case, exotoxin is released, which, spreading with blood flow, provokes damage to the heart muscle, adrenal glands, kidneys and peripheral nervous system. The patient raises the temperature and holds for a long time. Sometimes infection occurs through household items, food.

Susceptibility to the causative agent of the disease is very high. The reason for this is the lack of vaccination, weak immunity, relative resistance of diphtheria bacillus to external influences.

Types and current

Depending on the location, diphtheria of the oropharynx, respiratory organs, nose is found. In rare cases, eyes, genitals, and skin are affected. If several organs are affected simultaneously, then this form of the disease is called combined.

The most common form of the disease is the oropharyngeal diphtheria (about 95% of cases). First, the patient's temperature rises slightly, symptoms of intoxication increase, joint aches and bones arise, headache, weakness, skin pale, appetite decreases.

Diphtheria of the oropharynx is localized, common and toxic, hypertoxic.

Most often the disease occurs in a localized (easy) form. At visual inspection at the beginning of the disease a white coating on tonsils with clear boundaries and smooth structure is found, the mucous membrane of bright red color. After a while, the raid becomes gray or yellowish gray. It can not be removed. If you try to make it with tweezers, there will be a bleeding wound. Pain in the throat is manifested when swallowing.

The common form is less common. It is characterized by the fact that not only the tonsils but also the palatine arches, the tongue, the pharyngeal walls, the swelling and redness are covered not only with pronotal pain, but also with mild tenderness. The raid disappears in about two weeks.

With a toxic form, the temperature rises rapidly to 39.5-41 ° C, the symptoms of intoxication of the body increase, pain in the abdomen, severe headaches, drowsiness, apathy, swollen organs, pale skin. In the language you can find a white coating. With the development of the disease appears barking cough, because of the laryngeal edema the patient is difficult to breathe, there is a loss of voice.

The hypertoxic form is characterized by more pronounced symptoms of intoxication. The person is unconscious. If treatment is not started on time, a fatal outcome is possible. There is a defeat of the circulatory system, there is a rash on the body, hemorrhages in the mucous membranes, the gastrointestinal tract.

Diphtheria croup

Diphtheria (true) cereals can be localized and spread. The severity of the course of the disease depends on the degree of respiratory failure.

Signs of diphtheria of the larynx develop gradually. In the catarrhal period, the patient appears hoarseness of voice, barking cough, the temperature rises a little. After one or two days, the cough becomes stronger, breathing is difficult, a whistling sound is heard during inspiration.

In the second period - stenotic, the patient suffers from spasmodic cough, which lasts from 2 to 30 minutes. In this case, the face becomes cyanotic, the pallor of the nasolabial triangle, increased sweating is noted.

After this comes the asphyxic period, characterized by drowsiness, apathy, skin pallor, convulsions, low blood pressure. If the patient does not provide medical assistance on time, a fatal outcome will occur.

This form of diphtheria is affected by small children, elderly people and people with weak immunity, which is caused by the abuse of alcohol, malnutrition.

Diphtheria of the nose

This form of the disease is not so difficult. It is characterized by the appearance of a purulent rhinitis, the nasal mucosa is covered with sores, bloom, the face swells into the cheeks and eyes. The temperature is either within normal limits, or slightly elevated, intoxication is absent. The area around the nose is irritated, there are wetting and crusts. In the case of a toxic form of the disease, the subcutaneous tissue of the cheeks and neck swells.

Eye Diphtheria

This form of the disease can be confused with the usual conjunctivitis. The disease is characterized by moderate hyperemia and edema of the conjunctiva of the century. With catarrhal form, slight serous-purulent discharge is observed. When the film form on the conjunctiva appear gray-white films that are difficult to remove, the temperature is slightly increased. The toxic form has an acute onset. Eyelids swell, there are secretions of a purulent-purulent character. Sites of skin around the eyes are irritated and damp, cellulose around the orbit swells.

Diphtheria of skin, genital organs, ear

Such forms of diphtheria are rare and often develop in complex with other types of this disease. All these variants have common manifestations for the disease: edema, redness of the skin and mucous membranes, fibrinous plaque on the affected area, inflamed and painful regional lymph nodes.

In diphtheria of male genital organs, the pathological process is concentrated in the foreskin. In women, it can spread to the crotch, anus, grab the vagina and labia. In this case, the appearance of serous-bloody discharge. There are difficulties with urination, it becomes painful.

With diphtheria of the skin, a pathological process develops in an area on which diaper rash, wounds, eczema or fungus are concentrated. There is a dirty gray coating on the skin and serous-purulent discharge. General intoxication is not observed.

Separately, one can distinguish such a form of the disease as hemorrhagic diphtheria. What it is? With this form, bleeding from the affected area is observed. In order for the treatment to be successful, it is important to determine whether this is a sign of diphtheria or a common vessel trauma. For this, it is necessary to pay attention to the condition of the patient and the presence of other symptoms.

Diagnostics

On the basis of a visual inspection of the presence of characteristic films, shortness of breath with a whistling noise on inspiration, barking cough diagnoses "diphtheria". Diagnosis also includes additional research methods that are used to determine specific strains, diagnose atypical forms of the disease.

In such cases, a bacteriological method of investigation is used, which consists in the fact that the patient receives a diphtheria smear from the throat. This method allows to isolate the pathogen and to study its toxic characteristics.

The serological method is necessary to determine the degree of immunity, the detection of antitoxic and antibacterial antibodies.

With the help of a genetic method, the DNA of the pathogen is examined.

Treatment of diphtheria

Regardless of the severity of the disease, diphtheria in adults and children is treated exclusively in a hospital setting. The patient should adhere to the diet and comply with bed rest. In order to neutralize the diphtheria exotoxin and stop the intoxication of the body, antidiphtheria serum (PDS) is administered. The drug should be administered as soon as possible, this will avoid the development of complications. It is especially effective for 4 days from the onset of the disease. The drug is used even if you suspect a contamination after contact with a sick person.

In addition, the patient is prescribed a course of antibiotics, which reduces the number of pathogens, reduces the symptoms of intoxication. Usually they use "Ampicillin", "Amoxicillin", "Cephalexin", "Oxycillin". If necessary, prescribe hormones (drugs prednisolone), antihistamine ("Diazolin", "Suprastin", etc.), antipyretics, vitamins.

To prevent stenosis, the room should be well ventilated, the patient is prescribed a warm drink in the form of tea or milk with soda, steam inhalation. To reduce hypoxia, moistened oxygen is injected with a nasal catheter. If these procedures do not help improve the patient's condition, "Prednisolone" is prescribed.

If the patient has acute respiratory failure, in this case, urgent measures should be taken to remove the films. For this purpose, use forceps, electric pump. Too serious cases do not do without surgery. The patient is given a breathing tube in the larynx or trachea.

With severe toxic diphtheria, diphtheria croup, infectious-toxic shock and other dangerous complications, the patient is hospitalized in resuscitation.

Complications

The toxin that produces the diphtheria bacillus is immediately absorbed into the blood, which causes severe and dangerous complications. They are specific (toxic) and nonspecific.

The development of specific ones occurs most often with a toxic form of the disease, although it is possible in other forms. Complications include myocarditis, neuritis, nephrotic syndrome.

Myocarditis can be early and late. Early can occur on the 1-2 week of the disease. The course is severe, heart failure progresses. Patients experience abdominal pain, vomiting, and a quicker pulse. There is a systolic murmur in the heart, irregular rhythm, a sharp drop in blood pressure. The liver is enlarged and becomes sensitive.

Late myocarditis, which develops at 3-4 weeks, is more benign.

A typical complication of diphtheria is early and late peripheral paralysis. In the second week of the disease, early paralysis of the cranial nerves is possible. The patient becomes a nasal voice, there are difficulties in swallowing, absence of reflex from the soft palate. Sometimes the patient can not read and does not distinguish between small objects.

After 4-5 weeks, late flaccid paralysis may occur. The tendon reflexes decrease, muscle weakness, coordination disorders are noted.

If the muscles of the neck and trunk are affected, a person can not be in a sitting position, it is difficult for him to hold his head. Possible development of paralysis of the larynx, pharynx, diaphragm. This leads to loss of voice and the appearance of a silent cough, the patient is difficult to swallow, the stomach is drawn.

In the acute stage of the disease can develop a nephrotic syndrome. In urine there is an increased amount of protein, above the norm erythrocytes and leukocytes. In this case, the kidney function is not violated.

Nonspecific complications include pneumonia, otitis media, lymphadenitis, and others.

Forecast

The prognosis depends on how hard the diphtheria disease is, on the timing of the onset of serum treatment, and on the development of various complications.

On the second or fifth day of the disease, a lethal outcome can occur mainly in the toxic form of diphtheria. The cause is infectious-toxic shock and asphyxiation. After two or three weeks from the onset of the illness, death can come from severe myocarditis.

Prevention

The disease is better to prevent than treat, especially as dangerous as diphtheria. We have already found out what it is, but how can we protect ourselves? The main measure of prevention is vaccination, which is carried out according to the scheme, starting from the age of 3 months, in three stages. Vaccination against this disease is included in the National Vaccination Schedule. Use the DTP vaccine or other containing diphtheria toxoid. Adults need to be revaccinated to maintain immunity against diphtheria.

Do I need to vaccinate against diphtheria? Of course, vaccination is not a guarantee that you will not get sick, but the disease will proceed easily and without serious complications. Revaccination of adults is carried out every ten years.

Competent prevention of diphtheria allows you to prevent the spread of infection. The patient should immediately isolate and examine people who have been in contact with him. Detected carriers of corynebacteria diphtheria are also isolated and the necessary treatment is prescribed.

In kindergartens and schools, quarantine is introduced, the rooms in which the patient was in disinfection. The patient should be in the hospital until complete recovery, which is confirmed by two analyzes with a negative result.

A person who has suffered a disease develops unstable immunity. After ten years, he may get sick again, but the disease will flow easily.

If the timing of vaccination and revaccination is not met, the intensity of the antidiphtheria immunity decreases, and the prerequisites for the development of the disease are created. In vaccinated diphtheria proceeds in mild form, complications are rare.

Nonspecific prophylaxis of diphtheria is hardening, moderate physical activity, adequate nutrition, staying in the open air.