One of the most serious infectious diseases is diphtheria. What it is is known to many. This disease, which affects both adults and children, is difficult not only to treat, but also to diagnose. Vaccination against diphtheria is required and is included in the vaccination calendar.
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 this and what is the danger of the disease?
With this disease, the mucous membranes of the nasopharynx and oropharynx are affected. In addition, general intoxication develops, the nervous and cardiovascular systems suffer. Inflammation is accompanied by the appearance of fibrin films resembling a white coating. Diphtheria can be benign in nature, without severe intoxication.
The danger is that with this disease, asphyxia of the larynx, respiratory paralysis, toxic myocarditis or acute adrenal insufficiency can develop, which can lead to death. With a disease such as diphtheria, vaccination is the best prevention method that avoids, if not the disease itself, then at least its complications.
Causes
The causative agent of the disease is Leffler's bacillus, which is very resistant to external influences. Under standard conditions, stability lasts for two weeks, in water or milk - three weeks, at low temperatures - about five months. During boiling or treatment with chlorine, the pathogen dies within one minute.
You can get infected by airborne droplets from a person with diphtheria or from a healthy carrier of bacteria. When it gets onto the mucous membranes of the nasopharynx, fulminant reproduction of diphtheria bacillus occurs. In this case, exotoxin is released, which, spreading with a blood stream, provokes damage to the heart muscle, adrenal glands, kidneys and peripheral nervous system. The patient's temperature rises and lasts 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, the relative resistance of diphtheria bacillus to external influences.
Types and course
Depending on the localization, diphtheria of the oropharynx, respiratory organs, and nose occurs. In rare cases, the eyes, genitals, and skin suffer. If several organs are affected at the same time, then this form of the disease is called combined.
The most common form of the disease is oropharyngeal diphtheria (about 95% of cases). At first, the patient's temperature rises slightly, intoxication symptoms increase, aches in the joints and bones occur, headache, weakness appear, the skin turns pale, appetite decreases.
Oropharyngeal diphtheria is localized, widespread and toxic, hypertoxic.
Most often, the disease proceeds in a localized (mild) form. A visual examination at the beginning of the disease reveals a white coating on the tonsils with clear boundaries and a smooth structure, the mucous membrane is bright red. After some time, the coating becomes gray or yellowish gray. It is impossible to remove. If you try to do this with tweezers, a bleeding wound will remain. Pain in the throat occurs when swallowing.
The common form is less common. It is characterized by the fact that not only the tonsils, but also the palatine arches, tongue, pharyngeal walls, swelling and redness are more pronounced, and the soreness is moderate. The plaque disappears after about two weeks.
In the toxic form, there is a rapid increase in temperature to 39.5-41 ° C, the symptoms of intoxication of the body increase, pain in the abdomen, severe headaches, drowsiness, apathy, swollen affected organs, pale skin. On the tongue you can find a white coating. With the development of the disease, a barking cough appears, due to swelling of the larynx, it is difficult for the patient to breathe, voice loss is observed.
The hypertoxic form is characterized by more pronounced symptoms of intoxication. Man is in an unconscious state. If treatment is not started on time, death is possible. The circulatory system is affected, a rash appears on the body, hemorrhages in the mucous membranes, and the gastrointestinal tract.
Diphtheria croup
Diphtheria (true) croup can be localized and widespread. The severity of the disease depends on the degree of respiratory failure.
Symptoms of laryngeal diphtheria develop gradually. In the catarrhal period, the patient has a hoarse voice, a barking cough, the temperature rises slightly. 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 is tormented by spasmodic coughing attacks, which lasts from 2 to 30 minutes. In this case, the face becomes cyanotic, pallor of the nasolabial triangle, increased sweating are noted.
After this comes the asphyxiation period, which is characterized by drowsiness, apathy, pallor of the skin, convulsions, low blood pressure. If the patient does not receive medical attention on time, death will occur.
This form of diphtheria affects small children, the elderly and people with weak immunity, which is caused by alcohol abuse, malnutrition.
Diphtheria of the nose
This form of the disease is not so difficult. It is characterized by the appearance of a purulent runny nose, the nasal mucosa is covered with sores, plaque, the face swells in the cheeks and eyes. The temperature is either within normal limits or slightly elevated, there is no intoxication. The area around the nose is irritated, weeping and crusts appear. In the case of a toxic form of the disease, the subcutaneous tissue of the cheeks and neck swells.
Diphtheria eye
This form of the disease can be confused with conventional conjunctivitis. The disease is characterized by moderate hyperemia and edema of the conjunctiva of the eyelid. With a catarrhal form, slight serous-purulent discharge is observed. With a film-like form, gray-white films appear on the conjunctiva, which are difficult to remove, the temperature is slightly elevated. The toxic form has an acute onset. The eyelids swell, discharge of a purulent-purulent character is observed. The skin around the eyes is irritated and wet, fiber around the orbit swells.
Diphtheria of the skin, genitals, ear
Such forms of diphtheria are rare and most often develop in a complex with other types of this disease. All these options have common manifestations for this disease: edema, redness of the skin and mucous membranes, fibrinous plaque on the affected area, inflamed and painful regional lymph nodes.
With diphtheria of the male genital organs, the pathological process is concentrated in the foreskin. In women, it can spread to the perineum, anus, capture the vagina and labia. In this case, the appearance of serous-bloody discharge is possible. There are difficulties with urination, it becomes painful.
With skin diphtheria, the pathological process develops in the area on which diaper rash, wounds, eczema or fungus are concentrated. A dirty gray coating on the skin and serous-purulent discharge appears. In this case, 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. For treatment to be successful, it is important to determine if this is a sign of diphtheria or a common vessel injury. To do this, you need to pay attention to the condition of the patient and the presence of other symptoms.
Diagnostics
On the basis of a visual examination for the presence of characteristic films, shortness of breath with wheezing noise on inspiration, a barking cough is diagnosed with diphtheria. Diagnosis includes additional research methods that are used to determine specific strains and diagnose atypical forms of the disease.
In such cases, a bacteriological research method is used , which consists in taking a smear for diphtheria from the pharynx from the patient. This method allows you to select the pathogen and study its toxic characteristics.
The serological method is necessary to determine the degree of immunity tension, the detection of antitoxic and antibacterial antibodies.
Using the genetic method, the DNA of the pathogen is examined.
Diphtheria treatment
Regardless of the severity of the disease, diphtheria in adults and children is treated exclusively in a hospital. The patient must adhere to a diet and observe bed rest. In order to neutralize diphtheria exotoxin and stop the intoxication of the body, anti-diphtheria serum (PDS) is administered. The drug should be administered as early as possible, this will avoid the development of complications. It is especially effective within 4 days from the onset of the disease. The drug is used even with suspected infection after contact with a sick person.
In addition, the patient is prescribed a course of antibiotics, due to which the amount of the pathogen is reduced, the symptoms of intoxication are reduced. Usually use Ampicillin, Amoxicillin, Cephalexin, Oxycillin. If necessary, prescribe hormones (prednisone preparations), antihistamines (Diazolin, Suprastin, etc.), antipyretic drugs, vitamins.
In order to prevent stenosis, the ward 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 introduced using 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 it is urgent to take measures to remove the films. For this purpose, use forceps, an electric suction pump. Too severe cases can not do without surgical intervention. The patient is given a breathing tube into the larynx or trachea.
In severe toxic diphtheria, diphtheria croup, toxic shock and other dangerous complications, the patient is hospitalized in intensive care.
Complications
The toxin produced by diphtheria bacillus is immediately absorbed into the bloodstream, causing serious and dangerous complications. They are specific (toxic) and non-specific.
Specific development most often occurs with the toxic form of the disease, although it is possible with other forms. Complications include myocarditis, neuritis, and nephrotic syndrome.
Myocarditis can be early and late. Early may occur at 1-2 weeks of illness. The course is severe, heart failure progresses. Patients experience abdominal pain, vomiting, and pulse quickens. There is systolic murmur in the heart, rhythm disturbances, a sharp decrease in blood pressure. The liver grows and becomes sensitive.
Late myocarditis, which develops at 3-4 weeks, is characterized by a more benign course.
A typical complication of diphtheria is early and late peripheral paralysis. In the second week of the disease, the development of early cranial nerve palsy is possible. The patient becomes a nasal voice, difficulty swallowing, lack of reflex from the soft palate. Sometimes the patient cannot read and does not distinguish between small objects.
After 4-5 weeks, late flaccid paralysis may occur . Tendon reflexes decrease, muscle weakness, impaired coordination are noted.
If the muscles of the neck and torso are affected, a person cannot be in a sitting position, it is difficult for him to hold his head. Perhaps the development of paralysis of the larynx, pharynx, diaphragm. This leads to loss of voice and the appearance of a soundless cough, it is difficult for the patient to swallow, the stomach is pulled in.
In the acute stage of the disease, nephrotic syndrome can develop . In the urine, an increased amount of protein is observed, erythrocytes and leukocytes are higher than normal. In this case, kidney function is not impaired.
Non-specific complications include pneumonia, otitis media, lymphadenitis, etc.
Forecast
The prognosis depends on how severe diphtheria disease is, on the timing of initiation of serum treatment, and also on the development of various complications.
On the second or fifth day of the disease, a fatal outcome can occur mainly with the toxic form of diphtheria. The reason is infectious toxic shock and asphyxiation. Two to three weeks after the onset of the disease, death can occur from severe myocarditis.
Prevention
The disease is better to prevent than to treat, especially as dangerous as diphtheria. What is it, we have already figured out, but how can we protect ourselves? The main preventive measure 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 part of the National Vaccination Calendar. DTP vaccine or others containing diphtheria toxoid are used. Adults need revaccination to maintain immunity against diphtheria.
Should I get a diphtheria vaccine? 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.
Proper prevention of diphtheria allows you to prevent the spread of infection. The patient must immediately isolate and examine people who have contacted him. Identified carriers of corynebacteria diphtheria are also isolated and prescribed the necessary treatment.
In kindergartens and schools quarantine is introduced, the premises in which the patient was located are disinfected. The patient should be in the hospital until complete recovery, which is confirmed by two tests with a negative result.
A person who has suffered a disease develops unstable immunity. Ten years later, he may re-fall ill, but the disease will flow easily.
If the timing of vaccination and revaccination is not respected, the tension of anti-diphtheria immunity decreases, and the prerequisites for the development of the disease are created. In vaccinated, diphtheria proceeds in a mild form, complications are rare.
Non-specific prophylaxis of diphtheria is hardening, moderate physical activity, good nutrition, and staying in the fresh air.