Diphtheria – the acute infectious disease of the bacterial nature which is characterized by development of a fibrinozny inflammation in the field of introduction of the activator (is surprised mainly top airways, a mucous membrane of a rotoglotka). Diphtheria is transmitted in the airborne and air and dust way. The infection can affect a rotoglotka, a throat, a trachea and bronchial tubes, eyes, a nose, skin and genitals. Diagnosis of diphtheria is based on results of a bacteriological research of dab from survey and the laringoskopiya struck mucous or skin, this. When developing myocarditis and neurologic complications consultation of the cardiologist and neurologist is required.
Diphtheria – the acute infectious disease of the bacterial nature which is characterized by development of a fibrinozny inflammation in the field of introduction of the activator (is surprised mainly top airways, a mucous membrane of a rotoglotka).
Characteristic of the activator
Diphtheria is caused by Corynebacterium diphtheriae - the grampolozhitelny motionless bacterium having an appearance of a stick on which ends the grains of a volyutin giving it a type of a mace settle down. The diphtheritic stick is presented by two main biovara and several intermediate options. Pathogenicity of a microorganism consists in allocation of the strong ekzotoksin, on toxicity conceding only tetanic and botulinichesky. The strains of a bacterium which are not producing diphtheritic toxin do not cause a disease.
The activator is steady against influence of the external environment, is capable to remain on objects, in dust up to two months. Well transfers the lowered temperature, perishes when heating to 60 °C 10 minutes later. Ultra-violet radiation and chemical disinfectants (licked, chlorine-containing means, etc.) affect a diphtheritic stick perniciously.
The tank and source of diphtheria is the sick person or the carrier allocating pathogenic strains of a diphtheritic stick. In most cases infection occurs from sick people, the greatest epidemiological value have the erased and atypical clinical forms of a disease. Allocation of the activator in the period of a convalescence can continue 15-20 days, being sometimes extended up to three months.
Diphtheria is transmitted on the aerosol mechanism in mainly airborne or air and dust way. Realization of a contact and household way of infection (is in certain cases possible when using of the polluted household items, ware, transfer through dirty hands). The activator is capable to breed in foodstuff (milk, confectionery), promoting transmission of infection in the alimentary way.
People possess a high natural susceptibility to an infection, after transferring of a disease the anti-toxic immunity which is not interfering a carriage of the activator and not protecting from a repeated infection is formed, but promotes easier current and lack of complications in case of its emergence. Children of the first year of life are protected by the antibodies to diphtheritic toxin transferred from mother transplatsentarno.
Classification of diphtheria
Diphtheria differs depending on localization of defeat and a clinical current on the following forms:
- the diphtheria of a rotoglotka (localized, widespread, subtoxic, toxic and hypertoxical);
- diphtheritic croup (the localized throat croup, a widespread croup at damage of a throat and trachea and the descending croup at distribution on bronchial tubes);
- diphtheria of a nose, genitals, eyes, skin;
- the combined defeat of various bodies.
The localized diphtheria of a rotoglotka can proceed by catarrhal, ostrovchaty and filmy option. Toxic diphtheria is subdivided into the first, second and third severity.
Diphtheria of a rotoglotka develops in most cases of infection with a diphtheritic stick. 70-75% of cases are presented by the localized form. The beginning of a disease – sharp, rises body temperature to febrilny figures (remains less often subfebrilitt), symptoms of moderate intoxication (a headache, the general weakness, appetite loss, a pobledneniye of integuments, increase in pulse rate), a sore throat appear. Fever lasts 2-3 days, by second day a raid on almonds, before fibrinozny, becomes more dense, smooth, gains nacreous gloss. Raids are removed hard, leaving after removal sites bleeding mucous, and the next days the cleared place becomes covered by a fibrin film again.
The localized diphtheria of a rotoglotka is shown in the form of characteristic fibrinozny raids at a third of adults, in other cases raids friable and easily acting, not leaving behind bleeding. Such are also typical diphtheritic raids 5-7 days later since the beginning of a disease. The inflammation of a rotoglotka usually is followed by moderate increase and sensitivity to a palpation of regionarny lymph nodes. The inflammation of almonds and regionarny lymphadenitis can be both unilateral, and bilateral. Lymph nodes are surprised asymmetrically.
The localized diphtheria quite seldom proceeds in catarrhal option. It is in that case noted subfebrilitt, or temperature remains within norm, intoxication is a little expressed, at survey of a rotoglotka hyperaemia mucous and some puffiness of almonds is noticeable. Pain when swallowing moderate. It is the easiest form of diphtheria. The localized diphtheria usually comes to an end with recovery, but in certain cases (without due treatment) can progress in more common forms and promote development of complications. Usually fever passes for 2-3 day, raids on almonds – for 6-8 days.
Widespread diphtheria of a rotoglotka is noted quite seldom, no more than in 3-11% of cases. At such form raids come to light not only on almonds, but also rotoglotka extend on surrounding mucous. At the same time the obshcheintoksikatsionny syndrome, a limfoadenopatiya and fever are more intensive, than at the localized diphtheria. The subtoxic form of diphtheria of a rotoglotka is characterized by intensive pains when swallowing in a throat and area of a neck. At survey of almonds, they have the expressed crimson color with a tsianotichny shade, are covered with raids which are also noted on a uvula and palatal handles. Puffiness of hypodermic cellulose over the condensed painful regionarny lymph nodes is characteristic of this form. Lymphadenitis often unilateral.
Now the toxic form of diphtheria of a rotoglotka is quite widespread, it is frequent (in 20% of cases) developing at adults. The beginning is usually rough, quickly there is a temperature increase of a body to high values, increase of intensive toxicosis, cyanosis of lips, tachycardia, arterial hypotension is noted. Severe pain in a throat and a neck, sometimes – in a stomach takes place. Intoxication promotes violation of the central nervous activity, developing of nausea and vomiting, frustration of mood (euphoria, excitement), consciousnesses, perceptions (hallucinations, nonsense) is possible.
Toxic diphtheria of II and III degrees can promote the intensive hypostasis of a rotoglotka interfering breath. Raids appear quickly enough, extend on walls of a rotoglotka. Films are thickened and grow coarse, raids remain on two and more than a week. Early lymphadenitis, knots painful, dense is noted. Usually process occupies one party. Toxic diphtheria differs in the available painless hypostasis of a neck. The first degree is characterized by the hypostasis which is limited to the middle of a neck, at the second degree it reaches clavicles and at the third - extends further to a breast, to the person, the back surface of a neck and a back. Patients note an unpleasant putrefactive smell from a mouth, change of a timbre of a voice (twang).
The hypertoxical form proceeds most hard, develops usually at the persons having a serious chronic illness (alcoholism, AIDS, diabetes, cirrhosis, etc.). Fever with a tremendous fever reaches critical figures, tachycardia, pulse of small filling, falling of arterial pressure, the expressed pallor in combination with akrotsianozy. At such form of diphtheria the hemorrhagic syndrome can develop, progress infectious and toxic shock with nadpochechnikovy insufficiency. Without due medical care death can come already in the first - second day of a disease.
At the localized diphtheritic croup process is limited to a mucous membrane of a throat, at a common form – the trachea is involved, and at the descending croup – bronchial tubes. Quite often the croup accompanies diphtheria of a rotoglotka. Even more often recently such form of an infection is noted at adults. The disease usually is not followed by considerable all-infectious symptomatology. Distinguish three consecutive stages of a croup: disfonichesky, stenotichesky and stage of asphyxia.
The Disfonichesky stage is characterized by developing of the rough "barking" cough and the progressing voice osiplost. Duration of this stage fluctuates of 1-3 days at children about one week at adults. Then there is an aphonia, cough becomes silent – vocal chords stenozirutsya. This state can last of several o'clock and up to three days. Patients are usually uneasy, at survey note pallor of integuments, noisy breath. In view of difficulty of passing of air retractions of intercostal spaces can be noted during a breath.
The Stenotichesky stage passes into asfiksichesky – difficulty of breath progresses, becomes frequent, arrhythmic up to a full stop as a result of impassability of airways. The long hypoxia breaks work of a brain and conducts by death from suffocation.
It is shown in the form of difficulty of breath through a nose. At catarrhal option of a current – separated from a nose serous and purulent (sometimes – hemorrhagic) character. Body temperature, as a rule, is normal (sometimes subfebrilitt), intoxication is not expressed. Mucous a nose at survey of an izjyazvlen, note the fibrinozny raids which at filmy option are removed like shreds. Skin around nostrils is angry, macerations, crusts can be noted. Most often diphtheria of a nose accompanies diphtheria of a rotoglotka.
Diphtheria of eyes
The catarrhal option is shown in the form of conjunctivitis (mainly unilateral) with moderate serous separated. The general states usually satisfactory, fever is absent. The filmy option differs in formation of a fibrinozny raid on the inflamed conjunctiva, puffiness a century and separated serous and purulent character. Local manifestations are followed subfebrilitety and ill-defined intoxication. The infection can extend to the second eye.
The toxic form is characterized by the sharp beginning, rapid development of the obshcheintoksikatsionny symptomatology and fever which is followed by the expressed hypostasis a century, is purulent - hemorrhagic allocations from an eye, maceration and irritation of surrounding skin. The inflammation extends to the second eye and surrounding fabrics.
Diphtheria of an ear, genitals (anal and genital), skin
These forms of an infection are quite rare and are, as a rule, connected with features of a way of infection. Are most often combined with diphtheria of a rotoglotka or a nose. Are characterized by hypostasis and a giperemirovannost of the struck fabrics, regionarny lymphadenitis and fibrinozny diphtheritic raids. At men diphtheria of genitals usually develops on extreme flesh and around a head, at women – in a vagina, but can easily extend and affect small and big vulvar lips, a crotch and the field of back pass. Diphtheria of female genitals is followed by allocations of hemorrhagic character. At distribution of an inflammation on area of an urethra – the urination causes pain.
Diphtheria of skin develops in places of damage of integrity of integuments (a wound, a graze, an ulceration, bacterial and fungal damages) in case of hit of the activator on them. It is shown in the form of a gray raid on the site of hyperemic edematous skin. The general states is usually satisfactory, but local manifestations can exist long and slowly regress. In certain cases the asymptomatic carriage of a diphtheritic stick is registered, is more often peculiar to persons with chronic inflammations of a cavity of a nose and throat.
Most often and dangerously diphtheria is complicated by infectious and toxic shock, a toxic nefroz, insufficiency of adrenal glands. Defeats are possible from nervous (poliradikulonevropatiya, neuritis) cardiovascular (myocarditis) of systems. Toxic and hypertoxical diphtheria is most dangerous from the point of view of risk of development of lethal complications.
Diagnosis of diphtheria
In blood test a picture of bacterial damage which intensity depends on a diphtheria form. Specific diagnostics is made on the basis of a bacteriological research of dab from mucous membranes of a nose and a rotoglotka, eyes, genitals, skin, etc. Bakposev on nutrient mediums need to be carried out no later than 2-4 hours after a material intake.
Definition of increase of a caption of anti-toxic antibodies has auxiliary value, is made by means of RNGA. Diphtheritic toxin is revealed by means of PTsR. Diagnostics of a diphtheritic croup is made at survey of a throat by means of the laryngoscope (hypostasis, hyperaemia and fibrinozny films in a throat, in a glottis, a trachea is noted). At development of neurologic complications consultation of the neurologist is necessary for the patient with diphtheria. At emergence of symptoms of diphtheritic myocarditis appoint consultation of the cardiologist, the ECG, ultrasonography of heart.
Treatment of diphtheria
Patients with diphtheria are hospitalized in infectious offices, etiologichesky treatment consists in maintaining antidiphtherial anti-toxic serum by the modified Bezredki's method. At a heavy current perhaps intravenous administration of serum.
Complex of therapeutic measures supplement with medicines according to indications, at toxic forms appoint dezintoksikatsionny therapy with use of glucose, cocarboxylase, vitamin C introduction, if necessary - Prednisolonum, in certain cases – a plasma exchange. At threat of asphyxia make an intubation, in cases of impassability of the top airways – a trakheostomiya. At threat of development of a secondary infection antibiotic treatment is appointed.
Forecast and prevention of diphtheria
The forecast of the localized forms of diphtheria of an easy and medium-weight current, and also at timely introduction of anti-toxic serum - is favorable. The heavy current of a toxic form, development of complications, the late beginning of medical actions can aggravate the forecast. Now in view of development of means of the help to patients and to mass immunization of the population diphtheria mortality - no more than 5%.
Specific prevention is performed according to plan to all population. Vaccination of children begins with three-months age, the revaccination is carried out in 9-12 months, 6-7, 11-12 and 16-17 years. Inoculations are carried out by a complex vaccine against diphtheria and tetanus or against whooping cough, diphtheria and tetanus. If necessary make vaccination of adults. The extract of patients is made after recovery and a double negative bacteriological research.