A characteristic symptom of diphtheria is. Diphtheria: symptoms, diagnosis, causes, treatment, vaccination

RCRZ (Republican Center for Health Development MD RK)
Version: Clinical Protocols MH RK - 2017

Diphtheria (A36), Diphthery Uncomfortable (A36.9)

Short description

Approved
Joint Commission for Medical Services
Ministry of Health of the Republic of Kazakhstan
from "12" May 2017
Protocol №22.

Diphteria (Diphtheria) - acute anthroponous infectious disease with an aerosol mechanism for transmitting the pathogen, characterized by the preemptive damage to the rotogling and respiratory tract with the development of fibrinous inflammation at the site of the deployment of the pathogen and the toxic damage of the cardiovascular system, the nervous system and the kidneys.

Input part

Code (s) μb-10:

Protocol development date:2017 year.

Abbreviations used in the protocol:

Classification

Classification

On the localization of the process:
· Diphthery of the rotogling (zea);
- Localized (islets, film);
- Common;
- toxic (suboxy, toxic I, II, III degree, hypecoxic);
· Respiratory diffraction:
- larynx diphtheria (diphtheria, localized diphtheria);
- diphtheria debris widespread (diphtheria laryngotracycondi);
· Nose diftere;
· Eye difftheria;
· Genital difftheria;
· Skin difftheria;
· Combined diphtheria form.

By severity:
· Light;
· Medium-haired;
· Heavy.

Diagnostics

Methods, approaches and diagnostic procedures

Diagnostic criteria:

Complaints and history:
Non-toxic forms of diphtheria Rotoglots begin with moderately pronounced symptoms of intoxication:
· Fucking;
· Income temperature (up to 38-39 ° C for 2-4 days);
· Throat pain, mostly when swallowing;
· headache;
· Skin palls.

L.okalized rotogloty diffraction - fibrinous raids do not go beyond the limits of the sky almonds:
in the islet form In the Rothoglotka marks:
· Increase, swelling of almonds and skydly
· Non-soldering hyperemia with a cyanotic tint;
· The formation of fibrinous traffic in the depth of crypt and on the convex surface of the almonds;
· Edema prevails over infiltration, leading to a uniform spherical increase in the almonds, the smoothing of their surface structure.
with a film form :
· Initially, the raids have the form of a translucent pink film;
· Then impregnated with fibrin;
· By the end of the first, the beginning of the second day becomes fibrinous films with a smooth surface of white-gray and pearlescent glitter;
· Subsequently, a thick film is formed, dense, more often solid, difficult to remove;
· With violent rejection under the film on the surface of the almonds, bleeding erosions are visible;
· The film lowered into water does not dissolve, sinks and does not lose its shape, it does not rub on the glass;
· The duration of the raids is 6-8 days;
· Rangeryless (angular, tonsillarous) lymphatic nodes increase to 1-2 cm, low-elastic or painless, elastic.

Specific inflammation outside the tonsils in the tongue, the soft heaven, the oral mucosa, intracanalicularly in the larynx, the nasal cavity is more pronounced:
· Eveniness, hyperemia of almonds, skydly mead;
· Increase in regional lymph nodes;
· Pain sensations;
· Cars favorable;
· 12.5% \u200b\u200bThe development of complications in the form of non-heavy polyneuropathies.

Difteria Gortani. - gradual start;
· Subfebrile temperature with a weakly pronounced general intoxication;
· Lack of catarrhal phenomena.

Three stages of cereals with diphtheria of the larynx:
1. The stage of catarrhal (body cough) - Sharp, loud cough, which soon became rough, barking, and then loses the sound, is done with husky.
2. Stage of stenosis (Stenotic) - Aphony, silent cough, the lengthening of the breath, the respiration is noisy with the attraction of the supple places of the chest, psychomotor excitation, increasing hypoxia.
3. Asphisical Stage - The tone of the respiratory center falls, drowsiness, adamius appears. Breathing is rapid, but superficially, the limb is cold, the pulse is frequent, thread, sometimes paradoxical. The fatal outcome occurs as a result of the depletion of respiratory centers and circulatory disorders.

Toxic form of rotogling diphtheria - The acute development of symptoms:
· Increase temperature up to 39-40 ° C;
· headache;
· Chills;
· Pronounced general weakness;
· Anorexia;
· Pallor of skin cover;
· Repeated vomiting;
· abdominal pain;
· Periods of excitation are replaced by progressive adamisses;
· Early spread of raids beyond almonds;
· The appearance of an unpleasant shower-sweet smell of mouth;
· Regional lymph nodes are significantly increased and painful.

For suboxic acid rotogling diphtheria:
· The raids are limited to almonds or distributed to the tongue, the soft sky, the rear wall of the pharynx;
· Effect of soft tissues of the o'clock
· The edema of cervical fiber is unilateral, slightly distributed, mainly in the field of lymph nodes.

For toxic rotogloty diphtheria It is characterized by swelling of the subcutaneous fiber of the neck, test consistency, appears on 2 - 3 days of the disease, spreads down down, then on the face, head and spin, skin color over the edema is not changed:
· Edema to the middle of the neck - toxic form 1 degree;
· The spread of edema to the clavicle - 2 degrees;
· Below the clavicle is a toxic form of 3 degrees.

Nose Diphthery Characterized by the difficulty of nasal respiration:
· The appearance of mucous, serous-mucous, succulent discharges from the nose;
· Irritation of the wings of the nose and the skin of the upper lip;
· On the nasal mucosa Typical diphtheritic films, sometimes erosion;
· Film raids can spread to the sinks and bottom of the nose;
· The well-being is disturbed slightly;
· No intoxication;
· Body temperature is normal or subfebrile;
· Convenience of nasal strokes and a sucrie disconnected from the nose for 2 to 3 weeks.

Difteria eye It may be localized (with the lesion of only the mucous age), common (with the defeat of the eyeball) and toxic (with an edema of subcutaneous fiber around the eyes):
· Ivea swell, become dense to the touch, open up with difficulty;
· The separated serous-bleeding, firstly scarce, then abundant, after 3-5 days - purulent;
· On the junction shell of the eyelid, dirty gray, tightly sitting raids, swelling is sharply expressed;
· The temperature rises;
· The patient's well-being is broken;
· Moderately expressed symptoms of intoxication;
· In cases of cases, a horn shell is affected, which leads to violation of vision.

Skin difftheria It is more common in children of the first year of life, it is localized in the skin folds - on the neck, in the inguinal folds, armpits, behind the ear shell.

Diphtheria external genital organs It is found predominantly in girls of preschool and school age.

Typical Localized Film Form - Hyperemia with a cyanotic tint, fibrinous films, an increase in the inguinal lymph nodes.
Common form - The inflammatory process goes into the crotch, the skin around the anus.
Toxic form - swelling of the germ lip (1st degree), subcutaneous fiber of inguinal areas, pubis and hips (2 -3-th degree).

Physical examination:

Localized forms:
rotoglot Diphthery:
· Neurry hyperemia of the mucous membrane;
· Moderate edema of the tonsils and skydie;
· Film raids on almonds;
· Moderately enlarged and weakly painful regional lymph nodes;
· The raids are uniformly fibrinous, at the beginning of the formation;
· Loose web-like either jelly-like (transparent or turbulent);
· Easily removed;
· The shaped raids are dense;
· Removed with difficulty and bleeding.
nasophop difftheria:
· Increased rear lymph nodes;
· Detection of fibrinous raids at rear rososcopy.
nose Diffiter:
· SUCH DISCLOSITIONS, more often one-sided;
· Catarist-ulcerative inflammation or fibrinous films originally appearing on the nasal partition.
eye difftheria:
· Sharp edema of the age;
· Abundant mucinous-purulent discharge;
· Hyperemia conjunctiva;
· Film at the conjunctival of one or both century.
difteria Genitalia:
· Catarist-ulcerative or fibrinous necrotic urethritis or vulvit.

Common forms:
rotoglot Diphthery:
· Hays extend to pacifices, tongue, lower sections of the soft sky, side and rear walls of the pharynx;
· Regional lymphadenitis moderate;
· Toxic edema of the mucous membranes of the rotogling and subcutaneous fiber of the neck is not.
nose Diffiter:
· Proliferation of raids in the apparent sinuses of the nose.
eye difftheria:
· Keratoconjunctivitis.
difteria Genitalia:
· Naves outside the vulva and penis head.

Toxic forms:
rotoglotka difftheria :
· Toxic enemy of mucous oxides with maximum propagation on a solid sky and in the altarlotch;
· The color of the mucous membranes is from bright hyperemia to a sharp pallor, with cyanosis and a yellowish tinge;
· An extensive or limited hemorrhagic immigibization is possible, fibrinous taxes are first formed on almonds, then at the places of toxic edema outside them, with III degree and hypecoxic - with hemorrhagic impregnation;
· Tononic lymph nodes are increased, painful and dense;
· Increase temperature up to 39-40 0 s;
· Pallor;
· With toxic III degree and hypertoxic - delicious excitation with hyperemia.

Table 1. Criteria for determining the case of diphtheria [3 ].

Differential diagnosis

Differential diagnosis and substantiation of additional research [3 ]

Table 2.Differential diagnosis of localized rotogling diphtheria

Treatment abroad

Treat treatment in Korea, Israel, Germany, USA

Get advice on medical examination

Treatment

Preparations (active substances) used in the treatment

Treatment (ambulatory)

Tactics of treatment on an outpatient level:
· In the outpatient conditions, the treatment of diphtheria is not carried out;
· Assistance to emergency testimony depending on the prevailing disease syndrome, followed by transportation and hospitalization of the patient to an infectious hospital.

Non-drug treatment: not.

Medical treatment: not.

Surgery: not.

Further maintenance:
Monitoring the patient's condition is carried out by the physicians of the CII / general practitioners by dispensarization.

Dispensary observation of reconversion:
· Reconvalues \u200b\u200bof diphtheria and carriers of toxic corinbacterium diphtheria are subject to observation within 3 months after discharge from the hospital;
· The primary inspection of the reconvaluezent is carried out by a district doctor or KIZ physician together with the otolaryngologist and the cardiorevmatologist. Monthly inspection and bacteriological examination on diphtheria, urine and blood test, electrocardiography 7-10 days after discharge from the hospital, detection and treatment of diseases of the octopling and nose;
· The dispensary observation of media of toxic corinbacterium diphtheria includes a monthly inspection by a precinct doctor, a KIZ doctor, bacteriological examination and an inspection of a otolaryngologist in order to identify and treat chronic pathology of the oral tag and nose;
· Removal from the records of reconvaluezent diphtheria is carried out not earlier than 3 months after discharge from the hospital, if there are 2 negative tests on diphtheria.

in ambulatory conditions, treatment is not carried out.

Criteria for the effectiveness of the dispensary observation and the treatment of persons undergoing diphtheria:
· Termination of the excitation of the pathogen;
· Restoration of violations of the functions of various organs and body systems.

Treatment (hospital)

Tactics of treatment at a stationary level: All detected patients with diphtheria, with suspicion of diphtheria, bacteria carriers of the toxygenic causative agent of diphtheria are treated under hospital.

Non-drug treatment:
· Mode: In the acute period of the disease and in a later date, in the presence of signs of heart lesions and the nervous system, bedding is shown.
· Diet: Table number 10, depending on the state of the patient, use probe or parenteral nutrition.

Medical treatment:
Etiotropic therapy.
The main means of treatment is PDS, which neutralizes diphtheria toxin, circulating in the blood (effective only in early illness). The dose of serum and the path of administration depend on the form of diphtheria and the severity of the course of the disease.

PDS diphtheria treatment:

Hospitalization

Indications for hospitalization indicating the type of hospitalization

Indications for planned hospitalization: not.

Indications for emergency hospitalization: All identified diphtheria patients are subject to mandatory hospitalization, with suspicion of diphtheria, bacteria carriers of the toxygenic causative agent of diphtheria.

Information

Sources and literature

1. Meeting Protocols of the Joint Commission on the Quality of Medical Services MD RK, 2017
   1. 1) Infectious diseases: National Guide / Ed. ND, Yu.I.V.Vergerova. - M.: Gootar Media, 2010. - 1056 p. - (Series "National Guides"). 2) Public Health Control And Management of Diphtheria (In England and Wales) Public Health England 2015. 3) Diagnosis of a typical case of infectious disease (standardized patient). Tutorial. Edited by Academician of the Russian Academy of Sciences, Professor E.V.Vachkovka. Moscow 2017 4) Clinical recommendations (protocol of treatment) for medical care to children with diphtheria. FSBI NIIDI FMBA Russia, 2015. 5) http: //madportal.com/infektsionnyie-zabolevaniya 6) diagnosis and treatment of toxic diphtheria. Korjornkova M.P., Berko A.I., Malyshev N.A., Galvidis I.A., Yakovleva I.V. Attending Physician No. 6, 2010. 7) Korjornkova M.P., Platonova T.V., Cherkasova V.V., Malyshev N.A. and others. Features of the diphtheria clinic under conditions of circulation of the pathogen of high degree of toxiosis. Early diagnosis of hyperstoxic and toxic diphtheria: manual for doctors. - M., 2002. - 40 s. 8) Korzhenkova M.P., Malyshev N.A., Berko A.I., Arseniev V.A. Diphtheria (clinic, diagnosis, treatment): Methodical recommendations. - M., 2008. - 54 p. 9) E. G. Fokina. Forgotten disease "Difteria". The attending physician number 11, 2016. 10) Updated Recommendation for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (TDAP) Vaccine in Adults 65 YEARS AND OLDER-ADVISORY COMMITTEE ON IMMUNIZATION Practices (Acip), 2012. MMWR. 2012; 61 (25): 468-70. 11) https://www.cdc.gov/diphtheria/clinicians.html

Information

Organizational aspects of the Protocol

List of protocol developers with qualifying data:
1) Kosherova Bakhyt Nurgaliyevna - Doctor of Medical Sciences, Professor, RGP at PCB "Karaganda State Medical University", Vice-Rector for Clinical Work and Continuing Professional Development, Chief Freelance Infectiousness of the Republic of Kazakhstan.
2) Abuova Gulzhan Naryaenovna - Candidate of Medical Sciences, RGP on PFV "South Kazakhstan State Pharmaceutical Academy", I.O. Professor, head of the department of infectious diseases and dermatovenerology.
3) Nurpeisov Aymanva Wamyevna is the main freelance infectiousness in the Kostanay region, the headature officer, the doctor infectious system of the KSP Polyclinic No. 1 of the Health Department of the Kostanay region.
4) Yuhnevich Ekaterina Aleksandrovna - RGP on PVV "Karaganda State Medical University", Clinical Pharmacologist.

Indication for the absence of conflict of interest:absent.

Reviews list:
1) Cultuzhanova Sholpan Adlgazievna - Doctor of Medical Sciences, Professor, RSP at PVV Medical University Astana, Head of the Department of Infectious Diseases.

Reclamation conditions:revision of the Protocol 5 years after its publication and from the date of its entry into force or in the presence of new methods with the level of evidence.

Attached files

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Diphtheria

Diphtheria (Diphteria) is an acute infectious disease caused by toxigenic centers, which is characterized by fibrinous inflammation at the site of the input gate of infection and toxic lesion predominantly cardiovascular and nervous systems.

Historical information. Mention of diphtheria are available in the writings of Hippocratic, Homer, Galen. Under the name "deadly pharynx", "suffocating disease" described the doctors of the I-II centuries. AD At the beginning of the XIX century. Diphthery was highlighted as an independent disease by the French scientist PF Bretonno, which proposed the name "diphtherite" (from Greek. Diphthera - film, membrane). At the end of the XIX century. His student A.Terusso Anatomical term "diphtherite" replaced the term "dipteria".

The causative agent of infection was discovered by T.A. Klebsom in 1883 and F. Luleffler in 1884. A few years later, e.bering and E.Ru was obtained anti-informy serum, which allowed to reduce the mortality of the disease. In 1923, Mr. Laon proposed immunization with anatoksin, which was the basis for the active prevention of the disease. As a result of vaccination, the incidence in many countries of the world, including in our country, decreased dramatically. However, since 1990, in large cities of Russia, primarily in St. Petersburg and Moscow, due to defects, epidemic outbreaks of diphtheria began to record in the conduct of vaccinocyphilaxis in adults. At the same time, the incidence rate was up to 10-20 people per 100,000 population with mortality of 2-4%.

Etiology. The causative agent of the disease is CorineBacterium Diphtheriae, or Leflare wand. Diffine Corinbacteria - gram-positive, immobile, disputes are not formed, their ends are pinned with polyphosphate clusters (the so-called volutive grains, the grains of Babesh - Ernsta). In the smears are located in pairs, often, due to division in the form of a break - in the form of a Roman figure V. When painting along the neussa, the body of bacteria is painted in brown-yellow, and the accumulation of polyphosphate is in blue.

Corinbacteria is well growing on media containing serum and blood (environments of ru and lefflera). Optimal growth conditions are available in the Clauberga (blood agar with the addition of Telllura salt). Three culture-biochemical types of C. Diphtheriae: Mitis, Gravis Intermediate, of which the GRAVIS type has the greatest virulence.

There are toxygenic and non-operational strains S. Diphtheriae. Difteria is caused only toxic strains, i.e. Corinbacteria, producing exotoxins. Toxigenicity is peculiar to the lysogenic strains of S. Diphtheriae, carrying moderate phages (in particular,? -Fag), in the chromosoma of which the gene is included, deterministic toxicogeneoses.

The degree of toxiosis of various strains can fluctuate. The unit of measurement of the exotoxin force is the minimum fatal dose (DOSIS Letalis Minima - DLM) is the smallest amount of Toxin C. Diphtheriae, which kills a guinea pig weighing 250 g for 3-4 days.

The exotoxin S. Diphtheriae is distinguished by dermontoxin, hemolysin, neuraminidase and hyaluronidase.

S. Diphtheriae is resistant to low temperatures, lasting on the surface of dry items. In the presence of moisture and light, they are quickly inactivated. When exposed to disinfectants in working concentrations, die within 1-2 minutes, and when boiling - instantly.

Epidemiology. The source of infection is a sick person or a carrier of a toxic strain of the causative agent. The patient is inflated from the last incubation day to the complete sanitation of the body, which is possible at different times.

Bacteriamers represent a serious epidemiological threat, especially in non-immune organized teams. It should be noted that the number of cases of the carriage of toxic strains of diphtheria bacteria is hundreds of times higher than the number of patients with diphtheria. In the foci of diphtheria, the number of carriers can reach 10% or more of the number of healthy faces.

From a practical point of view, transient carriages are distinguished when the toxygenic diphtheria microorganisms are released into an external environment for 1-7 days, short-term - within 7-15 days, medium duration - for 15-30 days and protracted - more than 1 month. There are also more prolonged carriage of the Corinbacteria of diphtheria in individuals who are closely in close contact with patients with diphtheria and in patients with chronic infections of the upper respiratory tract.

Seasonal rates of morbidity occur on the autumn-winter period. The main routes of transmission of infection are air-drip and air-dusty. It is possible to infect diphtheria through items - toys, underwear, etc. It does not rule out the food path of the transmission when infected with products (milk, cream, etc.)

The susceptibility to diphtheria depends on the level of antitoxic immunity. Currently, in connection with the active vaccine-philantal of young children, mostly adults and older children have suffered, lost immunity.

Pathogenesis and pathoanatomy painting. Diphtheria is a cyclic localized form of an infectious process characterized by the development of fibrinous inflammation at the entrance gate of infection and toxic damage to cardiovascular, nervous and other systems.

The entrance gate of infection is usually a throat, a nasal cavity, larynx, occasionally the mucous membranes of the eyes, genital organs and the skin (wound, ears, etc.). Penetrating into the human body, the pathogen is set in the field of entrance gate (the mucous membrane of the rotogling, nose, etc.), producing exotoxin. In some cases, short-term bacteremia is noted, but its role in the pathogenesis of the disease is small.

Clinical manifestations of diphtheria are due to the exposure to exotoxin consisting of fractions. The first fraction - necrotoxin - causes an epithelial layer necrosis in the place of the entrance gate, increase the permeability of the vessels, their paretic dilatation, increased fragility and blood stasis. As a result, blood plasma is healing in the surrounding fabrics. The fibrinogen contained in the plasma when contacting the thromboplastin of necrotic epithelium turns into fibrin, which forms a fibrin film on the mucous membrane.

In the mucous membrane of the rotogling, coated with a multilayer flat epithelium, develops diphtheritic inflammation with damage to the epithelial layer and subject to connective tissue, so the fibrin film of the mood with the tissues to be tissues and removed with difficulty. In the mucous membrane covered with single-layer cylindrical epithelium (larynx, trachea, bronchi), a bitter inflammation occurs with the damage only epithelial layer, while the fibrin film is easily separated from the tissues that are subject to tissues.

The result of the action of the necrotoxin is the reduction of pain sensitivity and tissue edema in the field of entrance gates, regional lymph nodes and subcutaneous fiber of the neck.

The second fraction of diphtheria toxin, similar to the structure with cytochrome in, penetrating into the cells, replaces the specified respiratory enzyme, which causes the blockade of cellular respiration and cell death, determines the violation of the function and structure of vital systems (cardiovascular, central and peripheral nervous systems, adrenal glands , kidneys, etc.).

The third fraction of toxin - hyaluronidase - causes an increase in the permeability of vessels and tissues, exacerbating tissue swelling.

The fourth fraction of toxin is a hemolysis factor and determines the development of hemorrhagic syndrome during diphtheria.

Thus, the clinical manifestations of diphtheria are determined by the local and general effect of diphtheria exotoxin on the human body. In the genesis of toxic and hypertoxic forms of the disease, the body sensitization is important.

Cardiovascular disorders in the early period are due to hemodynamic disorders (stises, foci of edema, hemorrhage), and from the end of the 1st - early 2nd week with inflammatory-degenerative and sometimes necrotic processes in myocardium.

In the peripheral nervous system, signs of neuritis involvement in the process of myelin and Schvanna shells are noted, immunopathological processes are developing at the later dates. Hemodynamics disorders are observed and the destruction of cells in the cortical and brain substance of the adrenal glands; Renseral epithelium dystrophy.

In response to the effects of diphtheria toxin in the human body, antimicrobial and antitoxic antibodies are produced - antitoxins, which together provide neutralization of exotoxin, elimination of the pathogen followed by recovery. Reconvaluents are formed by antitoxic immunity, but repeated diseases are possible.

Functional disorders and destructive changes in cardiovascular and nervous systems, in kidneys and other organs, especially with inadequate treatment of patients with toxic forms of diphtheria, with hyperstoxic and hemorrhagic forms of illness, may become irreversible and determine the death of patients during different terms of the disease.

In most of those infected with toxigenic strains S. Diphtheriae people develop an inapparanty form of illness - bacteriathos.

Clinical picture. The incubation period ranges from 2 to 10 days. There are a number of forms of the disease: the localization is the diphteria of the pharynx, nose, larynx, respiratory tract (trachea, bronchi) and rare localizations (eyes, skin, wounds, genitals, ear); By the nature of the flow - typical (film) and atypical - catarrhal, hyperstoxic (fulminant) and hemorrhagic; By severity - light, moderate gravity and heavy. During the defeat of several organs, the combined form of the disease is distinguished. The predominant is the pharynx diphtheria (90-95% of all cases of the disease).

Difteria pharynx. There is a localized, common, subtoxic and toxic form.

Localized form. With this form, the raids are located only on almonds. The disease begins with general malaise, reducing appetite, headache, minor (in adults more pronounced) pain when swallowing. The temperature rises to 38 ° C, less often up to 39 ° C, keeps from several hours to 2-3 days and is normalized even without treatment while maintaining local changes. The patients have a slight increase in regional lymph nodes, often on both sides. They are moderately painful, moving.

Disassemble the film, island and catarrhal forms of localized diphtheria pharynx. Typichna film (solid) form, At which the film is a grayish color, smooth with pearl gloss, well-defined edges covers all the spherical and edema almond. Film with difficulty is removed, exposing a bleeding surface. The formation of a new plaque on the spot removed is an important diagnostic sign. The film is not frozen between the size glass and sinks when immersed in water. In the later dates, the raids become rude, loose and easier removed. Against the background of serotherapy, they disappear within 3-4 days. The almonds are moderately seed. There is a non-market hyperemia with a cyanotic tint.

Islated form It is characterized by the presence of tightly sitting islets of white or grayish-white color on almonds. Inxication is weakly pronounced or no absent, the reaction of lymph nodes is insignificant.

Catarial form. Refers to an atypical variant of the flow of diphtheria, in which only small hyperemia and the edema of the almonds are noted. Temperature reaction and intoxication may be absent. Epidemiological data and bacteriological studies help in establishing a diagnosis. The localized form of pharmacy diphtheria without specific treatment can progress and move into common.

Common pharyngeal difftheria. It is found at 15-18%. With this form, the raid is coming out of the almonds on the mucous membrane of the sky, tongue, and sometimes the walls of the pharynx. The symptoms of the common form may be the same as localized diphtheria, however, inxication and almonds are more pronounced, the lymph nodes of large sizes and more painful. There is no edema of cervical fiber.

Toxic form. Often starts rapidly. The temperature in the first hours rises to 40 ° C. Sacred pale, sluggish, drowsy, complain of severe weakness, headache and throat pain, sometimes in the abdomen area, neck. From the first hours of the throat, hyperemia and tonsil swells, tongue, a mead, which precedes the appearance of raids. With a pronounced adhesion of almonds in contact, almost not leaving the lumen. The raids first in the form of a tender web-like network or a jelly-like film are easily removed, but in the same place quickly arise again. On the 2-3rd day of the disease, the rands are thick, dirty gray, completely cover the surface of the almonds, go to the arms, a small tongue, a soft and solid sky. Hyperemia of the pharynx by this time decreases, has a shiny shade, and the edema increases. Language is covered, dry lips, cracked, Specific, Specific, Sweet-shifted smell, breathing difficult, noisy, hoarse, voice with a nasal shade. All cervical lymph nodes are increased, elastic and painful. The swelling of cervical fiber is developing. The severity and prevalence of cervical fiber edema are adequate to generally toxic manifestations and underlie the unit toxic diphtheria. The edema of the cervical fiber of the I degree reaches the middle of the neck, II degree - applies to the clavicle, III degree - below the clavicle.

A feature of the modern flow of toxic forms of diphtheria in adults is the frequent development of combined forms with the lesion of the rotogling, larynx and nose. Such forms have a rapidly progressive malignant flow and poorly amenable to therapy.

The suboxy shape of the diphtheria of the pharynx. In this form, in contrast to toxic intoxication and changes in the throat are less pronounced, the swelling or the peasinity of the cervical fiber is minor. The more pronounced edema of the cervical fiber can only be on the one hand.

Hyperstoxic and hemorrhagic forms. Refer to the most severe manifestations of diphtheria. With hyperstoxic form, the symptoms of intoxication are sharply expressed: hyperthermia, cramps, collapse, unconscious state. Extensive films; It is characterized by the progressive swelling of the rotogling and cervical fiber. The course of the disease is lightning. The fatal outcome occurs on the 2-3 and day of the disease due to the development of infectious-toxic shock and (or) asphyxia. In hemorrhagic form, the raids are impregnated with blood, multiple hemorrhages on the skin, bleeding from the nose, pharynx, gum, gastrointestinal tract are noted.

Difteria Large, or diphtheria (true) croup. Lained damage can be isolated and combined (respiratory tract, throat and / or nose). Depending on the propagation of the process, diphtheria chromium is distinguished (larynx diphtheria); Diffex croup common: Difteria of larynx and trachea, Difteria of larynx, trachea and bronchi - diphtheria laryngotracytracyt.

In the clinical picture of the croup, three stages are distinguished: catarrhal, or dysphonic, wallotic and asphisical.

Distonic stage It begins gradually with an increase in body temperature up to 38 ° C, moderate intoxication (malaise, decrease in appetite), coarse cough and voting weight. It continues 1-3 days and in the future goes into the second - stenotic stage. There is noisy breathing with a difficult sigh, the interactions of the intercores, over-and subclavian depressions, the yapper, the voltage of the auxiliary respiratory muscles (breast-curable-bed-like, trapezoid muscles, etc.). Voice husky or afonical, cough gradually becomes silent. The wall period lasts from several hours to 2-3 days. In the transition period, a strong concern, feeling of fear, sweating, lip and nasolanity triangle, loss of the pulse at the entrance ("Paradoxical Pulse") are joined in the stage of asphyxia. In the absence of timely assistance, asphisical stage occurs. Breathing becomes frequent, superficial, arrhythmical, but less noisy, reduces the increase in the fuel facilities of the chest. The condition of the patients is progressively deteriorating. The skin of pale gray, cyanosis is not only the nasolabic triangle, but also the tip of the nose and lips, fingers and legs. The muscle tone is sharply reduced, the limbs are cold. Pulse frequent, threaded, blood pressure drops, pupils are expanded. In the future, consciousness is disturbed, convulsions are developing, there is an involuntary tendering of feces and urine. Death comes from asphyxia.

Timely conduct of specific therapy prevents the sequential development of all stages of diphtheria. After 18-24 hours after the administration of anti-diamiferous serum, clinical manifestations of the disease begin to be relocated.

Difteria Large in adults has a number of features. Classic symptoms of cereals are the same as in children: a sipid voice, noisy stenotic breathing, Aphony, participation in the act of breathing an auxiliary musculature, however, the increase in breathless pieces of the chest is often absent. Part of the patients with the only symptom of the damage to the larynx is the malfunction of the voice (even with a downward croup). On the development of respiratory and cardiovascular failure, it is possible to assume the pallor of the skin, the cyanosis of the nasolabial triangle, to weaken breathing, tachycardia and extrasystole. These symptoms are indicated for operational treatment (tracheostomy).

Nose difftheria. The beginning of the disease is gradual, with minor symptoms of intoxication. The body temperature is moderately elevated or normal. From the nose, more often from one nostril, serous, and then serous-purulent, succinous sections appear (catarrhal), Causes of mocking, the formation of cracks, crusts on the eve of the nose and on the upper lip. The nasal moves during inspection are narrowed due to the swelling of the mucous membrane, erosion, ulcers, crusts and bloody seals are detected on the nasal partition. (Catar and ulcerative form) or whitish film flask, tightly sitting on the mucous membrane (film shape). Sometimes the process goes beyond the nasal mucosa, acquiring the features of a common or toxic form.

The discharge of the nasal diphtheria is long, stubborn. Timely administration of antitoxic serum leads to rapid recovery.

Difteria eyes, skin, wounds, ear, exterior genital organs are rarely observed.

Eye difftheria. Fibrin flare is located on conjunctiva and can spread to the eyeball; The process is more often unilateral. On the affected side of the eyelids, the edema is sealed, a minor purulent separated with an admixture of blood appears from the conjunctival bag. The general condition of the patients is broken slightly.

Skin difftheria. Developed by damage to the epithelial cover. A dense fibrin film is formed, the swelling of the skin or mucous membranes in the place of cracks, scratches, wounds, and diameters, eczema sites. The inflammatory process in girls is localized on the mucous membranes of external genital organs. Diphthery of the umbilical wound can occur in newborns.

Clinical picture of diphtheria in graft. Failure to follow the timing of vaccination and revaccination, as well as transferred other diseases, unfavorable environmental and social factors reduce the intensity of anti-informy immunity and create prerequisites for the occurrence of diphtheria. The flow of diphtheria in graft is usually smooth enough, there are more complications less often. Inxication decreases on the 2-3rd day of the disease, the edema is insignificant, the film is most often the islands, are loosely soldered with the subject to cloth, they can spontaneously melted, the throat is cleaned by the 3-5th day of the disease. Such a clinical picture is usually noted in cases where the disease occurs against the background of residual anti-informitian immunity. With the complete absence of vaccine immunity, the symptomatics of diphtheria does not differ from those in universal.

Complications. Severe specific (toxic) and non-specific complications of diphtheria.

Specific complications. They can develop with any form of the disease, but more often are observed with toxic forms of diphtheria. These include myocarditis, mono- and poly neurites, nephrotic syndrome.

Lesions of cardio-vascular system In the early period of toxic and hyperstoxic forms, it is primarily due to vascular failure and to a lesser extent toxic lesion of myocardium (infectious heart syndrome). Skin covers are pale, cyanotic, the pulse is weak, thread, blood pressure drops quickly. Developing shock may cause death.

Myocardits may be early and late. Early myocarditis arises at the end of the 1st - early 2nd week of the disease and proceeds hard with progressive heart failure. Patients are adamic, complain of pain in the abdomen, vomiting. The pulse is frequent, the arrhythmical, the boundaries of the heart are expanded, systolic noise is listened. Specified pronounced rhythm (extrasystole, sinus arrhythmia, galop rhythm). Arterial pressure decreases sharply. The liver is usually enlarged, sensitive.

Late myocarditis, developing on the 3-4th week, has a more benign current.

Early and Late Peripheral Paraliaments are typical complications of diphtheria. Early paralysis of cranial nerves arise at the 2nd week of the disease. More often, paresis of a soft sky and accommodation paralysis are noted. The voice becomes bent, patients cannot blown the burning candle, when swallowing, liquid food is poured through the nose, there is no reflex with a soft sky, the sky curtain is fixed, hangs or asymmetric, the tongue is deflected in the disabilities. Sometimes patients can not read and distinguish small objects. Less often observed ophthalmoplegia, ptosis, neuritis facial nerve.

Late sluggish paralysis proceeds by the type of polyradiculoneuritis and arise on the 4-5th week of the disease. A decrease in tendon reflexes, muscle weakness, coordination disorder, uncertain gaitage is detected.

With the damage to the muscles of the neck and the torso, the patient is not able to sit, hold the head. Paralysis of larynx, pharynx, diaphragms may occur, while the voice and cough become silent, the patient is not able to swallow food and even saliva, the belly is drawn. These lesions can be isolated or found in various combinations. Polyradiculoneuritis disappear after 1-3 months with the full restoration of the structure and muscle functions.

Nephrotic syndrome It develops in the acute period of the disease and is characterized mainly by urinary changes (a large amount of protein, hyaline and grain cylinders, erythrocytes and leukocytes). The kidney function is usually not violated.

Nonspecific complications. From nonspecific diphtheria complications, pneumonia, otitis, lymphadenitis, etc. are possible.

Forecast. In the first 2-5 days, the deadly outcomes occur mainly in the case of toxic forms of diphtheria from infectious-toxic shock and asphyxia - in the case of a common cereal; On the 2-3rd week of the disease - in the case of severe myocarditis.

The threat of death in patients with diphtheria polyradiculite is due to the damage to the nerves, innervating lads, respiratory muscles and a diaphragm (respiratory paralysis), as well as a conductive system, heart (heart paralysis).

Diagnostics. The diagnosis of clinical and epidemiological data is crucial. The leading clinical symptom of diphtheria is the presence of fibrin, dense whiteish-gray raids located on the surface of the mucous membranes or skin.

To confirm the diagnosis of the disease, the bacteriological method of the study is used. The material collected from the locations, usually strokes from the nose and pharynx, are squeezed on elective media (Lefball, Clauberga, etc.) and placed in a thermostat at 37 ° C. In case of detection of growth on media after 24 hours, the preliminary result is reported, and after 48-72 hours - the final, after studying the biochemical toxigenic properties of pathogens. The serological methods use RNG to detect the growth of antibodies in the dynamics of the disease. Perspectively studying toxinemia.

Differential diagnosis. The pharmaceutical diphtheria should be differentiated from Streptococcal Angry, Simanovsky - Plata's angina - Wenzanan, infectious mononucleosis, angiosno-bubonic form of Tularemia, epidemic vapotitis. The diphtheria of the larynx is distinguished from a false groove occurring in acute respiratory viral infection, measles and other diseases.

The differential diagnosis of toxic diphtheria should be carried out with paraphrolular abscess, infectious mononucleosis, epidemic parotitis.

It is most difficult to differentiate toxic diphtheria from paratonic abscess (paraphalitis). In the differential diagnosis of paraphalitis and toxic diphtheria, the pharynx needs to pay attention to the following flow features and symptoms:

1) Paramylitis is often a complication of chronic tonsillitis and develops after re-angina, while the toxic pharyx diffraction is most often sharp; 2) When paratanzillite pain syndrome is sharply expressed from the very beginning and increases with the development of the disease: the difficulty and pain in swallowing and touching, the triumm of chewing muscles, the forced position of the head. Reducing the pain occurs after opening abscesses or against the background of active antibiotic therapy. With the toxic diphtheria of the pharynx pain, the pain syndrome is expressed to a lesser extent and only in the initial period, then it is weakening, despite the further increase in the edema of the mucous membrane of the pharynx and the raids;

3) Paramylitis is characterized by one-sided edema of the pharynx, on the site of the abscessive abscessive is noted local swelling and fluctuation; In the toxic diphtheria, the edema is more often bilateral, it is homogeneous consistency and has a spilled nature, only its dimensions change; 4) With paratonicillite, the increase in edema is not accompanied by the spread of the plaque beyond the tonsils, with a significant edema of the almonds and the soft sky, the fall may be missing. The swelling of the subcutaneous fiber is rarely noted and has no tendency to

distribution; 5) body temperature in paratrozillite is kept until the abscessess is opened or decreases parallel to the elevation of the inflammatory process under the influence of antibiotics, with the toxic diphtheria, it decreases after the 3-4th day, despite the ongoing process; 6) the nature of intoxication is different: excitation, hyperemia of the face, tachycardia - with paratrozillite; Adamina, pallor, hemodynamic disorders - with toxic diphtheria.

Treatment. The basis of the treatment of patients with diphtheria is etiotropic - specific and antibacterial - therapy carried out in a complex with pathogenetic methods under conditions of insulation of the patient to the infectious hospital and ensuring the necessary sanitary and dietary, motor and dietary modes.

Early specific, mainly serotherapy with adequate doses of antitoxic anti-diaphteric horse serum (PDS) "diamers" in accordance with the form and duration of the disease is crucial in cure.

The most pronounced effect of serotherapy is observed during the first day or hours of the disease, while in cases of localized forms of the disease, a single introduction of PDS may be sufficient. Unfortunately, with hyperstoxic and hemorrhagic forms, as well as with a late (on the 3rd day of the disease and later), the treatment of toxic forms of diphtheria serotherapy is often ineffective.

Anti-dieminic antitoxic serum is introduced in accordance with the general rules for the use of heterologous protein drugs aimed at preventing anaphylactic reactions.

The patients with hypecoxic, hemorrhagic and toxic forms of diphtheria, the PDS are prescribed regardless of the results of determining the sensitivity to the heterologous protein, but in cases of sensitization, serum is administered against the background of a set of measures warning anaphylaxis, in particular anaphylactic shock.

With localized and common forms of diphtheria, the PDS are administered 1 time per day intramuscularly, with a subtoxic form - twice a day with an interval of 12 hours.

With toxic, hyperstoxic and hemorrhagic forms of diphtheria, part of the daily dose of PDS is administered intravenously against the background of glucocorticosteroid and disinfecting therapy, preferably under conditions of resuscitation and intensive therapy (orit).

The healing effect of serotherapy is manifested in the first hours of treatment in the form of a decrease in the degree of edema of tissues, areas of raids, their thinning ("lifting") and (or) disappearance. When developing a positive effect, improving the condition of the patient, the subsequent daily dose of PDS can be reduced by half. PDS is canceled on the disappearance of the raids.

The duration of serotherapy ranges from 1 -3 days with localized forms to 5-7 days and sometimes more - with toxic, hyperstoxic and hemorrhagic forms of diphtheria; In the last cases, the total dose of PDS can be 1-1.5 million AE and more. With long and massive serotherapy, manifestations of serum disease are often developing, requiring additional hyposensitizing therapy.

Along with the PDS, a positive effect was obtained from the use of drugs from donor blood - anti-informy plasma and immunoglobulin, titrated on antitoxic antibodies.

Simultaneously with serotherapy, antibiotic therapy is carried out using bebeeylenecyllinate, erythromycin, cephalosporin derivatives, rifampicin, etc. In generally accepted doses for 5-10 days.

Locally prescribed rinsing with solutions of antiseptic preparations of Furatcin, Rivanola, etc.

For disinteling and improving hemodynamics, a native plasma is prescribed, neocompensen, refooliglukin, hemodez, 10% glucose solution. Together with solutions, caocarboxylase, ascorbic acid, insulin are introduced. With toxic forms, corticosteroids are shown (hydrocortisone of 5-10 mg / kg, prednisone 2-5 mg / kg body weight per day for 5-7 days). Heparin is introduced for the prevention of the DVS syndrome. Plasmapheresis, hemosorption and other efferent methods of disintellation are effective.

The appearance of signs of myocarditis serves as an indication for the appointment of ATP, cocarboxylase, antioxidants, non-steroidal anti-inflammatory drugs (indomethacin, etc.) and (or) glucocorticosteroids. With heart rate disorders, the use of cardiac cards is effective. In neurites, vitamin vitamin in the first days 1 , Strichnin, Prezero, Dibazole. Heavy polyradiculoneuritis with respiratory impairment require the appointment of artificial ventilation of lungs, hormone therapy.

Patients need strict bed regime for 3-4 weeks with complicated toxic forms and 5-7 weeks and more - in the development of complications.

The peculiarity of therapeutic measures during diphtheria of the larynx is due to the need to stop the phenomena of stenosis. This is achieved by good aeration of the chamber, the appointment of warm drink (tea, milk with soda), steam inhalations with the addition of sodium hydrocarbonate, hydrocortisone (125 mg per inhalation), introduction of euphilline, ephedrine, antihistamine and sedatives. To reduce hypoxia, humidified oxygen is used through the nasal catheter, films with electric cover are removed to improve breathing. If thermal and distracting procedures do not have a therapeutic effect, prescribed prednisone at a dose of 2-5 mg / kg per day to a decrease in stenosis. Under the progression of phenomena phenomena in the pre-analysis stage, urgent unifunctional intubation is shown, and when it is difficulty, due to edema of the tissue of the pharynx or larynx, and with a downward croup - tracheostomy with the removal of fibrin films using electrotoxos.

Treatment of bacteria carriers. Transport carrier does not require treatment. With a stubborn carrier of toxic strains of the diphtheria sticks, it is necessary to increase the overall resistance of the body (full nutrition, walking, ultraviolet irradiation) and sanitate the nasophal. Antibiotics are prescribed (erythromycin, tetracycline, etc.), taking into account the sensitivity to them of the microorganism - the pathogen.

Prevention. Immunization is given in the prophylacticity of diphtheria.

Particular attention in the conduct of vaccine-philaxcies of diphtheria appeals to the achievement of a sufficient level of immune layer (90-95%), primarily in organized groups (children's, student, military personnel, etc.), since these persons are groups of risk of infection and the spread of infection. Modern methods of immunological screening make it possible to identify seronegative individuals that are subject to additional vaccination. Contraindications for vaccinations against diphtheria are extremely limited and indicated in the instruction to vaccine preparations; It seems very important to correctly record with the rationale for medical discharges.

The focus is carried out, including hospitalization of patients, bacteriological examination of the material from the nose and pharynx in all contact, current and final disinfection.

After hospitalizing the last patient (carrier of the toxigenic strain of the pathogen), a medical observation is established for a period of 7 days using emergency clinical and immunological control methods for all contact (risk contingent). When detecting susceptible to diphtheria (seronegative and previously not vaccinated), their vaccination is carried out.

For carriers of toxic diphtheria sticks, similar activities are carried out with isolation and treatment at home.

The laboratory reference criteria from the toxic strain of the diphtheria microbial is the negative results of a 3-fold bacteriological examination, which is carried out no earlier than 36 hours after the abolition of antibiotics with an interval of 2 days between the fence of the material from the nose and the pharynx. Non-etoxy isolation carriers are not subject to, their treatment is carried out under clinical indications.

Author Viktor Borisovich Zaitsev

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Difteria in adults Machine for many centuries and symptoms of the disease are already familiar with the angina. Previously, this disease wore the character of epidemics, the symptoms appeared instantly, mortality reached 60%.

Now the level of immunization of the population of most countries is so high that the diphtheria will meet infrequently. But anti-vaccination movements are some danger in this regard.

Therapist: Azalea Solntsev ✓ Article verified by the doctor

Diphtheria - symptoms in adults

Diphtheria is an acute infectious disease. The disease is caused by penetration into the human body Cornobacteria diphtheria - Corynebacterium Diphtheriae. Infection occurs most often with airborne droplets or contact-domestic (toys, furniture) when the bacteria is hit on the mucous membranes of the mouth, the nose, as well as the upper respiratory tract.

Signs of the disease vary depending on where the pathological center is located. It is worth noting that in the early stages, the disease is difficult to diagnose, there are also asymptomic and low-power form.

To the symptoms that are observed in all patients belong:

• increased body temperature for several days, which then reaches 39-40 ° C;
• malaise, weakness, headaches;
• the pallor of the skin, which arises due to the spasm of small vessels;
• decrease in blood pressure;
• chills and fevering condition;
• an increase in the size of lymph nodes;
• allocations from affected mucous membranes, their swelling and pain.

Basically, the process of intoxication of the body, launched by diphtheria toxin, is expressed.

Treatment of diphtheria in adults

Difteria treatment is mandatory and carried out in the hospital infectious department hospital. It helps to avoid the spread of a dangerous disease.

Treatment includes the use of the following methods:

1. Etiotropic therapy is the introduction of seed whey against diphtheria, since the main cause of the severity of the disease is diphtheria toxin. In each case, the doctor prescribes a certain dosage, which depends on the set of factors.
2. Antibiotics are used within the framework of comprehensive therapy, which is aimed at combating pathogen.
3. Local treatment of the focus of inflammation.
4. Glucocorticosteroids are prescribed with pronounced inxication of the body, often in combination with different saline solutions and vitamin C.
5. Prednisolone and plasmapheresis - in some cases.
6. Intubation and tracheostomy - with the threat of asphyxia or obstruction of the respiratory tract.

The patient was prescribed a bed mode, as well as a diet with a large number of calories and vitamins.

Prevention of diphtheria and vaccination

Prevention plays an important role in stopping the spread of such a serious illness as diphteria. Since the infection is transmitted by air-droplet, first of all contact with patients with people should be avoided.

If the patient is found, the place where it appeared, it is necessary to be treated with a disinfectant. Timely appeal to the hospital and the insulation of the patient is an important step in prevention.

Vaccination and vaccination ADHS - warn tetanus and diphtheria

The most effective means of prophylaxis remains periodic vaccination of diphtheria in adults. In Russia, this is an ads called DC.

It is made for free in the clinic, starting from 3 months of age. Next, a certain revaccination schedule should be observed - it is built on diphtheria, the tetanus separately.

How often revaccination

Adult vaccine put every 10 years. The presence of vaccination will not protect against accidental infection, but facilitates the course of the disease. Immunity has developed protection, so the fight against the diphtheria sticks starts immediately.

Side Effects Vaccination for the Patient

At the DPC there are side effects. Among them: an increase in temperature, change in behavior due to poor well-being, capriciousness, in the injection site there may be red and seal. Symptoms usually pass within 3 days.

Differacy development stages

The disease does not reach the peak of development for 1 day, but takes place in several stages.

Incubation period of development of infection

After the causative agent of the disease in the human body and until the first symptoms appear on average, it takes from 2 to 10 days - this is the incubation period. By the end of this period, a small temperature appears, general weakness and indisposition. In classical form, there is an arrangement and pain in the throat, the libations coming to the place of inflammation are increasing.

As the inflammatory period is manifested

It is characterized by pronounced symptoms, since the body enters into the fight against infection. Signs of intoxication are clearly manifested, high temperature due to diphtheria toxin, poisoning the body. During this period of time, signs inherent in a certain kind of illness are detected in one severity. Most often, the sharp period lasts about 3 days.

Patient recovery and toxin removal

Gradually distinguished toxins are output, due to which the temperature drops. But other signs, for example, raid and selection, can bother further up to 8 days. Gradually pumps the edema of tissues and the size of lymph nodes.

Characteristic features of the disease

Since there is a disease in an atypical form, it makes it difficult to diagnose, and accordingly, hospitalization. About 90% of all cases is localized diphteria.

Due to the mass vaccination of serious cases of intoxication, it usually does not occur, and the disease itself passes with a minor deterioration of well-being.

But this does not mean that the treatment is not necessary. At a running stage, for example, a cereal, inflammation can fall below, which will cause asphyxia and death.

Given the severity of the state and severity of symptoms, the forms of diphtheria are shaped as follows:

1. Non-toxic - the disease passes relatively easy. This happens when a person will be vaccinated.
2. Suboxy - all signs of serious intoxication appear slightly.
3. Toxic is the most common. It develops rapidly: all stages of the disease right up to acute intoxication develop literally for 3 days. It is expressed in a strong edema, affecting the neck and the surrounding fabrics, can disturb the abdominal pain.
4. Hypertoxic - very strongly expressed symptoms of intoxication. In this case, swelling and high temperature accompany the convulsions, the person loses consciousness, suffers from fever. If there is no treatment, death may occur as a result of the development of heart failure.
5. Hemorrhagic - Difteria is striking the blood formation system. This is a very severe form at which hemorrhagic nature rashes occur on the body, hemorrhages may occur in the tract and mucous membranes.

The last 3 forms are very dangerous and require urgent appeal to doctors to appoint the necessary treatment.

Difteria forms or types of disease

Depending on the location of the bacterium, there are several types of this disease.

How does the rotogling difftheria manifest

This type is considered classic, since 90% of ill people suffer from this form.

If the bacteria gets into the mucous membrane, its inflammation and further necrotization occurs. The process is accompanied by the emergence of strong edema and jelly-like discharge on almonds.

Soon they are replaced with dense fibrinous films of grayish color. Mechanically, the flare is poorly removed, and if it succeeded, the fabric blemaches. During the day, it is formed again.

The formation of plaque and edema can achieve this size that there is breathing problems. This process is capable of applying to neighboring tissues.

Differian larynx, trachea, bronchi

The respiratory system is defeated, because of which a strong cough becomes the problem of this form. Voice of husky, breathing is difficult, the pallor of the skin, a violation of the heart rhythm appears.

There is a confusion of consciousness, the drop in blood pressure and the pulse frequency. A combination of factors leads to loss of consciousness, suffocation and fatal outcome.

Nose Diftere - Development Process

It is manifested by a pronounced breathing with his nose, as well as the discharge of sucrovitsy and purulent - serous. At the same time, the mucosa of the nose is affected and swells, is covered with ulcers and fibrinous film separated by flap.

Corks and irritation can spread around the nose. Independently, this form is almost never manifested, but it comes in combination with the damage of the larynx, the rotogling or eye.

Eye Diffhechy - Basic Provisions

Rare phenomenon, and is often expressed only to redness of the eyes.

There are 3 varieties:

1. Catarial - a conjunctive is inflamed, and small succulent discharge can be observed. Incication does not occur, but body temperature - within the normal range, or slightly increased.
2. Film fabric eyes swell and coated with fibrinous film, purulent - serous selection may be present. The temperature is slightly rising, and intoxication is poorly expressed.
3. Toxic - arises rapidly and manifests edema of fabrics of the eye and eyelids. In addition to the conjunctiva, the inflammation affects other departments of the eye, in also adjacent fabrics. Incication is manifested quite strongly.

Rare Localization Diftere - Types of Defeat

Occasionally lesions arise:

1. Genital organs: men are extreme flesh, in women - sex lips. There is a swelling and succulent discharge, the process of urination is painful. Infection can affect the neighboring fabrics.
2. Damaged skin: wound, dough, crack, etc. In the wound, a gray film and purulent - serous discharge is formed. Inxication is poorly expressed, but the wound slowly heals - from the month and more.

Diagnosis and research

Diagnose diphtheria is difficult to doctors, not to mention independent diagnosis. The problem lies in the fact that the symptoms are easy to confuse with other diseases - angina or stomatitis. Since it is manifested by dangerous consequences for the body and death, the correct diagnosis has saves life.

Laboratory studies are prescribed for this:

• bacteriological strokes from the rotogling - determines the causative agent of the disease;
• serological - helps to determine the acuteness of the inflammatory process;
• PCR - determines the DNA of bacteria.

Due to the large number of possible complications, additional surveys of other organs and systems are carried out.

Treatment by folk methods

Folk remedies are designed to initially ease local symptoms and support immunity using decoctions for drinking and rinsing, compresses, etc.

The popular tool is cranberry, lingonberry and lemon. Plant juice is recommended to drink in warm and lubricate them on the throat. Rinse is also effective.

Features of the course in pregnant and old people

The contamination of the diphtheria of a pregnant woman has a number of features and difficulties associated with its treatment. Her position imposes a lot of restrictions on the reception of medical drugs.

In addition to the consequences of the transferred disease characteristic of all, pregnant women are observed:

• damage to the genital organs, which can cause the obstruction of the vagina;
• fruit infection - at birth during some time will have immunity - vaccination is also effective;
• an early period may have miscarriage.

The severity of the disease in the elderly is due to a reduced immunity. It should be borne in mind that the vaccine has a temporary effect. Every 10 years the revaccination is carried out, since often age is not a meal of infection.

With timely handling of the medical institution, as well as the beginning of treatment, the forecast for the flow of the disease is favorable. The mass vaccination of the population, which begins with 3 months of age, is promoted. If there is a severe form of toxic poisoning and the late treatment is possible and fatal outcome. At the moment, mortality is not more than 5% of the total number of ill.

Diphtheria - Acute infectious disease causeing inflammation of the upper respiratory tract. It is manifested by intoxicating and the appearance of dense whitic fibrinous films on the affected areas. Therefore, until the end of the XIX century, the disease was called diphtherite, translated from Latin - "Film".

With diphtheria in 95% of cases, the throat is affected. Also distinguished by the diphtheria of the nose, eye, genital organs, skin.
The disease is called diphtheria stick (Klebsa-lofler's wand). Of particular danger is not the bacterium itself, but the toxin that it highlights. This poison is considered one of the most dangerous. If the treatment has begun indefinitely, it strikes the nervous system, heart and kidney. Heavy poisoning by bacterial toxin can cause the death of patients.

It is possible to infected diphtheria with air-droplet or through objects to which bacteria fell. Difteria susceptibility is relatively low - 30% of the contacting people are ill.

Difteria was also known before our era, then it was called "Syrian ulcers" or "hinge of the remotely". She caused large epidemics during which children were predominantly ill. Mortality then reached 70-90%. The situation has changed dramatically in 1920, after the injection of mass vaccination. Due to the vaccination from the serum of immunized horses, it was possible to reduce mortality to 1%.

The last epidemic on the territory of the former USSR occurred in the 90s, when tens of thousands of people were silent. Doctors hoped on vaccination efficiency and not enough attention to the insulation of patients and examination of persons who were in contact with them. In this regard, the outbreak stretched for 5 years. In developed countries, where the majority of the population is vaccinated, the incidence rate is 2 cases per 100,000 people.

Today, diphteria is destroyed. Therefore, not every doctor has seen patients with diphtheria. This complicates the diagnosis.

Difteria causative agent

Causative agent - corinbacterium diphtheria. These are rather large sticks that have a slightly curved bulva. When studying under the microscope, a characteristic picture is found: bacteria are located in pairs, at an angle to each other, in the form of Latin V.

The genetic material is contained in the DNA two-stranded molecule. Bacteria are resistant in the external environment, well withstand freezing. In drops of dried mucus retain their livelihoods up to 2 weeks, in water and milk up to 20 days. Bacteria are sensitive to disinfectant solutions: 10% peroxide kills them in 10 minutes, 60 ° alcohol in 1 minute, while heated to 60 degrees are dying after 10 minutes. Chlorine-containing drugs are effective for combating diphtheria sticks.

Diffiter infection It comes from a patient or a bacteria carrier that does not have manifestations of the disease. Bacteria fall on the mucous pharynx by air-droplet, with drops of saliva or mucus of the patient. You can get infected through contaminated items and products, with close physical contact.

Entrance gate For infection are: mucosa of pharynx, nose, genital organs, eye conjunctive, skin damage. Difteria bacteria multiplied at the site of penetration, which causes different forms of the disease: difteria of the oz, larynx, the eyes of the nose, leather. Most often, cinnobacteria will be pulled on the almond mucous membrane and a soft sky.

Properties of diphtheria sticks.

Bacteria have drank - special veins for attaching to body cells. Attaching, the bacteria begin to actively multiply, but do not penetrate the bloodstream. Such colonization causes a local inflammatory process - swelling and an increase in temperature. At this stage, toxin gets into the blood.

Properties of diphtheria toxin:

• provides binding of bacteria with epithelium cells;
• causes the death of cells of the mucous membrane and leather;
• disrupts the synthesis of proteins in a cage, leading to her death. Particularly susceptible to it, cells of the heart, kidneys and nerve roots;
• destroys the connecting tissue, breaking the walls of the vessels. This leads to the release of liquid blood through their walls;
• leads to the destruction of the myelin shell of nerves.

Under the action of toxin, the fabric is impregnated with a liquid containing a large amount of fibrinogen, which is the cause of edema. The enzyme of dead cells rolls the soluble fibrinogen and turns it into fibrin. A dense gray-white film with a pearl tump is formed from fibrin fibers, which is slightly towers above the surface. The film is hardly removed, a bleeding surface is formed under it - the result of necrosis of the mucous cells.

Difteric toxin propagates with lymph current, causing lesions of lymphatic nodes. It reaches the heart, kidneys, adrenal glands, nerve cells and binds to them. If for several hours the patient receives contaminiferial serum, then the defeat of the organs can be stopped.

It is believed that the course of the disease depends on the action of toxin. If it is produced in large quantities, the patient has a severe toxic form of illness with a variety of complications. Fortunately, changes are reversible. Properly selected treatment can fully restore the work of the affected organs.

Causes of diphtheria

Source of infection:

• Patient: Starting from the last days of the incubation period and until the moment he ceases to allocate bacteria;
• Bacteriamaker. In his mucous pharynx, bacteria dwells, but the body is not sensitive to toxin and the disease does not develop.

Diphetheria susceptibility relatively low. Of 100 contacted patients, 15-20 people are infected with patients. These are mainly people with a reduced immunity and non-unmet. In the grafts, chasing and having moved the risk of infecting less.

Children up to a year almost do not hurt diphtheria, they are defended by innate immunity, which took them from the mother. However, at the age of 1-5 years, children become very susceptible, and it is hard to carry diphtheria.

In the risk group:

• students of boarding schools;
• pupils of orphanages;
• recruits;
• people who are treated in psychoneurological hospitals;
• refugees;
• unmucky children and adults.

Causes of outbreaks of diphtheria - non-compliance with hygienic rules, high crowding, decrease in immunity, defective nutrition, insufficient medical care.

Control the disease is possible by mass vaccination. Unreasonable taps from vaccinations lead to an increase in the incidence and the appearance of severe forms of diphtheria.

Seasonality diphtheria. Now the diphtheria is suffering in greater extent adults. Cases of diphtheria among them are registered throughout the year. In children, the rise of morbidity is noted in the autumn-winter period.

Types of diphtheria

Depending on where the bacteria penetrated, various forms of diphtheria may occur. Inflammation of mucous membranes, nose, conjunctivities of the eyes, genital organs, wound surface, umbilical wounds in newborns.

Classification of diphtheria forms

1. Rotoglotka difftheria
   1. Localized form - Bacteria multiply in palatine almonds. This form of illness is developing in 70-80% of the diseased. She, in turn, has several subspecies.
      • Catarial. Sky almond salmon, slightly reddened, but there are no traces of films. In this case, the toxin is distinguished by little and it does not cause poisoning (intoxication) of the body.
      • Oslands. Films have the appearance of individual islands of pearl color. They are located on the convex surface of inflamed almonds.
      • Filmian. The almond surface is covered with dense blessing films.
   2. Common form. 10-15% of the sick. Bacteria can spread to a solid sky, tongue. Incication is strongly expressed. High risk of complications.
   3. Toxic form (I, II and III degrees)up to 20% of cases of illness. From the rest of the forms, it is characterized by massive intake of toxin in blood. The disease occurs hard and can endally end. Films are completely covered by almonds and neighboring phase of pharynx. There is a swelling of the subcutaneous fiber of the neck, significantly narrows the gossip of the ZEV, the voice changes.
   4. Hyperstoxic form.It is rare. The high concentration of toxin in the overwhelming majority leads to death.
2. Diphtheria:
   • diftere larynx (diphtheria debris is localized) - acute narrowing of the larynx caused by the accumulation of fluid in the field of voice ligaments and the swelling of the mucous membrane of the larynx.
   • difteria of the larynx and trachea (croup common) is the narrowing of the larynx and the lumen of the trachea;
   • difteria of larynx, trachea and bronchi (downward croup) - bacteria cause the epithelium of the respiratory system.
3. Difteria of other localizations:
   • nasal difftheria;
   • eye difftheria;
   • skin diphtheria;
   • genital difcthery.
4. Combined forms of diphtheria

At the site of infection, the primary hearth is developing. Subsequently, the bacteria are spread to other parts of the body. Thus, there is a combined lesion of the oz and eyes, larynx and genital organs.

Symptoms of rotogling diphtheria

Symptom	Development mechanism	Feelings of the patient	External manifestations
General intoxication	The result of exposure to exotoxin on the nervous system.	Weakness, headache, decreased appetite, lethargy drowsiness.	The patient becomes sluggish and apathetic at the end of the incubation period.
Moderate temperature rise to 38 degrees	Fever is a protective reaction of immunity to enter the bacteria. Diffex toxin with blood flow reaches hypothalamus, where thermoregulation centers are located. It includes mechanisms that provide temperature rise	Chills gradually passes into the feeling of heat. The temperature rises from the first hours of the disease and keeps 7-14 days.	The skin is hot to the touch, a slight blush on the face.
Insignificant sore throat	The diphtheria wand causes swelling and necrosis of the almond mucosa. The pain is expressed less than with an angina. This is due to the fact that toxin damages the nerve endings in the throat, making them less sensitive.	Minor throat pain, difficulty swallowing. The pain in the throat appears in the first hours of the disease.	Almonds are slightly enlarged and slightly hyperemic.
Films on almonds	Bacteria multiply on the almond surfaces, causing cell death. An increase in the permeability of the walls of the vessels leads to a edema and an increase in the tonsils. For 2-3 days of the disease, a fibrin film is formed. This is a protective reaction of the body, designed to stop the reproduction of bacteria - to limit them with a protein "sarcophagus".	There is a moderate sore throat when swallowing.	Almonds slightly reddened and enlarged. On their surface, the fibrin mesh appears similar to a web. Over time are formed gray-white plaques Colors towering above the surface. May appear films. If you remove them, the erosed bleeding surface is taken off. A day later, the same place appears a new film.
Lymphadenit	Diffeter toxin propagates the lymphatic vessels and causes an increase in lymph nodes.	Regional lymph nodes are slightly increased and painless.	An increase in submandibular lymph nodes.
Lack of runny nose	Bacteria do not multiply in the nasal mucosa. This is a characteristic feature that distinguishes light forms of diphtheria from ARVI.	Nasal breathing is not difficult.	There is no discharge from the nose.

Symptoms of diphtheria in common form

Symptom	Development mechanism	Feelings of the patient	External manifestations
Intoxication	Toxin is oppressing the central and peripheral parts of the nervous system.	Lost drowsiness, weakness, apathy	The patient is sluggish, apathetic, refuses to eat
Films on almonds and surrounding sites	Bacteria colonize a significant segment of a soft sky.	More expressed pain in the throat.	The raids are distributed to palas and tongue. From mouth comes sweetly shrouded smell.
Increased lymph nodes	Lymph nodes are filtered from lymph toxin. The increase in lymph node is associated with the active development of lymphocytes to combat infection.	Lymph nodes reach the size of a large bob. When parsing or movements of the head appear unpleasant sensations Developed on the 2nd day of the disease.	Nexual swelling of the neck under the urine of the ears.

Symptoms of toxic diphtheria

Symptom	Development mechanism	Feelings of the patient	External manifestations
Strong intoxication	Abundant isolating toxin and entering it into the blood in large quantities causes severe poisoning by a bacterial poison.	Strong weakness, breakdown, dizziness, chills and lubrication.	From the first hours of the disease, the patient lies, almost motionless, refuses to eat.
Significant temperature rise, over 39 degrees	The high concentration of toxin in the blood causes a strong fever.	Fever and feeling heat. The temperature sharply rises in the first hours of the disease.	Redness of the face and neck leather, eye glitter, bright red dry cracked lips.
Extensive throat films	Fibrin's deposits on areas of accuracted bacteria.	Sore throat. The feeling of lagging and difficulty of breathing due to edema of the mucous membrane and narrowing the lumen of the pharynx. Already in the first day, a person cannot take food and swallow liquid. The raids are saved 5-7 days.	Films cover extensive areas from solid sky to pharynx. The film has a dirty gray color sometimes with brown blood stains.
Strong swelling of mucosa	Toxin affects the walls of the vessels, the exudate is seeping through them, which impresses the intercellular space.	Pain when swallowing when opening the mouth, when taking the lymph nodes and when conversing.	The almonds are significantly increased in size. They may be closed, infrainmenting a small tongue. Edema has clear boundaries. The affected area towers at right angles over a healthy mucous.
Voting voices	The change in the voice is associated with the edema of voice ligaments, mucous pharynx and nose.	The voice is changed. There are minor transparent discharge from the nose.	When viewing the nose, the enemy is visible to the mucosa without films.
Swelling of subcutaneous fiber neck	The damage to the vessels causes the toxic swelling of subcutaneous tissue.	Movement of the neck and turns of the head are difficult, cause pain. There is a feeling of lack of air.	The strong pasty swelling starts from the lower jaw and can fall below the collar to the sternum. Sweet is soft, has a tough consistency. On the second day, swelling becomes dense.
Increase and inflammation of cervical lymph nodes	The accumulation of toxin causes inflammation of lymphoid tissue.	Lymph nodes are very painful, reaches the size of the cherry. Often, the defeat is one-sided.	In the enemy's fiber, solid lymph nodes are tested as "pebbles in a pillow".

Symptoms of hyperstoxic diphtheria

Symptom	Development mechanism	Feelings of the patient	External manifestations
Intoxication	Strong poisoning of the body diphtheria toxin. The nervous and cardiovascular system are especially affected.	The disease begins acutely, a few hours after the infection, the condition deteriorates sharply. Sludging, pain in the joints, dizziness, nausea, weakness.	Pallor, lethargy, violation of the reaction to what is happening, nonsense, euphoria.
Temperature	Fever is a protective reaction of the body aimed at combating bacteria.	A sharp rise temperature up to 39-40 degrees. In some patients on the 3rd day, the temperature independently drops to 35 degrees, which is associated with a violation of the thermoregulation mechanism.	The skin in the patient is hyperemic or the opposite marks a sharp pallor.
Collapse	The impaired innervation of the heart and blood vessels leads to a violation of the blood circulation of the most important organs.	Blood pressure is reduced, the heart is reduced slightly pulse thread-shaped. Develops in the first hours of the disease.	Surface breathing, cool sweat is on the skin, pupils are expanded.
Causes	Disruption of the blood circulation of the brain and swelling of its individual sites leads to an increase in convulsive activity.	Skeletal muscle cramps and uncontrolled reductions in internal organs. This leads to an involuntary disorder of urine and feces.	Attacks of seizures that can end the loss of consciousness.
Damage to blood vessels	Damage to the connective tissue of the vessel walls lead to subcutaneous hemorrhages, external and internal bleeding.	Bloodstocking gums, nasal bleeding, feces with blood admixture.	Sonya and bleeding of god and skin.
Subcutaneous cell swelling	The liquid comes out through the walls of the vessels and accumulates in the subcutaneous fiber of the neck.	Edema causes a narrowing of the upper respiratory tract and choking. The patient is experiencing fear of death. Develops for 2-3 days.	Sweet extends down the neck to the sternum. And also on the back, chin and face.
Pain syndrome	Pains are caused by inflammation of lymph nodes and deep erosions on the mucous membrane.	The patient is experiencing pain in the throat, when taking a lymph node, pain in conversation, when opening the mouth.	The patient shudders from pain when trying to try to face lymph nodes.
Infectious-toxic shock	Violations in the work of the most important systems of the body caused by the high content of toxin in the blood.	Concision confusion, pressure reduction below 90 mm RT Art., Fit-shaped pulse. Nausea and vomiting .	On the skin, small red rash, similar to sunburn. Localizes mainly on the palms and footsteps.
Diffex films	The diphtheria wand colonizes extensive areas, so the films can descend into the larynx and detect on the nasal mucosa.	Dense gray films can be quite extensive and remain on the throat to 2 weeks.	After removal, the film does not smear along the soldier and sinking in water. There is a voosity of voices, discharge from a nose with particles of films and an admixture of blood. The patient's mouth comes with a specific renovation smell.

Symptoms of diphtheria and diphtheria larynx

Symptom	Development mechanism	Feelings of the patient	External manifestations
Catarial Stage continues from a few hours (in children) up to 7 days (in adults)
Moderate intoxication	The reproduction of bacteria is accompanied by the release of ekzotoxin.	Weakness, lubrication in body, headache. In contrast to false groats with flu, diphtheria croup develops slowly.	Temperature of the body rises to 38 degrees
Inflammation and swelling of voice ligaments	Toxin causes a cluster of fluid in the mucous membrane of the larynx	Wispness voice, barking cough.	Ground cough.
Stenotic stage (narrowing larynx) duration 2-3 days
Highland swelling	Casting fluid in the intercellular space.	The feeling of lack of air, feeling of fear.	The voice goes to the whisper; Cough becomes silent.
Asphyxia	The narrowing of the larynx violates the flow of air into the lungs. Oxygen starvation develops.	Anxiety, feeling shortness of air.	The sinusiness of the mucous membranes and the pallor of the skin.
Difficulty breathing	To improve the supply of oxygen into easy access, all respiratory muscles are included.	Inhale is given with difficulty. On the neck, pits appear above the clavicle and between the ribs, the twig is drawn. The operation of the respiratory muscles is clearly visible in children.	When inhaling, a bubble sound is heard. It occurs when air passes through the narrow slit in the larynx.
Disturbance of cardiac rhythm	Lack of oxygen and toxin action lead to tachycardia. The heart beats at an accelerated pace to compensate for the lack of oxygen in the blood.	Heart palpitations.	Accelerated pulse, which is underlinking poorly.
Asphisical Stage in a few hours can lead to death
Shinny or pale gray shade of leather and mucous membranes	With oxygen starvation in the blood, the high content of restored hemoglobin.	Fear of death, sharp air shortage.	The cyanotic shade is most noticeable on the mucous membranes, the tip of the nose and the nasolabial triangle.
Surface student breathing	The protective reaction of the body to the oppression of the respiratory center in the oblong brain.	The patient cannot take a deep breath.	Breathing becomes superficial, frequent, but more rhythmic.
Blood pressure reduction threaded pulse	The lack of oxygen oppresses the activity of the heart. It decreases weakly, feeding in the vessels is not enough blood.	Weak heartbeat, loss of consciousness	Pupils are expanded, the reaction to what is happening is broken.
Lumbout or loss of consciousness, convulsions.	Hypoxia of the brain leads to irreversible disorders in different areas. It can manifest itself with convulsions, and without emergency assistance to lead to a fatal outcome.	Uncontrollable muscle contractions. Loss of consciousness.	Fast rhythmic reductions in individual muscle groups, loss of consciousness.

Difteria of other localization

Eye difftheria 0.3%

Symptom	Development mechanism	Feelings of the patient	External manifestations
Incixing and temperature rise	The diphtheria stick penetrated the body through the conjunctival or hit the oral cavity. Bacteria multiply in the penetration site, and their toxin is distributed throughout the body.	With local defeat of the eye, intoxication is moderately expressed. With a combined form (eye damage and zoom), the temperature rises to 39 degrees, dizziness and lubrication occurs in the body.	The patient is sluggish, refuses to eat, the skin is pale, the eyes will disappear.
Sweet of Century	Diffex toxin damages the walls of the vessels and leads to an affected segment.	Itching in the eyes, burning tear. Appears for 1-3 day of the disease.	Eyelids edema, dense, blushing. In most cases, the defeat is one-sided. After 3 days, swelling on the eyelids softened.
Films in conjunctiva	Bacteria stimulate the fluid yield with a rich protected, from which gray fibrin films are formed.	Bulk view. The feeling of the foreign body in the eye with the separation of the film.	Films are easily separated, a slight bleeding mucosa is found under them. In severe cases, painless ulcers are formed. Subsequently, they scarce and can deform the eyelids.
Blisters on the eyelids	Through small damage to the bacteria penetrate the eyelids, causing the rover for the liquid part of the blood under the skin.	Painless bubbles on the outer surface of the eyelids.	Blisters are filled with a transparent grayish liquid. After 1-2 days in their place, ulcers are formed, which when scarring can cause the deformation of the eyelids.
Defeat cornea	Bacteria penetrate the cornea, appearing the appearance of an ulcer.	Tear, pain in the eye, violation of vision. Developed by 4-5 sickness day.	The cornea is noticeable erosion and hemorrhage.
Purulent	Pump appears when leukocytes are involved in the fight against bacteria.	Appear when the films are outdated by 3-4 days.	Magnifies in the corners of the eyes and on the eyelashes.

0.5% nose difftheria

Symptom	Development mechanism	Feelings of the patient	External manifestations
Selection of nose	The reproduction of bacteria is accompanied by rejection of the surface layer of the nasal mucosa and the separation of exudate.	Constitution that does not pass after the use of vasoconstrictor droplets.	{!LANG-544b87e714df655a3207ab461b53ac7a!}
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