Diphtheria

2177 06 February

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Diphtheria: causes, symptoms, diagnosis and treatment methods.

Diphtheria is one of the most dangerous infections, posing a high risk to the patient’s life. It is no coincidence that the first Nobel Prize in Physiology or Medicine was awarded in 1901 to E.A. Bering for the development of a therapeutic serum against this disease.

Despite the fact that many consider diphtheria to be a childhood disease only, it also occurs in adults.

The source of infection is a patient or a bacteria carrier; the pathogen is transmitted by airborne droplets, household contact and food.

Causes

Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae (diphtheria bacillus, or Loeffler's bacillus).

This microorganism is highly resistant to environmental factors. This must be known and taken into account when carrying out disinfection in the source of spread.

Direct sunlight, high temperature and some chemicals (disinfectants) have a negative effect on C. diphtheriae.

The disease is anthroponotic, i.e. only people get sick. In most cases, corynebacteria enter the body through the mucous membranes of the oropharynx, nasopharynx and larynx. However, the mucous membranes of the eyes, genitals, and wounds can also become “entry gates” for infection. The bacteria multiply and release a toxin that enters the bloodstream.

The spread of the toxin throughout the body leads to damage to organs and systems, among which the heart, adrenal glands, kidneys and nerve fibers are most often affected.

A characteristic sign of the disease is the formation of dense grayish-white fibrin films on the mucous membranes of the oropharynx. Diphtheria plaque covers the tonsils, as well as the pharynx and larynx, which causes a narrowing of their lumen and disrupts the passage of air into the underlying respiratory tract. Airway obstruction by film and swelling can lead to the development of croup, especially in young children.

Classification of forms of the disease

Manifestations of the disease may be associated with the place of penetration of bacteria into the body: diphtheria of the oropharynx, larynx, nose, eyes, genitals, wounds, etc. Depending on the extent of the lesion, localized, widespread, combined, and toxic forms of the disease are distinguished. The toxic form is more severe than the others and is characterized by damage to internal organs.

Diphtheria varies in severity: mild, moderate and severe, which in turn is also divided into three degrees. This disease, especially when severe, is characterized by the development of complications, the addition of a secondary infection, as well as exacerbation of chronic diseases.

Diphtheria symptoms

The most common diphtheria is the oropharynx and larynx. Most forms of diphtheria are accompanied by fever (increased body temperature with chills), swelling and necrosis of the mucous membrane of the tonsils, and enlarged lymph nodes.

Diphtheria of the oropharynx is distinguished by the appearance of whitish-gray films on the palatine tonsils, which can spread to the palatine arches, uvula, and palate.

There is pain when swallowing. When you try to remove the films, bleeding mucosa is exposed. Diphtheria of the oropharynx, especially in unvaccinated patients, is characterized by the development of complications.

Unlike diphtheria of the oropharynx, with diphtheria of the larynx (true croup), toxic damage to internal organs is atypical. The danger in this case is represented by fibrin films that easily peel off from the mucous membrane, which lead to a narrowing of the airways up to their complete blockage and the development of asphyxia (suffocation).

It is necessary to distinguish between true croup in diphtheria and false croup in acute respiratory viral infection.

True croup is characterized by a gradual deterioration of the patient's condition, the appearance of a barking cough with a change in voice, sometimes to complete aphonia. Attacks of false croup can be alleviated by inhalation of glucocorticosteroid drugs, which, unfortunately, is not effective for diphtheria croup.

Diagnostics

Diagnosis of diphtheria begins with the collection of complaints, medical history, and clinical examination of the patient.

It is important for the doctor to know whether the child has been vaccinated against diphtheria, and also whether there are patients with suspected diphtheria in his environment.
The main method of laboratory diagnosis of diphtheria is bacteriological examination (culture) of a throat smear.

Historical information and interesting facts

Already in the first century AD one can find mention of diphtheria, then called “strangulated loop” or “deadly ulcer of the pharynx.” The first vaccination was made and used on a person by Emil Bering. On December 26, 1891, he saved the life of a sick child by giving him the first diphtheria vaccination. By the way, the first vaccination was made from the serum of a guinea pig that had recovered from diphtheria. And all previous studies were conducted on these animals. After this, Emil Roux began to make vaccinations for large-scale use not from the serum of guinea pigs, but used the blood of immunized horses. Thanks to this vaccine, the mortality rate from diphtheria dropped to 1%. The diphtheria toxoid now in use was discovered only in 1923 by Gaston Ramon, who was a biologist and veterinarian by training.

Diagnostics

Diagnostics includes an assessment of the clinical picture, instrumental and laboratory studies.

The doctor examines the patient’s pharynx, assesses the condition of the lymph nodes, their mobility and soreness.

In the process of collecting anamnesis, the doctor clarifies whether vaccination was carried out and whether there were contacts with patients with diphtheria.

Laboratory research:

clinical blood test;
biochemical research;
general urine analysis;
determination of antibodies to infection;
swab from the throat and nose to determine the pathogen.

Instrumental methods:

Ultrasound of the kidneys;
Ultrasound of the abdominal organs;
radiography of the nasal sinuses;
electrocardiography (ECG);
echocardiography (ultrasound of the heart).

Instrumental studies are of an auxiliary nature. With their help, you can determine the development of complications.

What it is?

Diphtheria is an acute infectious disease that is caused by a specific pathogen (infectious agent) and is characterized by damage to the upper respiratory tract, skin, cardiovascular and nervous systems. Much less often, diphtheria can affect other organs and tissues.

The disease is characterized by an extremely aggressive course (benign forms are rare), which without timely and adequate treatment can lead to irreversible damage to many organs, the development of toxic shock and even the death of the patient.

Prevention

The main method of prevention today is to vaccinate children, starting from the age of three months, with individual or combined vaccines along with tetanus and whooping cough. Today, many vaccines are approved for use - the anti-diphtheria component is contained in the combined vaccines DTP produced in Russia, Tetrakok, Bubokok, Infanrix, Infanrix PENTA or HEXA, Pentaxim. In addition, ADS and ADS toxoids, and separately AC toxoid, are released. All of them are used for routine vaccination and revaccination in children and toxoids in adults. Vaccination with combined vaccines is carried out three times, with an interval of one and a half months, starting from the age of three months, and a revaccination is carried out a year later. In addition, revaccination with ADS vaccine is carried out every 10 years to maintain antitoxic immunity against tetanus and diphtheria.

Statistics

The incidence of diphtheria is determined by the socio-economic standard of living and medical literacy of the population. In the days before the discovery of vaccinations, the incidence of diphtheria had a clear seasonality (it increased sharply in winter and decreased significantly in the warm season), which was due to the characteristics of the infectious agent. Mostly children of school age were affected.

After widespread diphtheria vaccine prevention, the seasonal nature of the incidence disappeared. Today, diphtheria is extremely rare in developed countries. According to various studies, the incidence rate ranges from 10 to 20 cases per 100 thousand population per year, and predominantly adults are affected (men and women are equally likely to get sick). Mortality (mortality) for this pathology ranges from 2 to 4%.

Vaccination

Diphtheria vaccination

There is no separate vaccine for diphtheria; it is part of a complex vaccine known as DTP and stimulates immunity against diphtheria, tetanus and whooping cough.

Recommended by WHO and the Ministry of Health of Ukraine for use. Included in the children's state vaccination calendar.

calendar sliver 2018

Source: moz.gov.ua

Adults should be vaccinated every 10 years, provided they have received an adequate course of vaccinations in the past (4 doses at a given time). If for some reason the interval was not observed, there is no need to revaccinate the previous vaccinations already given, the “course” simply continues.

In the media you can find information about the dangers of vaccinations, in particular DTP.
However, the WHO-based Global Advisory Committee on Vaccine Safety (GACVS), which in 2003 established an ad hoc independent working group to evaluate evidence of the harmful effects, if any, of DTP vaccination on child survival, concluded that this information does not have there is no real or indirect evidence behind it.

Complications

Severe forms of diphtheria (toxic and hypertoxic) often lead to the development of complications that are associated with damage to:

1) Kidney (nephrotic syndrome) is not a dangerous condition, the presence of which can only be determined by urine analysis and blood biochemistry. It does not cause additional symptoms that worsen the patient’s condition. Nephrotic syndrome completely disappears by the beginning of recovery;

2) Nerves – this is a typical complication of the toxic form of diphtheria. It can manifest itself in two ways:

Complete/partial paralysis of the cranial nerves - the child has difficulty swallowing solid food, he “chokes” on liquid food, he may see double or the eyelid droops;
Polyradiculoneuropathy - this condition is manifested by decreased sensitivity in the hands and feet (the “gloves and socks” type), partial paralysis in the arms and legs.

Symptoms of nerve damage usually disappear completely within 3 months;

Heart disease (myocarditis) is a very dangerous condition, the severity of which depends on the time the first signs of myocarditis appear. If problems with heartbeat appear in the first week, AHF (acute heart failure) quickly develops, which can lead to death. The onset of symptoms after the 2nd week has a favorable prognosis, since the patient can achieve complete recovery.

Of the other complications, only anemia (anemia) can be noted in patients with hemorrhagic diphtheria. It rarely manifests symptoms, but is easily determined using a general blood test (decreased hemoglobin and red blood cells).

Diphtheria croup

Diphtheria croup has 2 forms: diphtheria of the larynx and diphtheria of the larynx, trachea and bronchi. The latter form is often diagnosed in adults. Among the symptoms, the most pronounced are a strong, barking cough, voice changes (hoarseness), pallor, difficulty breathing, irregular heartbeat, and cyanosis.

The patient's pulse weakens, blood pressure decreases significantly, and consciousness is impaired. After the onset of convulsions, a person may die from asphyxia.

Treatment of the disease

Corynebacterium most often affects children aged 3-7 years, but you can get diphtheria at any age. Recently, cases among adults have become more frequent. Those who have reduced immunity and chronic diseases are especially at risk. Sick people are subject to hospitalization in an infectious diseases hospital, their contacts with the outside world are kept to a minimum in order to prevent further spread of the infection.

A patient with a confirmed diagnosis is injected intramuscularly with anti-diphtheria serum. It prevents the toxin from getting inside the cells. The dosage depends on the severity of the disease:

for mild forms – 20-40 thousand IU;
with average – 50-80 thousand IU;
for severe cases - 90-150 thousand IU, of which 2/3 doses are administered at a time.

Next, antibiotics are prescribed, which are taken for 10-14 days. Local therapy is also indicated - rinsing the throat and nose with special solutions.

For moderate and severe forms of diphtheria, detoxification therapy is carried out with glucose-saline solutions, and glucocorticosteroids are also prescribed. Meals during treatment should be high in calories and fortified. Dishes that have undergone sufficient heat treatment are allowed.

Patients who are carriers of the infection are prescribed a course of antibiotics and restorative therapy.

The last two days of the incubation period and the entire height of the disease, the person poses a threat to others. Even if appropriate treatment is given, it will remain a source of infection for at least four days. And if the disease was mild and the person did not receive anti-diphtheria serum, he is dangerous to others even 2-3 weeks after the symptoms disappear.