Diphtheria treatment with antibiotics

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DIPHTHERIA

Even when the mouth is closed, the question remains open.

Diphtheria is transmitted by airborne droplets. The diphtheria bacillus causes an inflammatory process, which most often (more than 90% of all cases of diphtheria) is localized in the pharynx[1].

Table of contents:

The disease begins with malaise, fever, and sore throat. This is where the special “meanness” of diphtheria toxin manifests itself - by affecting the nerve endings, it, firstly, causes a condition similar to local anesthesia (i.e., the throat seems to hurt, but not very much), and secondly, the effect of exotoxin on the body is not accompanied by a significant increase in temperature (above 38 ° C is quite rare [2]. Thus, the onset of diphtheria very often imitates not just an ordinary acute respiratory infection, but a mild acute respiratory infection: both the body temperature is low and the throat does not hurt much, and there is not even a runny nose (by the way, the absence of a runny nose is one of the most typical symptoms of diphtheria). All this leads to the fact that, as a rule, no one succeeds in diagnosing the disease in the first day after its onset. But already On the second day, plaque begins to appear in the throat (usually on the tonsils. At first they are thin and light - like a cobweb, but gradually turn gray and become dense, forming films (in Latin film is “diftera”, hence the name of the disease).

It is not difficult to imagine how severe the disease will be if films form not on the tonsils, but in the larynx. Damage to the larynx is accompanied by the development of diphtheria croup[3], which, unlike viral croup, is characterized by:

  • slow development of symptoms and gradual increase in severity of the condition;
  • very pronounced changes in voice;
  • absence of symptoms of ARVI - runny nose, high body temperature.
  • Changes in the throat (inflammation, diphtheria films, pain) are only temporary difficulties that, sooner or later, go away on their own, even without treatment. However, the toxin that the multiplying microbe secretes is very quickly absorbed into the blood and settles in the heart, kidneys and nerve trunks, causing specific complications of diphtheria (myocarditis, nephrosis, polyneuritis, respectively). You should know that it is complications that most often determine the severity of the disease and, sadly, sometimes become the cause of death.
  • Anti-diphtheria serum can only neutralize the toxin that circulates in the blood, but has absolutely no effect on the toxin that has already “connected” with the cells of the heart, kidneys, and nervous system. The information provided logically explains the fact that the success of diphtheria treatment depends, first of all, on the time period from the onset of the disease when the serum is administered. If, for example, the serum is administered on the fifth day of illness, and not on the second, the likelihood of very serious consequences and even death of a person increases 20 times! It follows that prudent parents under no circumstances should show special courage, and in case of any (!) sore throat, any changes in voice, any difficulty breathing, they are obliged to show the child to the doctor. We must not forget that diphtheria is not very common nowadays - many doctors have simply never seen it. Therefore, if your local pediatrician is overcome by doubts about the diagnosis, which may be quite natural, then you should not ignore the referral to the hospital - this is not the disease, diphtheria, to take risks.
  • As is already quite clear, the only real method of prevention is vaccinations. Diphtheria toxoid is part of the famous DPT vaccine (against whooping cough, diphtheria and tetanus). The vaccine does not provide a 100% guarantee of not getting sick, but it almost completely eliminates the possibility of developing severe forms of diphtheria.
  • Mild forms of diphtheria are quite difficult to diagnose, even for a very experienced infectious disease specialist. That is why medical workers are required to take swabs from the throat for absolutely all patients with any sore throat or any croup. It is not at all difficult to isolate the diphtheria bacillus in these smears, and in connection with mass research, two fairly typical situations often arise.
  1. The child had a sore throat; on the second day of illness, the parents called a pediatrician, who diagnosed a sore throat, prescribed treatment and took a smear. After 3-4 days the child’s condition is simply wonderful, he feels well and does not complain about anything. And against the background of this prosperity, the doorbell rings, a pediatrician appears and in a mournful voice tells the parents the “joyful” news - a diphtheria bacillus was found in the smear. The described situation in the overwhelming majority of cases indicates that the child, most likely correctly vaccinated, suffered a mild form of diphtheria. The administration of anti-diphtheria serum in such forms is not at all necessary, but the following is mandatory: firstly, careful observation for 10-20 days in order to promptly identify and treat possible complications from the heart, kidneys or nervous system, and secondly, Treatment with antibiotics is necessary in order to destroy the diphtheria bacillus. It is advisable to do both the first and second in the hospital, if only because the most effective way to prevent complications is to adhere to strict bed rest.
  2. After doctors diagnose someone with diphtheria, the sanitary services will begin to actively work - examining (taking swabs) everyone who has been in contact with the sick person, and this can be hundreds of people - the entire entrance, the entire class, the entire kindergarten, etc. etc. Such work does not go in vain: for one person with diphtheria, as a rule, 5-10 absolutely (!) healthy people are found who have the diphtheria bacillus “living” in their throat or nose. What kind of people are these and why didn’t they get diphtheria? The fact is that a properly vaccinated person, be it an adult or a child, has a sufficient amount of antibodies in the blood that protect him from the disease: the diphtheria bacillus lives in the throat, but the toxin it produces is neutralized in a timely manner and the disease does not occur. Such people, absolutely healthy, but with bacteria in the throat, are called carriers of diphtheria bacillus. It is the carriers who, without knowing it, spread the infection, exposing those who come into contact with them to a constant threat. And that is why carriers are treated and often isolated in an infectious diseases hospital. This is exactly the case when a person suffers not for himself, but for the sake of society. But there is nowhere to go - anyway, with this stick, neither you nor your child will be allowed anywhere - not to kindergarten, not to school, not to work.

First of all, of course, the serum is injected. Antibiotics must be prescribed (most often ordinary erythromycin) - the faster the diphtheria bacillus is destroyed, the less time it has time to produce toxin, firstly, and secondly, it is antibiotics that make a patient with diphtheria and carriers of the diphtheria shelf safe for others.

In case of diphtheria croup, if the patient is not able to cough up the films himself, they are removed - under anesthesia, the larynx is examined using a special device and the films are removed with forceps or an electric suction. In severe cases, intubation or tracheostomy has to be done[4].

When complications develop, there are many ways to help the patient, but, unfortunately, the effectiveness of this help leaves much to be desired. Treatment takes quite a long time (several months), but the consolation is that diphtheria complications rarely leave lifelong traces - that is, if things are getting better, the recovery will be complete, without any special consequences or disabilities.

[1] In addition to diphtheria of the pharynx, there are also rarer forms of the disease - diphtheria of the nose, diphtheria of the eye, diphtheria of the genital organs. Rare forms are usually milder than classic diphtheria of the pharynx. A special case is laryngeal diphtheria, but more about this in the text.

[2] This feature - the absence of high body temperature - is common to all exotoxic infections - diphtheria, botulism, and tetanus. But if the body temperature has risen to high numbers (39 °C and above), then this clearly indicates the significant severity of the disease.

[3] Diphtheria croup is also called “true croup”, and croup due to ARVI is called “false croup”.

[4] Intubation is the insertion into the larynx and trachea (through the mouth or nose) of a special flexible plastic tube through which the patient will breathe. Tracheostomy is the name of the operation. “Almost” the same as intubation, only the tube, naturally much shorter, is inserted directly into the trachea after an incision is made in the neck.

published 02/24/:29

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Diphtheria. Diagnosis, treatment, prevention and complications

Diphtheria diagnostic methods

Smear and culture for diphtheria

Antibody test for diphtheria

Complete blood count for diphtheria

  • An increase in the number of leukocytes ( normal – 9.0 x 10 9 / l ). Leukocytes are cells of the immune system that fight infection. When foreign agents penetrate the body, the number of leukocytes in the blood increases, and after recovery it returns to normal.
  • Determination of erythrocyte sedimentation rate ( ESR ). The sedimentation of red blood cells to the bottom of the test tube occurs at a certain rate, which depends on their number, as well as on the presence of foreign substances in the blood being tested. With the development of the inflammatory process, a large amount of so-called acute phase proteins of inflammation ( C-reactive protein, fibrinogen and others ) is released into the blood. These proteins promote the gluing of red blood cells to each other, as a result of which the ESR increases ( more than 10 mm per hour in men and more than 15 mm per hour in women ).

Differential diagnosis of diphtheria

  • From streptococcal tonsillitis. Angina ( acute tonsillitis ) is an infectious disease characterized by inflammation of the mucous membrane of the pharynx and the formation of purulent plaque on the tonsils ( tonsils ). Unlike diphtheria, angina does not produce fibrin films, and swelling of the tonsils is less intense.
  • From peritonsillar abscess. Peritonsillar abscess is one of the complications of tonsillitis, in which the infection penetrates into the tissue near the palatine tonsil. At the same time, a voluminous purulent focus is formed in the fiber itself, surrounded by a dense capsule. Clinically, this disease is manifested by severe pain in the throat ( increased when swallowing ), severe symptoms of intoxication and an increase in body temperature up to 40 degrees. Anamnesis data will help to distinguish it from a sore throat ( an abscess develops against or after a sore throat ), the absence of fibrin films, the predominant localization of swelling of the pharyngeal mucosa on one side and the rapid improvement in the patient’s general condition after opening the abscess and prescribing antibiotics.
  • From infectious mononucleosis. This is a viral disease that is manifested by fever, symptoms of general intoxication, sore throat, as well as damage to the lymph nodes and liver. You can distinguish mononucleosis from diphtheria by examining the pharynx ( with diphtheria, the plaque is dense and difficult to remove, while with mononucleosis it comes off quite easily ). Also, mononucleosis may be indicated by a generalized ( over the entire body ) enlargement of the lymph nodes, as well as an enlargement of the spleen and liver ( with diphtheria, only the cervical lymph nodes are enlarged ). In the blood during mononucleosis, an increase in the number of lymphocytes and monocytes ( related to the cells of the immune system ) is determined, and cells characteristic of this pathology - mononuclear cells - are also detected.

Treatment of diphtheria

  • specific anti-diphtheria therapy;
  • antibacterial therapy;
  • diet.

Specific therapy for diphtheria

  • For mild ( localized ) forms – 10–20 thousand International Units ( IU ).
  • For diphtheria of the larynx and/or respiratory tract - 40 - 50 thousand IU.
  • For toxic diphtheria - 50 - 80 thousand IU.
  • For hemorrhagic or hypertoxic form - 100 - 120 thousand IU.

With timely initiation of treatment for the local form of diphtheria, a single administration of the drug may be sufficient. At the same time, if you seek help 3–4 days after the onset of development of the toxic form of the disease, the serum may be ineffective even after long-term use in high doses.

  • 0.1 ml of serum is injected intradermally at a dilution of 1:100. The drug is injected into the skin of the anterior surface of the forearm. If after 20 minutes the diameter of swelling and redness in the injection area does not exceed 1 cm, the test is considered negative ( in this case, proceed to the next test ).
  • 0.1 ml of anti-diphtheria serum is injected subcutaneously. The drug is injected into the area of ​​the middle third of the shoulder, and the result is assessed according to the same criteria as during the first test. If after 45–60 minutes no reactions are observed and the patient’s well-being does not worsen, the test is considered negative.
  • The entire dose of serum is administered intramuscularly. After administration, the patient should be under medical supervision for at least 1 hour.

If an allergic reaction is detected at any stage of drug administration, further procedures are stopped. Anti-diphtheria serum can be administered to such patients only for health reasons ( that is, if without the serum the patient is likely to die ). The administration of the drug in this case should be carried out in the intensive care unit, and doctors should be ready to carry out anti-shock measures.

  • reducing the degree of swelling of the affected mucous membranes;
  • reduction in plaque size;
  • thinning plaque;
  • disappearance of plaque;
  • decrease in body temperature;
  • normalization of the patient's general condition.

Treatment of diphtheria with antibiotics

Mechanism of therapeutic action

Directions for use and doses

Blocks components of the genetic apparatus of corynebacteria diphtheria, thereby preventing their further reproduction.

Orally 250–500 mg every 6 hours. For the treatment of healthy carriers of the disease, 250 mg is prescribed every 12 hours. The duration of treatment is determined by the general condition of the patient and laboratory data.

Blocks the synthesis of components of the cell walls of corynebacteria, as a result of which the latter die.

Intramuscularly, 0.5–2 grams 1–2 times a day ( the maximum daily dose should not exceed 4 grams ).

Suppresses the process of reproduction of corynebacteria diphtheria.

Orally 450–600 mg 1–2 times a day.

Diet for diphtheria

What can you use?

What is not recommended to eat?

  • vegetable soups;
  • meat broths;
  • fish broth;
  • cooked meat;
  • mashed potatoes;
  • fruit purees;
  • any porridge;
  • milk;
  • dairy products;
  • warm compote;
  • warm tea;
  • honey ( in limited quantities ).
  • hot drinks;
  • cold drinks;
  • alcoholic drinks;
  • carbonated drinks;
  • mustard;
  • pepper;
  • spicy seasonings;
  • chocolate;
  • sugar in large quantities;
  • candies;
  • ice cream;
  • pure salt;
  • sour fruits ( lemon, orange ).

Emergency care for diphtheria

  • Oxygen administration. Oxygen can be given through a mask or through special nasal cannulas. An increase in the concentration of oxygen in the inhaled air contributes to a more effective saturation of red blood cells with it, even when external respiration is impaired.
  • Removal of fibrin films. In this case, the doctor inserts a special thin tube connected to a suction into the patient's airway, thereby trying to remove the films. This technique is not always effective, since in diphtheria the films are tightly attached to the surface of the mucous membrane and are difficult to separate from it.
  • Tracheal intubation. The essence of this procedure is that a special tube is inserted into the patient’s trachea, through which ( using a special apparatus ) the lungs are ventilated. The patient himself may be conscious or ( if necessary ) in a medical sleep ( induced by medications ). In case of diphtheria, it is recommended to insert the tube through the nose, since when inserting it through the mouth there is a high probability of damage to swollen and enlarged tonsils.
  • Tracheostomy. The essence of this manipulation is as follows. The doctor cuts the trachea in the area of ​​its anterior wall, and then inserts a tube ( tracheostomy ) through the resulting hole, through which the lungs are subsequently ventilated. Tracheostomy is indicated if intubation cannot be performed, and also if fibrin films are located deep in the trachea.

Prevention of diphtheria

Is immunity developed after diphtheria?

Vaccination ( vaccine ) against diphtheria

  • child at 3 months;
  • child at 4.5 months;
  • child at 6 months;
  • a child aged one and a half years;
  • child at 6 years old;
  • a teenager at 14 years old;
  • for adults every 10 years after the previous vaccination.

If for some reason the vaccination date was missed, the vaccination should be performed as soon as possible, without waiting for the next calendar date.

  • Moderate short-term increase in body temperature ( up to 37 - 37.5 degrees ).
  • Mild malaise and increased fatigue for 1 – 2 days.
  • Changes in the skin at the injection site ( redness, moderate swelling and pain ).
  • Severe reactions ( convulsions, anaphylactic shock, neurological disorders ). These phenomena are extremely rare and are more often caused by undiagnosed diseases that the patient has, rather than by the quality of the vaccine.

There are no absolute contraindications to vaccination against diphtheria. A relative contraindication is acute viral respiratory disease ( ARI ) or another infection during an exacerbation. In this case, the vaccination should be performed 10–14 days after the patient’s recovery ( confirmed clinically and laboratory ).

Can children develop diphtheria after vaccination?

Anti-epidemic measures in the outbreak of diphtheria

  • Immediate hospitalization of the patient in an infectious diseases hospital and his isolation. The patient should remain in isolation until complete recovery ( confirmed clinically and bacteriologically ). During the entire period of isolation, the patient must use individual utensils and personal hygiene items, which should be regularly treated with boiling water.
  • A one-time clinical and bacteriological ( taking a swab from the nose and throat ) examination of all persons in contact with the patient. These people should be informed about the length of the incubation period of diphtheria and the first manifestations of this disease. If they experience a sore throat or feel unwell within the next 7 to 10 days, they should consult a doctor immediately.
  • Disinfection of the room in which the patient lived or stayed for a long time ( for example, a school classroom ). After hospitalization of the patient, all surfaces ( walls, tables, floors ) are treated with a disinfectant solution ( chloramine solution, bleach solution, and so on ). Clothes, bedding or toys of a sick child should be disinfected by boiling ( for at least 10-15 minutes ) or soaking in a 3% chloramine solution.

Complications and consequences of diphtheria

  • Nephrotic syndrome. Occurs in the acute period of diphtheria and is characterized by kidney damage, which is manifested by proteinuria ( the appearance of a large amount of protein in the urine ). Specific treatment is usually not required, since the symptoms disappear simultaneously with the elimination of the underlying disease.
  • Myocarditis ( inflammation of the heart muscle ). It can develop 7–30 days after the infection and is clinically manifested by disturbances in the frequency and rhythm of heart contractions, pain in the heart area. In severe cases, signs of heart failure ( a condition in which the heart cannot pump blood ) progress quite quickly. The patient's skin becomes bluish, shortness of breath ( a feeling of lack of air ) increases, and swelling appears in the legs. Such patients should be admitted to the cardiology department of the hospital for treatment and observation.
  • Peripheral paralysis. Paralysis is a complete loss of movement in any part of the body due to damage to the motor nerve innervating that part. Signs of damage to the cranial nerves can be observed 10 to 20 days after the infection. This manifests itself as disturbances in swallowing or speech, visual impairment ( due to damage to the eye muscles ), and damage to the muscles of the limbs or torso. Patients cannot walk, sit upright, if the neck muscles are damaged, they cannot hold their head in a normal position, and so on. The described changes usually disappear after 2–3 months, but in rare cases they can persist for life.

Diphtheria mortality

  • Choking ( asphyxia ). Observed in laryngeal diphtheria 3–5 days after the onset of the disease.
  • Infectious-toxic shock. It is characteristic of toxic and hypertoxic forms of the disease and is manifested by a critical decrease in blood pressure, as a result of which the blood supply to the brain is disrupted and its death occurs.
  • Myocarditis. The development of severe myocarditis followed by heart failure can cause the patient's death 2 to 4 weeks after the infection.
  • Respiratory paralysis. Damage to the nerves innervating the diaphragm ( the main respiratory muscle ) can cause death in the patient several weeks after diphtheria.

Why is diphtheria dangerous during pregnancy?

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Source: http://www.tiensmed.ru/news/difteriya-lecenie2.html

Diphtheria

Description:

Diphtheria is an acute anthroponotic infectious disease with a droplet transmission mechanism, which is caused by diphtheria corynebacteria and is characterized by local fibrinous inflammation (usually the mucous membrane of the oropharynx) and symptoms of general intoxication with primary damage to the cardiovascular and nervous systems.

Causes of Diphtheria:

Diphtheria is caused by bacteria of the species Corynebacterium diphtheriae, characterized by polymorphism, positive Gram staining and complete immobility. The microbe has 2 types of antigens - K (surface antigen, which has pronounced thermolability) and O (thermostable antigen). Diphtheritic exotoxin is second only to botulinum and tetanus in its potency. Heat-labile antigen is an immune protein consisting of 2 fragments - A and B. Their lethal dose is about 100 mg/kg of body.

Diphtheria belongs to the so-called controlled infections. The source of diphtheritic infection is the patient or the carrier. This infection is transmitted by airborne droplets, but the household route is not excluded. In case of wound diphtheria, the contact route is established. The entry gate for corynebacteria is the mucous membrane of the tonsils, and less commonly, the nasopharynx and larynx. There is seasonality in the disease - the peak is observed in winter and autumn.

The modern epidemic process for diphtheria has its own characteristics:

- adults get sick more often;

- many patients have atypical forms, with a mild, blurred course, which are not diagnosed in time;

— the incidence rate is high in large cities.

Diphtheria bacillus - the causative agent of diphtheria

Diphtheria symptoms:

The clinical classification of diphtheria involves division into toxic, subtoxic, manifest and subclinical forms.

The disease is classified according to the location of the diphtheritic process:

- diphtheria of the anterior part of the nose;

According to the nature of the changes visible at the site of the lesion:

- catarrhal (development of edema, hyperemia, and then the appearance of delicate arachnoid layers);

With moderate severity of the disease, moderate intoxication and pale skin are noted. An acute onset with a sharp rise in temperature is possible, fibrous plaques are detected on the mucous membrane. There is serous-purulent discharge with blood, swelling and cyanosis of the mucous membrane. In severe cases, plaque often spreads to the paranasal sinuses. There is severe intoxication, a violent temperature reaction, swelling of the subcutaneous tissue under the eyes, in the cheeks and neck.

Toxic diphtheria of the oropharynx II-III severity

Type of pharynx with diphtheria

Diagnostics:

The manifestation of the disease is characterized by a local inflammatory reaction, the development of the catarrhal process - edema and hyperemia. When the toxin penetrates the cells, foci of local necrosis are formed. At this moment, macrophages are sent to the inflammation zone. On the tonsils and oropharynx, covered with stratified squamous epithelium, necrotic masses are impregnated with fibrin. The formed films are difficult to separate from the mucous membrane, exposing the bleeding surface. The films have a grayish color, and when hemorrhagically impregnated, they become black. If the larynx and trachea are involved in the pathological process, lobar inflammation develops. Here, necrotic masses are easily separated, which can lead to asphyxia. The toxin enters the blood and attaches to target cells. Many organs are targets for diphtheritic infection - heart, adrenal glands, kidneys. After about 1 week, peripheral polyneuritis develops, at the same time myocarditis is affected. In the heart muscle, hemorrhages and blood clots are possible, in the nervous system - myelin disintegration, in the respiratory system - membranous tracheobronchitis, congestive pneumonia.

Treatment of Diphtheria:

The most important part of the pathogenetic treatment of diphtheria is the administration of anti-diphtheria serum. For mild cases, ED is prescribed once. The moderate course of the disease requires the administration of units 1-2 times; if there is no effect from the indicated dose, the administration is repeated. Severe diphtheria is an indication for increasing the dose of serum, which is administered every hour for a total of 00 units, which should be administered over 2 days. A particularly severe form, the so-called hypertoxic form, requires the administration of 00 units for 2 days.

In addition, complex therapy for diphtheria includes the prescription of antibacterial drugs - penicillin 3-6 million units, ampicillin 4-6 g/day, tetracycline 1.6 g/day, and other drugs. The course lasts up to 1 week.

For the purpose of detoxification, intravenous infusions of Trisol solutions, reamberin, resuscitation cocktail, rheosorbilact and other drugs are carried out.

If the development of myocarditis is suspected, bed rest should be prescribed and fluid intake should be monitored. Drug therapy involves the use of steroids, NSAIDs, and metabolic drugs (riboxin, potassium orotate, asparkam, mildronate).

Where to go:

Medicines, drugs, tablets for the treatment of Diphtheria:

Antibiotic of the macrolide group.

JSC Sintez Russia

Antimicrobial agents for systemic use.

HFZ CJSC SPC Borshchagovsky Ukraine

Antibiotic of the macrolide group.

JSC Sintez Russia

Antimicrobial agents for systemic use.

Arterium (Arterium) Ukraine

Antibiotic of the macrolide group.

Astellas Pharma Europe BV (Astellas Pharma Europe B.V.) Netherlands

Antimicrobial agents for systemic use.

CJSC "Pharmaceutical Firm "Darnitsa" Ukraine

FSUE NPO Microgen Russia

Antibiotic of the lincosamide group.

Hemofarm, AD (Hemofarm A.D.) Serbia

Antibiotic of the penicillin group.

JSC "Biokhimik" Republic of Mordovia

Antibiotic of the macrolide group.

Astellas Pharma Europe BV (Astellas Pharma Europe B.V.) Netherlands

Vaccine for the prevention of diphtheria, tetanus, whooping cough.

Glaxo Operetaions UK Limited (Glaxo Operations UK Limited) Great Britain

Antimicrobial drug for systemic use. Macrolide

LLC "Farmland" Republic of Belarus

Antimicrobial agents for systemic use.

CJSC "Pharmaceutical Firm "Darnitsa" Ukraine

Vaccines, serums, phages and toxoids.

FSUE NPO Microgen Russia

Antibiotic of the macrolide group.

OJSC "Borisov Plant of Medical Preparations" Republic of Belarus

Source: http://www.24farm.ru/parazitologiya/difteria/

Diphtheria

Diphtheria is an acute infectious disease that poses a danger to human life. With diphtheria, inflammation of the upper respiratory tract develops, and an inflammatory process of the skin may also begin at the site where there are abrasions, inflammations and cuts. However, diphtheria poses a danger to humans not through local lesions, but through general intoxication of the body and subsequent toxic damage to the nervous and cardiovascular systems. People have known about this disease since ancient times. At different times, the following names were attributed to diphtheria: “Syrian disease”, “deadly pharyngeal ulcer”, “croup”, “malignant tonsillitis”. The disease called “diphtheria” was identified as an independent nosological form in the nineteenth century. Later it received its modern name.

The causative agent of diphtheria

The causative agent of the disease is the rod-shaped gram-positive bacterium Corynebacterium diphtheriae. It can persist in the external environment for a long time, being in dust and on the surface of objects. The source and reservoir of such an infection is a person who suffers from diphtheria or is a carrier of toxigenic strains. Most often, people with oropharyngeal diphtheria become sources of infection. The infection is transmitted by airborne droplets, but in some cases it can also be transmitted through dirty hands or household items, linen, dishes, etc. The occurrence of diphtheria of the skin, genitals, and eyes occurs due to the transfer of the pathogen through contaminated hands. Sometimes outbreaks of diphtheria are also recorded, which arise as a result of the multiplication of the pathogen in food products. The infection enters the human body mainly through the mucous membranes of the oropharynx, and in more rare cases - through the mucous membranes of the larynx and nose. It is extremely rare that infection occurs through the conjunctiva, genitals, ears, and skin.

Features of diphtheria

Diphtheria is a disease that directly depends on the level of vaccination of the population. Today, periodic increases in incidence are recorded, which occur with poor levels of vaccine prevention. Currently, the disease often shifts from childhood: diphtheria affects adults, especially those who, due to their profession, have to interact with a large number of people. As the epidemiological situation worsens, the disease occurs in people in a more severe form and the number of deaths increases. However, in people who have previously received diphtheria vaccinations, the disease is mild and is not accompanied by complications.

Diphtheria symptoms

The incubation period for diphtheria ranges from two to ten days. There are several variants of diphtheria according to its clinical classification. The flow options for these forms are somewhat different. In most cases (approximately 90-95%), both children and adults experience oropharyngeal diphtheria. If this form of diphtheria develops, the symptoms become acute. The patient's body temperature increases, ranging from low-grade to very high. It lasts for two to three days. Signs of moderate intoxication of the body appear. A person complains of headaches and a feeling of general malaise. His skin turns pale, his appetite decreases, and tachycardia periodically occurs. When the patient's body temperature begins to subside, local manifestations of diphtheria, which are noted in the area of ​​the entrance gate of the infection, may become more intense. In the patient's oropharynx there is diffuse congestive hyperthermia, moderate swelling of the tonsils, arches and soft palate. A plaque appears on the tonsils, which is located in the form of a film or in separate islands. In the first hours of the development of the disease, fibrinous plaque looks like a jelly-like mass, later it looks like a cobweb-like film. But already on the second day of illness, the plaque becomes much denser, has a gray color and a pearlescent sheen. If you try to remove that plaque with a spatula, the mucous membrane begins to bleed. Moreover, the very next day a new plaque will appear in the place from which the film was removed. In addition, with diphtheria, symptoms are expressed by enlargement and increased sensitivity of the lymph nodes. An asymmetrical reaction or a unilateral process on the tonsils and enlargement of regional lymph nodes are possible. Very rarely, catarrhal forms of localized diphtheria of the oropharynx are currently recorded. With this form of diphtheria there are a minimum of symptoms. A person experiences only minor discomfort during swallowing, and hypothermia of the oropharyngeal mucosa is slight. In this case, diagnosis may be difficult. With the right approach to treatment, the disease is completely cured. The common form of oropharyngeal diphtheria is diagnosed relatively rarely. If we compare it with the localized form, the difference lies in the spread of plaque not only on the tonsils, but beyond them. With this form of the disease, a person also experiences more pronounced intoxication of the body and all the corresponding symptoms. In the subtoxic form of diphtheria, symptoms of intoxication of the body also occur. The patient complains of pain when swallowing, sometimes pain is also present in the neck area. On the tonsils, painted in a purplish-cyanotic color, a plaque is observed, which may slightly affect the uvula and palatine arches. There is also moderate swelling, tenderness and enlarged lymph nodes. In addition, a feature of this form of diphtheria is the presence of local swelling of the subcutaneous tissue above the regional lymph nodes. A toxic form of oropharyngeal diphtheria is often found among adults. It is characterized by very rapid progression, a sharp rise in body temperature. With this form of diphtheria, pain may occur not only in the throat, but also in the abdomen and neck. In addition, some patients experience vomiting, agitation, delirium, and delirium. The person's skin turns pale, there is pronounced swelling of the oropharyngeal mucosa, and diffuse hyperemia. The plaque spreads to the entire oropharynx, and as the disease develops, the fibrin films become coarser. They do not go away for two weeks or more. If the patient has toxic diphtheria of the third degree, then swelling may appear on the face, on the back of the neck, on the back. There is a pronounced general toxic syndrome. If toxic diphtheria of the oropharynx is accompanied by damage to the larynx and nose, then this disease is especially difficult to treat. The most serious form of diphtheria is the hypertoxic form, which mainly develops in people suffering from alcoholism, diabetes mellitus, chronic hepatitis, etc. In this case, body temperature rises very quickly, sharp symptoms of intoxication of the body, tachycardia, decreased blood pressure, and weak pulse are observed. Hemorrhages may occur in the skin and organs; fibrinous deposits are also saturated with blood. The patient very quickly develops infectious-toxic shock, which can cause death within one or two days after the onset of the disease. With diphtheria croup, it is possible to manifest a localized form of the disease, in which the larynx is affected, and a widespread form, when the trachea, larynx, and bronchi are simultaneously affected. The manifestation of croup occurs in three successive stages - dysphonic, stenotic and asphyxic. The dysphonic stage is characterized by a rough cough and the development of hoarseness. At the stenotic stage, the patient's voice is aphonic, and the cough becomes silent. The intensity of difficulty breathing gradually increases, cyanosis and tachycardia appear. In the asphyxial stage, the patient’s breathing is clear, at first superficial, then rhythmic. Blood pressure drops, pulse is thready, cyanosis increases. A person experiences convulsions, impaired consciousness, and ultimately death occurs from asphyxia. In addition, diphtheria of the nose, eyes, genitals, and ears occurs. Such conditions are rarely recorded in patients.

Complications of diphtheria

A number of severe conditions are identified as complications of diphtheria: infectious-toxic shock, mono- and polyneuritis, myocarditis, toxic nephrosis, adrenal lesions. Such complications sometimes develop with localized diphtheria of the oropharynx, but most often they become a consequence of more severe forms of the disease. Most often, complications occur with toxic diphtheria. The most common complication of toxic diphtheria is severe myocarditis.

Diagnosis of diphtheria

When making a diagnosis, the specialist first of all pays attention to the presence of symptoms characteristic of diphtheria. If the membranous variant of the disease occurs, then diphtheria is much easier to diagnose due to the presence of the fibrinous nature of the deposits. At the same time, it is most difficult to diagnose the island variant of oropharyngeal diphtheria, since the symptoms for this condition are similar to those of angina of coccal etiology. In the process of diagnosing toxic diphtheria of the oropharynx, it is important to differentiate the disease from necrotizing tonsillitis, peritonsillar abscess, and candidiasis. To make a diagnosis, laboratory blood tests and bacteriological studies are performed. To do this, the causative agent of the disease is isolated from the focus of the inflammatory process, after which its toxigenicity and type are determined.

Treatment of diphtheria

If a patient is diagnosed with diphtheria, then he must be immediately hospitalized. Depending on how severe the disease is, the duration of the patient’s inpatient treatment process is determined. The main point in the treatment of diphtheria is the administration of antitoxic anti-diphtheria serum to the patient. Its effect is to neutralize the toxin that circulates in the blood. Therefore, the effect of such a serum is most effective if administered as early as possible. If there is a suspicion that the patient is developing a toxic form of the disease or diphtheria croup, then such serum should be administered immediately. A positive result of a skin test (the so-called Schick test) in a patient is a contraindication to the use of such serum for localized forms of diphtheria. In other cases, the serum is administered, while antihistamines and glucocorticoids are prescribed in parallel. This drug is administered intramuscularly and intravenously. Sometimes, in case of severe and prolonged intoxication, the drug may be re-administered. For detoxification treatment for diphtheria, crystalloid and colloid solutions are used intravenously. Sometimes, in especially severe cases, glucocorticoids are also added to these drugs. The treatment complex also includes vitamins that desensitize drugs. For toxic diphtheria of II and III degrees, severe combined forms of the disease and hypertoxic diphtheria, plasmapheresis is performed. In addition, in some forms of the disease (subtoxic, toxic), antibiotic treatment is used. As an auxiliary treatment for diphtheria of the larynx, it is important to regularly ventilate the room where the patient is lying, give him warm drinks, and do steam inhalations, for which it is advisable to use soda, chamomile, hydrocortisone, and eucalyptus. If hypoxia occurs in patients with diphtheria, to eliminate this phenomenon, humidified oxygen is used through a nasal catheter, and films are also removed with an electric suction. If a patient experiences a number of phenomena indicating a serious condition, surgical intervention (tracheal intubation, tracheostomy) may be used. This is tachypnea more than 40 per minute, tachycardia, hypercapnia, cyanosis, hypoxemia, respiratory acidosis. If the patient develops infectious-toxic shock, further treatment is carried out in the intensive care unit.

Prevention of diphtheria

The main measure to prevent diphtheria is vaccination coverage of the population. It is also important to conduct regular epidemiological analysis and predict the epidemic process of the disease in a specific area. Today, the main method of controlling diphtheria remains vaccine prevention. Vaccinations against diphtheria are carried out with the DPT vaccine for children starting from the third month of life. Children will receive diphtheria vaccinations three times, with the interval between vaccinations being one day. 9-12 months after vaccination, revaccination is carried out. Vaccinations against diphtheria are now also administered to adults. First of all, vaccination is carried out to those who are included in the so-called high-risk groups. These are doctors, students, staff of schools and children's institutions, etc. When vaccinating adults, the ADS-M vaccine is used, vaccinations are done every ten years until the person is 56 years old. Vaccinations against diphtheria are also given to those people who have previously suffered from this disease. There are practically no contraindications for vaccination against diphtheria. At the same time, people who have not received vaccinations in due time and have been in contact with a sick person must be immunized as an emergency. The effectiveness of diphtheria prevention depends directly on the vaccination coverage of the population, as well as on how high-quality the vaccine was used.

Education: Graduated from Rivne State Basic Medical College with a degree in Pharmacy. Graduated from Vinnitsa State Medical University named after. M.I. Pirogov and internship at his base.

Work experience: From 2003 to 2013 – worked as a pharmacist and manager of a pharmacy kiosk. She was awarded diplomas and decorations for many years of conscientious work. Articles on medical topics were published in local publications (newspapers) and on various Internet portals.

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Diphtheria. Causes, symptoms and signs, diagnosis and treatment of the disease

FAQ

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

Diphtheria is an acute infectious disease that causes inflammation of the upper respiratory tract. It is manifested by intoxication and the appearance of dense whitish fibrinous films on the affected areas. Therefore, until the end of the 19th century, the disease was called diphtheria, translated from Latin as “film.”

The disease is caused by the diphtheria bacillus (Klebs-Loeffler bacillus). It is not the bacterium itself that is particularly dangerous, but the toxin it produces. This poison is considered one of the most dangerous. If treatment is not started in a timely manner, it affects the nervous system, heart and kidneys. Severe poisoning with a bacterial toxin can cause death in patients.

The causative agent of diphtheria

  • ensures the binding of bacteria to epithelial cells;
  • causes death of cells of the mucous membrane and skin;
  • disrupts protein synthesis in the cell, leading to its death. Cells of the heart, kidneys and nerve roots are especially susceptible to it;
  • destroys connective tissue, damaging the walls of blood vessels. This leads to the release of the liquid part of the blood through their walls;
  • leads to destruction of the myelin sheath of nerves.

Under the influence of the toxin, the tissue is saturated with a liquid containing a large amount of fibrinogen, which causes swelling. An enzyme from dead cells coagulates soluble fibrinogen and converts it into fibrin. Fibrin fibers form a dense gray-white film with a pearly tint, which rises somewhat above the surface. The film is difficult to remove, and a bleeding surface forms underneath it - the result of necrosis of mucosal cells.

Causes of diphtheria

  • Patient: from the last days of the incubation period until he stops secreting bacteria;
  • Bacteria carrier. Bacteria live on the mucous membrane of his throat, but the body is not sensitive to the toxin and the disease does not develop.

Susceptibility to diphtheria is relatively low. Out of 100 contacts with a patient, a person becomes infected. These are mainly people with reduced immunity and unvaccinated people. Vaccinated people, those who have been ill and those who have been carriers have a lower risk of becoming infected.

  • boarding school students;
  • children from orphanages;
  • recruits;
  • people undergoing treatment in psychoneurological hospitals;
  • refugees;
  • unvaccinated children and adults.

The causes of diphtheria outbreaks are poor hygiene, high overcrowding, decreased immunity, poor nutrition, and insufficient medical care.

Types of diphtheria

  1. Oropharyngeal diphtheria
    1. Localized form - bacteria multiply on the tonsils. This form of the disease develops in 70-80% of patients. It, in turn, has several subspecies.
      • Catarrhal. The palatine tonsils are swollen, slightly reddened, but there are no traces of films. In this case, little toxin is released and it does not cause poisoning (intoxication) of the body.
      • Islanded. The films have the appearance of individual pearl-colored islands. They are located on the convex surface of the inflamed tonsils.
      • Membranous. The surface of the tonsils is covered with dense whitish films.

    At the site of infection, a primary focus develops. The bacteria are subsequently spread to other parts of the body. Thus, a combined lesion of the pharynx and eyes, larynx and genitals occurs.

    Symptoms of oropharyngeal diphtheria

    The temperature rises from the first hours of illness and lasts 7-14 days.

    The pain is less pronounced than with a sore throat. This is because the toxin damages the nerve endings in the throat, making them less sensitive.

    A sore throat appears in the first hours of illness.

    On days 2-3 of illness, a film of fibrin forms. This is a protective reaction of the body designed to stop the proliferation of bacteria - to limit them to a protein “sarcophagus”.

    Symptoms of diphtheria in the common form

    Develops on the 2nd day of illness.

    Symptoms of toxic diphtheria

    Already on the first day of illness, a person cannot eat or swallow liquids. The raids last 5-7 days.

    The swelling has clear boundaries. The affected area rises at a right angle above the healthy mucosa.

    Symptoms of hypertoxic diphtheria

    Symptoms of diphtheria croup or diphtheria of the larynx

    Diphtheria of other localizations

    Diphtheria of the eye 0.3%

    Nasal diphtheria 0.5%

    Diphtheria of the genital organs and skin 0.2%

    The swelling is dense and hard. Develops on days 1-3 of illness.

    Diphtheria of wound surfaces 0.1%

    During what period is the patient dangerous for others (infectious)?

    • in the last days of the incubation period, when there are still no signs of illness;
    • throughout the entire period of illness, until clinical symptoms disappear;
    • for 2-3 weeks after recovery;
    • in some cases, such bacteria carriage can last up to 3 months after recovery.

    How can you become infected with diphtheria?

    A sick person with any form of diphtheria is dangerous to others. Bacteria are spread through droplets of saliva and mucus when speaking. You can also become infected through household contact, when bacteria get through dirty hands onto household items (dishes, towels, bed linen, toys). A patient or carrier can infect people through food, especially dairy products and cream products.

    How to determine whether a patient is contagious?

    If there are symptoms of the disease, then it is dangerous to others in epidemic terms. Diphtheria is indicated by:

    • hoarseness of voice
    • barking or silent cough
    • brown crusts and cracks along the edge of the nostrils or on the upper lip
    • neck swelling
    • whitish films on the tonsils

    In the catarrhal form of diphtheria, these signs may not be present, but the patient is dangerous to others in epidemic terms.

    Hospitalization and care of patients with diphtheria.

    A patient with diphtheria is hospitalized in the infectious diseases department of the hospital. Typically, he will stay in the hospital for 4 weeks. This is necessary so that doctors have the opportunity to constantly monitor him and adjust treatment. This will help prevent serious complications.

    What needs to be done before hospitalization?

    • The patient is isolated in a separate room. He must remain in bed and, if possible, not leave his room.
    • The person caring for the patient should wear a gauze mask.
    • The patient is given personal dishes, which after each use are boiled in a 2% soda solution for 15 minutes after boiling.
    • Underwear and bed linen are also boiled in a soda solution or soaked in a 1% chloramine solution for an hour.
    • Household items and toys are treated with a 0.5% chloramine solution.
    • The room is wet cleaned twice a day with a 0.5% chloramine solution or a 0.2% clarified bleach solution.
    • The room is ventilated every 2 hours. If possible, it is better to leave the window open.

    Measures regarding contact persons.

    • take swabs from the nose and throat - once;
    • examine the mucous membranes of the throat and nose;
    • measure temperature.

    Children who have been in contact are suspended from visiting the children's group for a period of 7 days.

    Treatment of diphtheria

    Antidiphtheria serum

    Antitoxic diphtheria serum is a first aid measure and the only effective treatment for all forms of diphtheria.

    Drug treatment of diphtheria

    The drug of choice for the treatment of patients with diphtheria.

    To alleviate the condition of patients, the following are additionally prescribed:

    • Inhalation with hydrocortisone for breathing problems (125 mg per procedure) or inhalation with moist oxygen
    • Gargling with disinfectant solutions: 0.02% furatsilin, 0.01% potassium permanganate, a solution of soda and salt (a teaspoon of each component per glass of water).

    Nutrition for diphtheria (diet)

    • Soups in weak meat or fish broth with pureed vegetables and cereals.
    • Day-old or dried bread. Well-baked pies with meat, cabbage, jam, no more than 2 times a week.
    • Meat – low-fat varieties, cleaned of tendons. Preferably minced meat products, boiled or fried without crust, sausages.
    • Cereals porridge with water or with the addition of milk.
    • Dairy products: cottage cheese, cheese, fermented milk products. It is advisable to add cream and sour cream to dishes.
    • Vegetables: boiled, stewed, baked into cutlets, ripe tomatoes, finely chopped greens.
    • Confectionery products: jam, marshmallows, marshmallows, caramel.
    • Butter and vegetable oil.
    • Boiled eggs (not hard-boiled), in an omelet or fried without crust.
    • Warm drink. Up to 2.5 liters of liquid.
    • Milk soups, soups with peas or beans.
    • Fresh bread, products made from butter or puff pastry.
    • Duck, goose, fatty meats, canned food, smoked meats.
    • Fatty, smoked, salted fish.
    • Cereals: legumes, pearl barley, barley, corn.
    • Vegetables are raw, pickled, salted. And also garlic, mushrooms, radishes, radishes, sweet peppers.
    • Confectionery products, chocolate or with cream.
    • Cooking fat, lard.

    Is bed rest necessary for diphtheria?

    Can diphtheria be treated at home?

    Consequences of diphtheria

    Timing of occurrence: from the first to the sixth week after the onset of the disease. Myocarditis after diphtheria mainly develops in women.
    1. Early complications may appear during the first 2 weeks:
      • Paresis of the soft palate and larynx - difficulty swallowing, hoarseness, choking during eating, when food pours out through the nose;
      • Paralysis of the eye muscles - the eyeballs move uncoordinated;
      • Facial neuritis – causes facial asymmetry;
      • Paralysis of the diaphragm and respiratory muscles - respiratory arrest;
      • Lesions of the vagus nerve - tachycardia, cardiac arrest due to a violation of its innervation;
      • Paralysis of the cervical muscles - patients cannot hold their head up, it sways from side to side.
    2. Late complications (late diphtheria paralysis) - from the moment of illness it takes from 4 weeks to 3 months. Their development is associated with an immune attack on damaged nerve fiber cells.
      • Paralysis of the limbs - muscle weakness and atrophy, movement disorders, changes in gait;
      • Diphtheria polyneuropathy - extinction of deep reflexes, decreased sensitivity, especially on the hands and feet.

    Prevention of diphtheria

    Vaccines contain a modified bacterial toxin. Once in the body, it provokes the production of a protective antitoxin. Therefore, if suddenly an infection occurs, the bacterial toxin will not be able to harm the body - the antitoxin will neutralize it.

    • isolation of patients;
    • disinfection in the patient’s apartment;
    • examination of everyone who came into contact with him;
    • observation of those who have recovered from the disease to exclude carriage;
    • identification and treatment of diphtheria bacillus carriers;
    • observation and tonsil smears in patients with tonsillitis.

    Answers to frequently asked questions

    Is it possible to get diphtheria again?

    What is the duration of diphtheria and recovery time?

    • Symptoms of diphtheria of the pharynx with proper treatment disappear after 6-8 days, but therapy is continued for at least 2 weeks.
    • Manifestations of common diphtheria persist for days.
    • If there are complications, recovery may take 3-4 months.

    What do patients with diphtheria look like?

    • severe intoxication: weakness, fever, shiny eyes, redness of the lips, blush on the cheeks;
    • a grayish coating or individual round plaques appear on the tonsils, protruding above the mucous membrane, which after 3 days turn into dense films. They are tightly fused to the oral mucosa;
    • the tonsils are significantly enlarged and hyperemic;
    • swelling of the soft palate and uvula is pronounced.

    Thanks to vaccination, diphtheria in most cases is mild. However, complications occur in 10% of cases. Therefore, it is very important to seek medical help promptly.

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    Source: http://www.polismed.com/articles-difterija-prichiny-simptomy-i-priznaki-diagnostika.html