• Diphtheria - Causes, symptoms and treatment. MF.

    Diphtheria is an acute infectious disease caused by Corynebcterium diphtheria( Lefler's stick), manifested by inflammation of the oropharynx with the formation of fibrin films in the form of a white coating and with heavy concomitant general intoxication.

    The causative agent is significantly stable in the external environment: under standard conditions( up to 15 days), resistant to low temperatures( up to 5 months in autumn-winter time), in water and milk persists up to 3 weeks. When treated with disinfectants( chlorine) and boiling dies within a minute.

    Causes of diphtheria

    The source of the infection is a sick person or carrier of toxigenic strains( the type of causative agent causing the disease), their count increases to 40% on the territorial foci of infection. There is a carrier of non-toxic strains( diphtheria), ie they are not dangerous to others. Ways of infection: airborne, contact-household( through household items), food. Seasonality is autumn-winter, but there is a periodicity of epidemics, and not individual outbreaks, this is due to negligent attitude towards vaccine prevention both from the medical staff and the population, and this is explained by an increase in the number of persons who have lost the antitoxic immunity acquired intime of vaccination and / or revaccination. Causes of infection:

    • Violation of vaccine prophylaxis is the main cause of epidemic outbreaks of
    • Immunodeficiency disorder of
    • Relative resistance of pathogen in external environment.

    Symptoms of diphtheria

    The structure and properties of the pathogen always predetermines the dynamics of the course of the disease, complications and outcome, and on the basis of this knowledge create vaccines and prescribe treatment. Also in the case of diphtheria, it has the order of 12 pathogenic( causing symptoms) factors, due to which it is an extremely dangerous infectious disease in terms of frequent complications and high mortality.

    The main symptoms of diphtheria will be determined in stages( introduction, reproduction, propagation of the pathogen):

    From the moment of infection, to the first clinical manifestations, it lasts from 2-10 days( incubation period) - after this period symptoms appear abruptly( the stunted form is rare).During the days of the incubation period, the pathogen penetrates and multiplies at the entrance gate( oropharynx, respiratory tract, eyes, genital organs and skin microdamages), more often it is the oropharynx. During this period, the diphtheria bacterium, entering the epithelial cells of the mucous layer, begins to cause tissue cells to separate from each other and by blocking SIgA( secretory immunoglobulin A) by suppressing the synthesis of their protein fractions-that is, damage to the first defense line. In parallel, exotoxin( namely necrotoxin) starts to act - it kills tissues, causing edema of tissues with effusion of exudate( intercellular fluid), this exudate begins to turn into fibrin under the influence of necrotic substances from dead epithelial cells, fibrin deposits on tissues, and separated from ittissues is almost impossible, because the swelling of the exudate comes from the deeper layers and converts it into fibrin also occurs. Externally, this manifests itself as a buildup of a yellowish coating on the mucous membranes.

    Fibrin plaque in diphtheria

    Before the appearance of white-yellow fibrin deposit on the tonsils, there are no other symptoms, but after - an acute onset accompanied by catarrhal manifestations( fever to 38-39, malaise, moderate sore throat, moderateenlargement of the submaxillary lymph nodes, edema of the tonsils).

    The formation of this film is a "visiting card" of diphtheria, but the danger is that the same fibrin film can cause damage to the trachea with the underlying bronchial tubes, causing aspiration( blockage of the airways) and the lethality in this case is very high, because the film withtrachea and bronchi often leaves easier due to the structural features of the epithelium. Symptoms in this case are increasing more rapidly, death may occur by the end of 4 days, if not to take resuscitation measures, and the successively changing character of coughing comes to the fore: voice hoarseness with its subsequent disappearance - rough cough - barking cough - silent, with noisy breathing.

    As the pathogen spreads, regardless of the form of the disease( affecting the tonsils, trachea with bronchial tubes or associated lesions), the pathogen and its toxins spread through the blood, affecting the target organs( myocardium, kidneys, peripheral nerves, cells of the cortical and medulla of the adrenal glands)- causing the corresponding symptoms and complications on the part of these organs.

    Diagnosis of diphtheria

    Diagnosis "Diphtheria" is primarily a clinical one, ie often enough examination of the oropharynx. Additional laboratory methods are necessary for atypical flow and for the determination of strains, with the question of the removal of the diagnosis.

    Laboratory methods:

    • Bacteriological( taking a swab from the oropharynx on the border of healthy tissue and fibrin films) - this method is effective within 2-4 hours from the time of taking the material and using it to isolate the pathogen and determine its toxic properties. After this analysis and write, there is a causative agent or not.

    Excite diphtheria under the microscope

    • Serological - to determine IgG and M, which indicate the intensity of immunity, the definition of antitoxic antibodies and antibacterial antibodies( with the help of RNGA).For more accurate determination of antidiphtheria immunity, it is better to use ELISA, because it indicates more sensitivity / immunity, both for postvaccinal and for natural. Also for the differentiation between them - determine whether the natural is immunity, or post-vaccination. The determination of IgG and M will speak about the severity of the process: G is a recently transferred disease, M is acute.

    • Genetic method - PCR, to determine the DNA of the pathogen.

    The diagnosis of complications is also necessary: ​​

    • If carditis is suspected: ECG, phonocardiography, ultrasound of the heart;Study of the activity of lactate dehydrogenase, creatine phosphokinase, aspartate aminotransferase.

    • If nephrosis is suspected: OAM, UAC, biochemical blood test( determination of creatinine and urea), ultrasound of the kidneys.

    Treatment of diphtheria

    1. Antitoxic antidiphtheria serum. The earlier her appointment, the less complications. Especially it is effective in the first 4 days from the onset of symptoms or even better if suspected of being infected after contact with a patient with diphtheria.
    2. Antibiotics from the group of macrolides, aminopenicellins, cephalosporins of the 3rd generation. The course of treatment of antibiotics within 2-3 weeks
    3. Local treatment: interferon ointment( immunomodulator), hemotripsin ointment, neovintin. These drugs are used until the disappearance of fibrin plaque.
    4. Antihistamines( ketotifen, cytirizine)
    5. Symptomatic treatment( depending on what organ or system is affected)
    6. Antipyretic
    7. Multivitamins
    8. Membrane-protective antioxidants( membrane stabilizers that protect them from free radical oxidation)
    9. Desintoxication therapy by conducting fluid media( reopoliglyukin)
    10. Hemosorption, plasmapheresis, GCS( glucocorticosteroids - hormone therapy).Items 8-10 are used in hospitals, intensive care units or intensive care units.

    Nutrition and rehabilitation for diphtheria

    Strict bed rest for 3 weeks, after which it is necessary to register with a cardiologist to identify late complications. Gentle eating regimen, with a decrease in the use of hyper -ergic products.

    Complications of diphtheria

    Myocarditis, toxic nephrosis, soft palate paresis, generalized polyneuropathies, infectious-toxic shock, edema of the brain, pneumonia.

    Prevention of diphtheria

    Nonspecific prevention involves hospitalization of patients and carriers of diphtheria bacillus. Recovered before admission to the team are examined once. In the outbreak for contact patients, medical observation is established for 7-10 days with a daily clinical examination with a single bacteriological examination. Their immunization is carried out according to epidemiological indications and after determining the intensity of immunity( using the serological method presented above).

    Specific prophylaxis:

    • Use of DTP vaccine from 3 months of age three times, with an interval of 1.5 months. And then a year or a half later they are revaccinated. When vaccination and revaccination, contraindications are observed: if there are contraindications to the use of DTP( transferred whooping cough, with primary vaccination - if it for any reason passes at the age of 4-6 years) - then apply ADS-anatoxin.

    • ADS-M is used for routine age-specific revaccination( at 6 years, 17 years, and every 10 years for adults), for primary vaccination of the unvaccinated over 6 years( make 2 inoculations at 45-day intervals, then at 9 months and at 5years, then every 10 years).ADS-M is used for children with strong temperature responses to ADS and DTP.

    Doctor's consultation on diphtheria

    Question: "Can I treat myself?"
    Answer: no, otherwise it can cause epidemic and complications from target organs. To the doctor to address necessarily, as similar plaques can be and at other originators, but for their differentiation the clinical experience is necessary.

    Question: "What are the contraindications to vaccination and revaccination?"
    Answer: in case of mild manifestations of acute respiratory viral infection, vaccination can be carried out after normalization of temperature;with moderate and severe form - 2 weeks after recovery. Also it is impossible to inoculate during the period of exacerbation of chronic diseases, it is necessary to wait for remission.

    Physician therapist Shabanova IE