Diphtheria

Diphtheria is an acute bacterial infection that occurs with intoxication, damage to the cardiovascular system, nervous and renal. Currently, it is considered a controlled infection due to total vaccination in the post-war period with the drug AKDS.

ETIOLOGY
The causative agent of diphtheria is a corinobacterium that forms a strong exotoxin. There are several types of pathogens: Gravis, mitis, intermedius. The bacterium is well resistant in the external environment – it remains viable for up to 2 months, but it is quickly inactivated (13 minutes).

The source of the disease is both a sick person and a carrier. The mechanism of transmission of infection is aerogenic, the ways are airborne, contact-household, alimentary (food)

Exotoxin of corinobacteria leads to the formation of a fibrin film. The film is formed as a result of epithelial necrosis. Dense, gray-pearl color.

SYMPTOMS OF DIPHTHERIA
There are 3 forms of diphtheria and 1 emergency condition.

Oropharyngeal diphtheria. The patient has fever for 1-2 days, headache, weakness. Pain when swallowing, which makes it difficult to eat. Lymph nodes are slightly painful, do not bring discomfort, are mobile. The skin is pale. Tachycardia is observed. Characteristics of the plaque: dense, smooth, soldered with the underlying layers. The plaque is hardly separated with a spatula from the tonsils, when separated, the mucosa bleeds in the form of “drops of red dew”. The plaque is not rubbed with a spatula, it sinks in water (heavy fibrin films). A specific smell is observed from the patient’s mouth – “sweet apples”. This form of diphtheria has the most benign course. Intoxication disappears, the plaque disappears after 6-8 days.
The common form is characterized by the further spread of plaque beyond the tonsils, a more pronounced intoxication syndrome.
The toxic form most often occurs in adults. Fever sets in from the first hours of illness. The condition is of moderate severity, severe. Painful trism of the masticatory muscles, nasal voice, lymph nodes are dense, enlarged, painful. Fibrin films fall off under their own weight, closing the lumen of the throat. If no help is provided, such a patient has an urgent condition – diphtheria croup.
DIPHTHERIA (TRUE) CROUP.
Croup is characterized by a triad of symptoms – hoarse voice, barking cough, increasing shortness of breath.

STAGES OF DIPHTHERIA CROUP:
Dysphonic – barking cough. Lasts from 1 to 3 days
Stenotic – a soundless voice, disappears. Lasts up to 3 days
Asphyxiated – breathing is frequent, shallow, acrocyanosis, cyanosis, thready weak pulse, falling blood pressure
DIAGNOSIS OF DIPHTHERIA
The leading method is laboratory diagnostics. It includes a bacterial smear-seeding from the tonsils, tongue, and back wall of the pharynx. The serological method is also used – RGNA, PCR

TREATMENT OF DIPHTHERIA
Treatment of diphtheria always begins with the introduction of anti-diphtheria serum by the Bezredke method. The patient is hospitalized in the infectious department, antibacterial therapy is prescribed, detoxification measures are carried out, in severe cases glucocorticosteroids are used. Strict bed rest, warm frequent drinking, steam inhalations, diet therapy for the period of fever are prescribed.

COMPLICATIONS
Myocarditis – may occur at the end of the first week. Therefore, the patient is forbidden to turn over in bed on his own, get up.
Toxic nephrosis and renal failure
Peripheral paralysis – nasal voice, inability to read, impaired coordination of movements.
PREVENTION
Specific prevention is the introduction of the DPT vaccine according to the vaccination calendar. The first vaccination is carried out in 3 months, the second – 4.5 months, the third in 6 months. The first revaccination is at 18 months. Then, at 7 years of age, the drug ADS-M is introduced, at 14 years of age, then every 10 years, the revaccination is repeated.

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