Runny nose

Diphtheria symptoms causes. Maintaining good immunity

– acute infectious disease bacterial nature, characterized by the development of fibrinous inflammation in the area of introduction of the pathogen (mainly the upper respiratory tract and the mucous membrane of the oropharynx are affected). Diphtheria is transmitted by airborne droplets and airborne dust. The infection can affect the oropharynx, larynx, trachea and bronchi, eyes, nose, skin and genitals. Diagnosis of diphtheria is based on the results of a bacteriological examination of a smear from the affected mucous membrane or skin, examination data and laryngoscopy. If myocarditis and neurological complications occur, consultation with a cardiologist and neurologist is required.

ICD-10

A36

General information

– an acute infectious disease of a bacterial nature, characterized by the development of fibrinous inflammation in the area of introduction of the pathogen (mainly the upper respiratory tract and the mucous membrane of the oropharynx are affected).

Causes of diphtheria

Diphtheria is caused by Corynebacterium diphtheriae, a gram-positive, non-motile bacterium that has the appearance of a rod, at the ends of which there are grains of volutin, giving it the appearance of a club. The diphtheria bacillus is represented by two main biovars and several intermediate variants. The pathogenicity of the microorganism lies in the release of a potent exotoxin, second only to tetanus and botulinum in toxicity. Strains of bacteria that do not produce diphtheria toxin do not cause disease.

The pathogen is resistant to environmental influences and can survive on objects or in dust for up to two months. It tolerates low temperatures well and dies when heated to 60 °C after 10 minutes. Ultraviolet irradiation and chemical disinfectants (Lysol, chlorine-containing agents, etc.) have a detrimental effect on the diphtheria bacillus.

The reservoir and source of diphtheria is a sick person or carrier who secretes pathogenic strains of the diphtheria bacillus. In the vast majority of cases, infection occurs from sick people; the erased and atypical clinical forms of the disease are of greatest epidemiological significance. Isolation of the pathogen during the period of convalescence can last 15-20 days, sometimes extending to three months.

Diphtheria is transmitted via the aerosol mechanism mainly by airborne droplets or airborne dust. In some cases it is possible to implement contact and household path infection (when using contaminated household items, dishes, transmission through dirty hands). The pathogen is capable of multiplying in food products (milk, confectionery), facilitating the transmission of infection through nutritional routes.

People have a high natural susceptibility to infection; after suffering from the disease, antitoxic immunity is formed, which does not prevent the carriage of the pathogen and does not protect against re-infection, but contributes to more light current and the absence of complications if it occurs. Children of the first year of life are protected by antibodies to diphtheria toxin transmitted transplacentally from the mother.

Classification

Diphtheria varies depending on the location of the lesion and the clinical course into the following forms:

diphtheria of the oropharynx (localized, widespread, subtoxic, toxic and hypertoxic);
diphtheria croup (localized croup of the larynx, widespread croup when the larynx and trachea are affected, and descending croup when it spreads to the bronchi);
diphtheria of the nose, genitals, eyes, skin;
combined damage to various organs.

Localized diphtheria of the oropharynx can occur in the catarrhal, island and membranous form. Toxic diphtheria is divided into first, second and third degrees of severity.

Diphtheria symptoms

Diphtheria of the oropharynx develops in the vast majority of cases of infection with diphtheria bacillus. 70-75% of cases are represented by a localized form. The onset of the disease is acute, the body temperature rises to febrile levels (less often, low-grade fever persists), symptoms of moderate intoxication appear (headache, general weakness, loss of appetite, pale skin, increased pulse rate), sore throat. The fever lasts 2-3 days, by the second day the plaque on the tonsils, previously fibrinous, becomes denser, smoother, and acquires a pearlescent sheen. Plaques are difficult to remove, leaving areas of bleeding mucosa after removal, and the next day the cleaned area is again covered with a film of fibrin.

Localized diphtheria of the oropharynx manifests itself in the form of characteristic fibrinous plaques in a third of adults; in other cases, the plaques are loose and easily removable, leaving no bleeding behind. Typical diphtheria plaques become like this after 5-7 days from the onset of the disease. Inflammation of the oropharynx is usually accompanied by moderate enlargement and sensitivity to palpation of regional lymph nodes. Inflammation of the tonsils and regional lymphadenitis can be either unilateral or bilateral. Lymph nodes are affected asymmetrically.

Localized diphtheria rarely occurs in the catarrhal form. In this case, low-grade fever is noted, or the temperature remains within normal limits, intoxication is mild, and upon examination of the oropharynx, hyperemia of the mucous membrane and some swelling of the tonsils are noticeable. Pain when swallowing is moderate. This is the mildest form of diphtheria. Localized diphtheria usually ends in recovery, but in some cases (without proper treatment) it can progress to more widespread forms and contribute to the development of complications. Typically, the fever goes away on days 2-3, and plaque on the tonsils – on days 6-8.

Common diphtheria of the oropharynx is observed quite rarely, no more than 3-11% of cases. With this form, plaque is detected not only on the tonsils, but also spreads to the surrounding mucous membrane of the oropharynx. In this case, general intoxication syndrome, lymphadenopathy and fever are more intense than with localized diphtheria. The subtoxic form of oropharyngeal diphtheria is characterized by intense pain when swallowing in the throat and neck area. When examining the tonsils, they have a pronounced purple color with a cyanotic tint, covered with plaque, which is also noted on the uvula and palatine arches. This form is characterized by swelling subcutaneous tissue over dense, painful regional lymph nodes. Lymphadenitis is often unilateral.

Currently, the toxic form of oropharyngeal diphtheria is quite common, often (in 20% of cases) developing in adults. The onset is usually violent, with a rapid rise in body temperature to high values, an increase in intense toxicosis, cyanosis of the lips, tachycardia, arterial hypotension. Takes place severe pain in the throat and neck, sometimes in the stomach. Intoxication contributes to the disruption of the central nervous activity, nausea and vomiting, mood disorders (euphoria, excitement), consciousness, perception (hallucinations, delusions) may occur.

Toxic diphtheria of II and III degrees can contribute to intense swelling of the oropharynx, interfering with breathing. Plaques appear quite quickly and spread along the walls of the oropharynx. The films thicken and become coarser, and plaques persist for two or more weeks. Early lymphadenitis is noted, the nodes are painful and dense. Usually the process involves one side. Toxic diphtheria is characterized by painless swelling of the neck. The first degree is characterized by swelling limited to the middle of the neck, in the second degree it reaches the collarbones and in the third it spreads further to the chest, face, back of the neck and back. Patients report unpleasant putrid smell from the mouth, change in voice timbre (nasality).

The hypertoxic form is the most severe and usually develops in people suffering from severe chronic diseases(alcoholism, AIDS, diabetes, cirrhosis, etc.). Fever with tremendous chills reaches critical levels, tachycardia, low pulse, falling blood pressure, severe pallor combined with acrocyanosis. With this form of diphtheria, it can develop hemorrhagic syndrome, progress infectious-toxic shock with adrenal insufficiency. Without proper medical care, death can occur within the first or second day of the disease.

Diphtheria croup

With localized diphtheria croup the process is limited to the mucous membrane of the larynx; in the common form, the trachea is involved, and in descending croup, the bronchi are involved. Croup often accompanies oropharyngeal diphtheria. Increasingly in lately this form of infection is observed in adults. The disease is usually not accompanied by significant general infectious symptoms. There are three successive stages of croup: dysphonic, stenotic and asphyxia.

The dysphonic stage is characterized by the appearance of a rough “barking” cough and progressive hoarseness of the voice. The duration of this stage ranges from 1-3 days in children to a week in adults. Then aphonia occurs, the cough becomes silent - vocal cords become stenotic. This condition can last from several hours to three days. Patients are usually restless; upon examination, pale skin and noisy breathing are noted. Due to the obstruction of air passage, retractions of the intercostal spaces may occur during inhalation.

The stenotic stage turns into asphyxia - difficulty breathing progresses, becomes frequent, arrhythmic until it stops completely as a result of obstruction respiratory tract. Prolonged hypoxia disrupts brain function and leads to death from suffocation.

Nasal diphtheria

Manifests itself in the form of difficulty breathing through the nose. With the catarrhal variant of the course - discharge from the nose of a serous-purulent (sometimes hemorrhagic) nature. Body temperature, as a rule, is normal (sometimes low-grade fever), intoxication is not pronounced. Upon examination, the nasal mucosa is ulcerated, fibrinous deposits are noted, which in the filmy version are removed like shreds. The skin around the nostrils is irritated, maceration and crusts may occur. Most often, nasal diphtheria accompanies oropharyngeal diphtheria.

Diphtheria eye

The catarrhal variant manifests itself in the form of conjunctivitis (mostly unilateral) with moderate serous discharge. General condition usually satisfactory, no fever. The membranous variant is characterized by the formation of fibrinous plaque on the inflamed conjunctiva, swelling of the eyelids and discharge of a serous-purulent nature. Local manifestations are accompanied by low-grade fever and mild intoxication. The infection may spread to the other eye.

The toxic form is characterized by an acute onset, rapid development of general intoxication symptoms and fever, accompanied by severe swelling of the eyelids, purulent-hemorrhagic discharge from the eye, maceration and irritation of the surrounding skin. Inflammation spreads to the second eye and surrounding tissues.

Diphtheria of the ear, genital organs (anal-genital), skin

These forms of infection are quite rare and, as a rule, are associated with the peculiarities of the method of infection. Most often combined with diphtheria of the oropharynx or nose. They are characterized by edema and hyperemia of the affected tissues, regional lymphadenitis and fibrinous diphtheria plaques. In men, diphtheria of the genital organs usually develops in foreskin and around the glans, in women - in the vagina, but can easily spread and affect the labia minora and majora, perineum and area anus. Diphtheria of the female genital organs is accompanied by hemorrhagic discharge. When inflammation spreads to the urethral area, urination causes pain.

Diphtheria of the skin develops in places where the integrity of the skin is damaged (wounds, abrasions, ulcerations, bacterial and fungal lesions) if they are exposed to a pathogen. Appears as gray plaque on an area of hyperemic, edematous skin. General condition is usually satisfactory, but local manifestations can exist for a long time and slowly regress. In some cases, asymptomatic carriage of the diphtheria bacillus is recorded, which is more often characteristic of persons with chronic inflammation of the nasal cavity and pharynx.

Determining the increase in the titer of antitoxic antibodies is of auxiliary importance and is carried out using RNGA. Diphtheria toxin is detected with using PCR. Diphtheria croup is diagnosed by examining the larynx using a laryngoscope (swelling, hyperemia and fibrinous films are noted in the larynx, in the area of the glottis, and trachea). If neurological complications develop, a patient with diphtheria needs to consult a neurologist. If signs of diphtheria myocarditis appear, a consultation with a cardiologist, ECG, and ultrasound of the heart are prescribed.

Treatment of diphtheria

Patients with diphtheria are hospitalized in infectious diseases departments, etiological treatment consists of administering anti-diphtheria antitoxic serum using the modified Bezredki method. In severe cases, intravenous administration of serum is possible.

The complex of therapeutic measures is supplemented with drugs according to indications; for toxic forms, detoxification therapy is prescribed using glucose, cocarboxylase, vitamin C, and, if necessary, prednisolone, in some cases -. If there is a threat of asphyxia, intubation is performed, in cases of obstruction of the upper respiratory tract - tracheostomy. If there is a threat of developing a secondary infection, antibiotic therapy is prescribed.

Prognosis and prevention

Prognosis of localized forms of pulmonary diphtheria and moderate course, as well as with timely administration of antitoxic serum - favorable. The prognosis can be aggravated by the severe course of the toxic form, the development of complications, and late onset. therapeutic measures. Currently, due to the development of means of helping patients and mass immunization of the population, the mortality rate from diphtheria is no more than 5%.

Specific prevention is carried out as planned for the entire population. Vaccination of children begins at three months of age, revaccination is carried out at 9-12 months, 6-7, 11-12 and 16-17 years. Vaccinations are carried out with a complex vaccine against diphtheria and tetanus or against whooping cough, diphtheria and tetanus. If necessary, adults are vaccinated. Patients are discharged after recovery and a double negative bacteriological examination.

Diphtheria is a disease caused by acute infection of the respiratory tract or skin due to injury. In this case, extensive poisoning of the nervous and cardiovascular systems with toxins poses a serious danger. At the same time, the disease in unvaccinated people is more severe and even fatal.

The cause of the disease can be contact with an infected patient, as well as with an object. Pathogenic bacteria are transmitted through the air, household or food movement. The pathogen is often produced in lactic acid products. As a rule, the disease is seasonal, with exacerbation occurring in autumn and winter. There are frequent cases of outbreaks of epidemics occurring as a result of failure of normalized vaccination or persistence of infection in nature.

What is it?

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.

The causative agent of diphtheria

The causative agent of the disease is Corynebacterium diphtheria (see photo). These are quite large rods that have the shape of a slightly curved club. When examined under a microscope, a characteristic picture is revealed: bacteria are arranged in pairs, at an angle to each other, in the form of a Latin V.

Genetic material is contained in a double-stranded DNA molecule. Bacteria are resistant to external environment, withstands freezing well. In drops of dried mucus they retain their vital activity for up to 2 weeks, in water and milk for up to 20 days. Bacteria are sensitive to disinfectant solutions: 10% peroxide kills them in 10 minutes, 60° alcohol in 1 minute, when heated to 60 degrees they die in 10 minutes. Chlorine-containing preparations are also effective in combating diphtheria bacillus.
Infection with diphtheria occurs from a patient or a bacteria carrier who has no symptoms of the disease. Bacteria enter the mucous membrane of the pharynx by airborne droplets, with drops of saliva or mucus of the patient. You can also become infected through contaminated household items and products, or through close physical contact.

The entry points for infection are: mucous membrane of the pharynx, nose, genital organs, conjunctiva of the eye, skin lesions. Diphtheria bacteria multiply at the point of entry, which causes different shapes diseases: diphtheria of the pharynx, larynx, eyes, nose, skin. Most often, corynobacteria settle on the mucous membrane of the tonsils and soft palate.

Development mechanisms

As already mentioned above, the causative agent of the described pathology enters the body, overcoming the protective barriers of the mucous membranes ( oral cavity, eyes, digestive tract). Next, there is an active proliferation of corynebacteria in the region of the entrance gate.

After this, the pathogenic agent begins to actively produce substances that are toxic to the body, which cause disruption in the functioning of many organs and tissues. Among other things, these toxins cause the death of epithelial cells of the mucous membranes (necrosis), followed by the formation of a fibrinous film. It is firmly attached to the surrounding tissues in the tonsil area, and it is not possible to remove it with a spatula during examination of the patient. As for the more distant parts of the respiratory tract (trachea and bronchi), here it is not so tightly fused with the underlying tissues, which allows it to separate and clog the lumen of the airways, leading to suffocation.

The part of the toxin that enters the bloodstream can cause severe swelling of the tissue in the chin area. Its degree is an important differential diagnostic feature that allows diphtheria to be distinguished from other pathologies.

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 Vaccine prevention of diphtheria, 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%.

Classification

Depending on the location of the infection, several forms of diphtheria are distinguished.

Localized, when manifestations are limited only to the site of introduction of the bacterium.
Common. In this case, the plaque extends beyond the tonsils.
Toxic diphtheria. One of the most dangerous forms diseases. It is characterized by a rapid course and swelling of many tissues.
Diphtheria of other localizations. This diagnosis is made if the entry points of infection were the nose, skin, and genitals.

Another type of classification is based on the type of complications accompanying diphtheria:

damage to the heart and blood vessels;
the appearance of paralysis;
nephrotic syndrome.

Nonspecific complications are the addition of a secondary infection in the form of pneumonia, bronchitis or inflammation of other organs.

Incubation period

The incubation period of diphtheria lasts from 2 to 10 days. The patient develops severe intoxication, the temperature rises, the tonsils become enlarged, and the appetite disappears. The patient has difficulty swallowing, suffers from weakness and sore throat.

Diphtheria symptoms

Symptoms of diphtheria in children and adults include general malaise, increased body temperature (up to 38 °C), and sore throat. Often diphtheria in its initial stage can be confused with a regular acute respiratory infection, but after some time (1-2 days) a characteristic coating appears on the tonsils. At first it is whitish and thin, but gradually thickens and becomes gray.

The patient's condition slowly deteriorates, his voice changes; Body temperature is slightly elevated, runny nose and other signs of acute respiratory infections are absent.

Oropharyngeal diphtheria

Oropharyngeal diphtheria is the most common type of disease in adults and children (90–95%). The onset of the disease resembles an acute respiratory infection and occurs with moderate intoxication: the patient feels malaise, headache, and lack of appetite; the skin becomes pale, tachycardia appears, the palate and tonsils swell.

A light film (fibrous plaque) appears on the tonsils, resembling a cobweb, but as the disease progresses (on the second day), the plaque turns gray and thickens; It is quite difficult to remove the film, since the mucous membrane may bleed. After 3–5 days, the diphtheria film becomes loose and easy to remove; the lymph nodes become enlarged, and upon palpation the patient experiences pain.

A dirty white film on the soft palate, a classic sign of diphtheria.

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.

Diphtheria eye

This form of the disease is characterized by weak discharge, inflammation of the conjunctiva, slight increase temperature. The eyelids swell and a purulent secretion is released.

The skin around the eyes is irritated. Symptoms of the disease develop rapidly, damage to other parts of the eye is possible, development of diseases: acute purulent inflammation all tissues and membranes of the eye, lymphadenitis.

Diphtheria ear

Ear damage in diphtheria is rarely the initial form of the disease and usually develops as diphtheria of the pharynx progresses. Corynebacteria can penetrate from the pharynx into the middle ear cavity through eustachian tubes– mucous membrane-covered canals that connect the middle ear to the pharynx, which is necessary for the normal functioning of the hearing aid.

The spread of corynebacteria and their toxins into the tympanic cavity can lead to the development of a purulent-inflammatory process, perforation of the eardrum and hearing impairment. Clinically, diphtheria of the ear can manifest itself as pain and decreased hearing on the affected side; sometimes patients may complain of tinnitus. When the eardrum ruptures from the outer ear canal purulent-bloody masses are released, and upon examination, grayish-brown films can be identified.

Nasal diphtheria

Nasal diphtheria is accompanied by minor intoxication. Breathing is difficult, pus or ichor is released. Swelling of the nasal mucosa, the appearance of ulcers, erosions, and films are observed. The disease often accompanies lesions of the eyes, larynx, and oropharynx.

Diphtheria of the skin and genitals

Corynebacterium diphtheria does not penetrate normal, intact skin. The place of their introduction can be wounds, scratches, cracks, sores or ulcerations, bedsores and other pathological processes associated with a violation of the protective function of the skin. The symptoms that develop are local character, A systemic manifestations are extremely rare.

The main manifestation of skin diphtheria is the formation of a dense fibrin film of grayish color that covers wound surface. It is difficult to separate, and after removal it is quickly restored. The skin around the wound itself is swollen and painful when touched.

Damage to the mucous membranes of the external genitalia can occur in girls or women. The mucosal surface at the site of corynebacterium penetration becomes inflamed, swollen and becomes sharply painful. Over time, an ulcerative defect may form at the site of the edema, which is covered with a dense, gray, difficult-to-remove plaque.

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. Doesn't occur with it 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 of 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 favorable prognosis, since it is possible to achieve full recovery patient.

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).

Diagnostics

The symptoms of diphtheria in children are largely similar to those in adults. However, even knowing them, it is not always possible to understand that the baby is affected by this particular disease without advanced diagnostics.

Therefore, if the pediatrician has even the slightest doubt, as a rule, he prescribes the following tests for the little patient:

Bacterioscopy (when a smear taken from a problem area is examined under a microscope) is a procedure aimed at identifying Corynebacterium diphteriae ( specific bacteria having a certain shape).
Serological study using ELISA, RPGA and others similar methods– a test that helps detect the presence of certain antibodies in the blood serum.
A general blood test is a standard examination that allows you to determine the presence of an acute inflammatory process as such.
Assessment of the titer (level) of antitoxic antibodies in the body. If the result exceeds 0.05 IU/ml, diphtheria can be safely excluded.
Bacterial inoculation of the taken biological material - bacteriological examination, which makes it possible to determine not only the presence of bacteria in the body, but also their resistance to various types of antibiotics and the extent of infection.

Diphtheria in children is diagnosed without problems when, upon examination, films are found on the affected area, whistling noises in the throat and barking cough and other signs characteristic of the disease. However, if at the moment the disease is mild, it is impossible to detect it without the help of the tests described above.

How to treat diphtheria?

Effetvin treatment of diphtheria in children and adults is carried out only in a hospital setting (in a hospital). Hospitalization is mandatory for all patients, as well as patients with suspected diphtheria and bacteria carriers.

The main thing in the treatment of all forms of diphtheria (except for bacterial carriage) is the administration of antitoxic diphtheria serum (PDS), which suppresses diphtheria toxin. Antibiotics do not have a significant effect on the causative agent of diphtheria. The dose of anti-diphtheria serum is determined by the severity of the disease. If a localized form is suspected, serum administration can be delayed until the diagnosis is clarified. If the doctor suspects a toxic form of diphtheria, then treatment with serum should be started immediately. The serum is administered intramuscularly or intravenously (in severe forms).

For diphtheria of the oropharynx, gargling is also indicated disinfectant solutions(octenisept). Antibiotics can be prescribed to suppress concomitant infection, for a course of 5-7 days. For the purpose of detoxification, intravenous drip administration of solutions is prescribed: rheopolyglucin, albumin, plasma, glucose-potassium mixture, polyionic solutions, ascorbic acid. For swallowing problems, prednisolone can be used. For toxic form positive effect gives plasmapheresis followed by replacement with cryogenic plasma.

Prevention of diphtheria

Nonspecific prevention involves hospitalization of patients and carriers of diphtheria bacillus. Those who have recovered are examined once before being admitted to the team.

In the outbreak, contact patients are monitored for 7-10 days with a daily clinical examination and a single bacteriological examination. Their immunization is carried out according to epidemic indications and after determining the strength of immunity (using the serological method presented above).

Diphtheria vaccination

Vaccination against diphtheria is carried out with toxoid, that is, an inactivated toxin. In response to its administration, antibodies are formed in the body not to Corynebacterium diphteriae, but to diphtheria toxin.

Diphtheria toxoid is part of the combined domestic vaccines DTP (associated, that is, complex, vaccine against whooping cough, diphtheria and tetanus), AaDPT (vaccine with an acellular pertussis component) and ADS (diphtheria-tetanus toxoid), as well as “sparing” vaccines ADS-M and AD-M. In addition, the SanofiPasteur vaccines are registered in Russia: Tetracok (against diphtheria, tetanus, whooping cough, polio) and Tetraxim (against diphtheria, tetanus, whooping cough, polio, with an acellular pertussis component); D.T. Vax (diphtheria-tetanus toxoid for vaccination of children under 6 years of age) and Imovax D.T. Adult (diphtheria-tetanus toxoid for vaccination of children over 6 years of age and adults), as well as Pentaxim (vaccine against diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae infection with an acellular pertussis component).

According to the Russian vaccination calendar, vaccination of children under one year of age is carried out at 3, 4–5 and 6 months. The first revaccination is carried out at 18 months, the second at 7 years, the third at 14. Adults should be revaccinated against tetanus and diphtheria every 10 years.

Does the vaccine have side effects?

Numerous studies have proven the possibility of only 4 side effects:

Fever (37-38oC);
Weakness;
Redness at the injection site;
The appearance of slight swelling (after injection).

Do adults need to be re-vaccinated?

WHO does not see this as necessary. However, if you expect contact with a sick person in the near future, consult a doctor. He will order a test to look for antibodies to corynebacterium toxin in your blood. If there are not enough of them, it is recommended to install ADS once.

One of the hardest infectious diseases- this is diphtheria. Many people know what it is. This disease, which affects both adults and children, is difficult not only to treat, but also to diagnose. Diphtheria vaccination is mandatory and is included in the vaccination schedule.

When specific bacteria enter the human body, the rapid development of the disease begins. Diphtheria is acute and requires immediate treatment, otherwise serious complications are possible.

Diphtheria. What is it and why is the disease dangerous?

This disease affects the mucous membranes of the nasopharynx and oropharynx. In addition, general intoxication develops, the nervous and cardiovascular systems suffer. Inflammation is accompanied by the appearance of fibrin films resembling white coating. Diphtheria can be benign in nature, without significant intoxication.

The danger is that this disease can develop asphyxia of the larynx, paralysis of the respiratory tract, toxic myocarditis or acute adrenal insufficiency, which leads to death. For a disease such as diphtheria, vaccination is the best method prevention, which allows you to avoid, if not the disease itself, then at least its complications.

Reasons

The causative agent of the disease is Loeffler's bacillus, which is very resistant to external influences. Under standard conditions, stability remains for two weeks, in water or milk - three weeks, with low temperatures- about five months. During boiling or treatment with chlorine, the pathogen dies within one minute.

You can become infected through airborne droplets from a person with diphtheria or from a healthy carrier of the bacterium. When it comes into contact with the mucous membranes of the nasopharynx, the diphtheria bacillus multiplies at lightning speed. This releases an exotoxin, which, spreading through the bloodstream, provokes damage to the heart muscle, adrenal glands, kidneys and peripheral nervous system. The patient's temperature rises and lasts a long time. Sometimes infection occurs through household items and food products.

Susceptibility to the pathogen is very high. The reason for this is the lack of vaccination, weak immunity, and the relative resistance of the diphtheria bacillus to external influences.

Types and course

Depending on the location, diphtheria of the oropharynx, respiratory organs, and nose occurs. IN in rare cases eyes, genitals, and skin are affected. If several organs are affected simultaneously, this form of the disease is called combined.

The most common form of the disease is oropharyngeal diphtheria (about 95% of cases). Initially, the patient's temperature rises slightly, symptoms of intoxication increase, aches in the joints and bones occur, headache, weakness, pale skin, decreased appetite.

Diphtheria of the oropharynx can be localized, widespread and toxic, hypertoxic.

Most often, the disease occurs in a localized (mild) form. A visual examination at the onset of the disease reveals a white coating on the tonsils with clear boundaries and a smooth structure, the mucous membrane is bright red. After some time, the plaque becomes gray or yellowish gray. It cannot be removed. If you try to do this with tweezers, you will be left with a bleeding wound. Pain in the throat occurs when swallowing.

The common form is less common. It is characterized by the fact that not only the tonsils are covered with plaque, but also the palatine arches, the uvula, the walls of the pharynx, swelling and redness are more pronounced, and the pain is moderate. The plaque disappears after about two weeks.

In the toxic form, there is a rapid increase in temperature to 39.5-41°C, symptoms of intoxication of the body increase, and painful sensations in the abdominal area, severe headaches, drowsiness, apathy, affected organs swell, skin turns pale. A white coating may be found on the tongue. As the disease progresses, a barking cough appears; due to swelling of the larynx, it is difficult for the patient to breathe, and loss of voice is observed.

The hypertoxic form is characterized by more pronounced symptoms of intoxication. The man is in unconscious. If treatment is not started on time, death is possible. Defeat occurs circulatory system, a rash appears on the body, hemorrhages in the mucous membranes, and the gastrointestinal tract.

Diphtheria croup

Diphtheria (true) croup can be localized and widespread. The severity of the disease depends on the degree of respiratory failure.

Signs of laryngeal diphtheria develop gradually. IN catarrhal period The patient develops a barking cough and the temperature rises slightly. After one or two days, the cough becomes stronger, breathing is difficult, and a whistling sound is heard when inhaling.

In the second period - stenotic, the patient is tormented by attacks of spasmodic coughing, which last from 2 to 30 minutes. In this case, the face becomes cyanotic, pallor of the nasolabial triangle, and increased sweating are noted.

After this, an asphyxial period begins, which is characterized by drowsiness, apathy, pale skin, convulsions, and low blood pressure. If the patient is not provided with timely medical care, death will occur.

This form of diphtheria affects young children, the elderly and people with weak immunity, which is caused by alcohol abuse, malnutrition.

Nasal diphtheria

This form of the disease is not so severe. It is characterized by the appearance of a purulent runny nose, the nasal mucosa becomes covered with ulcers, plaque, and the face swells in the area of the cheeks and eyes. The temperature is either within normal limits or slightly elevated, there is no intoxication. The area around the nose is irritated and appears weeping and crusty. In the case of a toxic form of the disease, the subcutaneous tissue of the cheeks and neck swells.

Diphtheria eye

This form of the disease can be confused with ordinary conjunctivitis. The disease is characterized by moderate hyperemia and swelling of the conjunctiva of the eyelid. In the catarrhal form, slight serous-purulent discharge is observed. In the membranous form, gray-white films appear on the conjunctiva, which are difficult to remove, and the temperature is slightly elevated. The toxic form has an acute onset. The eyelids swell, and purulent discharge is observed. The areas of skin around the eyes are irritated and wet, and the tissue around the eye socket swells.

Diphtheria of the skin, genitals, ear

Such forms of diphtheria are rare and most often develop in combination with other types of this disease. All of these options have common manifestations for this disease: swelling, redness of the skin and mucous membranes, fibrinous plaque on the affected area, inflamed and painful regional lymph nodes.

With diphtheria of the male genital organs, the pathological process is concentrated in the foreskin. In women, it can spread to the perineum, anus, and involve the vagina and labia. In this case, the appearance of serous-bloody discharge is possible. There are difficulties with urination, it becomes painful.

With diphtheria of the skin, the pathological process develops in the area where diaper rash, wounds, eczema or fungus are concentrated. A dirty gray coating on the skin and serous-purulent discharge appears. There is no general intoxication observed.

A separate form of the disease can be identified as hemorrhagic diphtheria. What is it? With this form, bleeding from the affected area is observed. For treatment to be successful, it is important to determine whether this is a sign of diphtheria or a normal vascular injury. To do this, you need to pay attention to the condition of the patient and the presence of other symptoms.

Diagnostics

Based on visual inspection by the presence of characteristic films, difficulty breathing with whistling noise when inhaling, barking cough Diphtheria is diagnosed. Diagnostics also includes additional research methods that are used to identify specific strains and diagnose atypical forms diseases.

In such cases, the method used is to take a smear from the patient’s throat for diphtheria. This method allows you to isolate the pathogen and study its toxic characteristics.

The serological method is necessary to determine the degree of immunity, to identify antitoxic and antibacterial antibodies.

Using the genetic method, the DNA of the pathogen is examined.

Treatment of diphtheria

Regardless of the severity of the disease, diphtheria in adults and children is treated exclusively in a hospital setting. The patient must adhere to a diet and stay in bed. In order to neutralize diphtheria exotoxin and stop intoxication of the body, (PDS) is administered. The drug should be administered as early as possible to avoid the development of complications. It is especially effective within 4 days from the onset of the disease. The drug is used even if infection is suspected after contact with a sick person.

In addition, the patient is prescribed a course of antibiotics, which reduces the amount of the pathogen and reduces the symptoms of intoxication. Commonly used are Ampicillin, Amoxicillin, Cephalexin, and Oxycillin. If necessary, hormones (prednisolone preparations), antihistamines (Diazolin, Suprastin, etc.), antipyretics, and vitamins are prescribed.

To prevent stenosis, the ward should be well ventilated, the patient is prescribed warm drinks in the form of tea or milk with soda, steam inhalations. To reduce hypoxia, humidified oxygen is administered through a nasal catheter. If these procedures do not help improve the patient's condition, Prednisolone is prescribed.

If the patient has acute respiratory failure, in this case it is necessary to urgently take measures to remove the films. For this purpose, forceps and an electric suction are used. Too severe cases cannot be avoided surgical intervention. A breathing tube is inserted into the patient's larynx or trachea.

In case of severe toxic diphtheria, diphtheria croup, infectious-toxic shock and other dangerous complications, the patient is hospitalized in intensive care.

Complications

The toxin produced by the diphtheria bacillus is immediately absorbed into the blood, which causes severe and dangerous complications. They are specific (toxic) and nonspecific.

The development of specific ones most often occurs in the toxic form of the disease, although it is also possible in other forms. Complications include myocarditis, neuritis, nephrotic syndrome.

Myocarditis can be early or late. Early may occur at 1-2 weeks of illness. The course is severe, heart failure progresses. Patients experience abdominal pain, vomiting, and increased heart rate. Systolic heart murmur, rhythm disturbances, and a sharp decrease in blood pressure are observed. The liver enlarges and becomes sensitive.

Late myocarditis, which develops at 3-4 weeks, has a more benign course.

A typical complication of diphtheria is early and late peripheral paralysis. In the second week of the disease, early cranial nerve palsy may develop. The patient's voice becomes nasal, there are difficulties when swallowing, and the absence of a reflex from the soft palate. Sometimes the patient cannot read and cannot distinguish small objects.

After 4-5 weeks, late symptoms may occur. Tendon reflexes decrease, muscle weakness, and coordination problems are noted.

If the muscles of the neck and torso are affected, a person cannot be in a sitting position, and it is difficult for him to hold his head up. Paralysis of the larynx, pharynx, and diaphragm may develop. This leads to loss of voice and the appearance of a silent cough, the patient has difficulty swallowing, and the stomach is retracted.

IN acute stage diseases may develop in the urine increased amount protein, red blood cells and white blood cells are higher than normal. In this case, kidney function is not impaired.

Nonspecific complications include pneumonia, otitis media, lymphadenitis, etc.

Forecast

The prognosis depends on how severe the diphtheria disease is, the timing of the start of serum treatment, as well as the development of various complications.

On the second to fifth day of the disease, death can occur mainly due to the toxic form of diphtheria. The cause is infectious-toxic shock and asphyxia. Two to three weeks after the onset of the disease, death can occur from severe myocarditis.

Prevention

It is better to prevent a disease than to treat it, especially one as dangerous as diphtheria. We have already found out what it is, but how can we protect ourselves? The main preventive measure is vaccination, which is carried out according to the scheme, starting from the age of 3 months, in three stages. Vaccination against this disease is included in National calendar vaccinations. Use DPT vaccine or others containing diphtheria toxoid. Adults need booster vaccination to maintain immunity against diphtheria.

Should I be vaccinated against diphtheria? Of course, vaccination is not a guarantee that you will not get sick, but the disease will proceed easily and without serious complications. Revaccination of adults is carried out every ten years.

Proper prevention of diphtheria helps prevent the spread of infection. The patient must be immediately isolated and people who have been in contact with him examined. Identified carriers of Corynebacterium diphtheria are also isolated and the necessary treatment is prescribed.

Quarantine is introduced in kindergartens and schools, and the premises in which the patient was located are disinfected. The patient must remain in the hospital until complete recovery, which is confirmed by two tests with a negative result.

A person who has suffered from the disease develops unstable immunity. Ten years later, he may get sick again, but the disease will be mild.

Failure to comply with the timing of vaccination and revaccination reduces the intensity of anti-diphtheria immunity and creates the preconditions for the development of the disease. In vaccinated people, diphtheria occurs in a mild form, complications are rare.

Diphtheria is hardening, moderate physical activity, good nutrition, staying in the fresh air.

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.

Diphtheria has been known to civilization since ancient times, but the causative agent of the disease was first identified only in 1883. At that time, there was no adequate treatment for diphtheria, which is why most people who became ill died. However, just a few years after the discovery of the infectious agent, scientists developed an anti-diphtheria serum, which made it possible to significantly reduce mortality in this pathology. Subsequently, thanks to the development of a vaccine and active immunization of the population, the incidence of diphtheria was also significantly reduced. However, due to defects in vaccine prophylaxis ( that is, due to the fact that not all people get vaccinated on time) Epidemic outbreaks of diphtheria are periodically recorded in certain countries.

Epidemiology of diphtheria

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 ( increased sharply in winter and decreased significantly in the warm season), which is 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%.

The causative agent of diphtheria

The causative agent of the disease is Corynebacterium diphtheria ( Corynebacterium diphtheriae, Loeffler's bacillus). These are nonmotile microorganisms that can survive for long periods of time at low temperatures or on dry surfaces, which has contributed to seasonal illness in the past. At the same time, bacteria die quite quickly when exposed to moisture or high temperatures.

Corynebacterium diphtheria is killed by:

When boiling– within 1 minute.
At a temperature of 60 degrees– within 7 – 8 minutes.
When exposed to disinfectants– within 8 – 10 minutes.
On clothes and bedding– within 15 days.
In the dust– within 3 – 5 weeks.

In nature, there are many species of Corynebacterium diphtheria, some of which are toxigenic ( produce a substance toxic to humans - exotoxin), but others do not. It is the diphtheria exotoxin that determines the development of clinical manifestations of the disease and their severity. It is worth noting that in addition to exotoxin, corynebacteria can produce a number of other substances ( neuraminidase, hemolysin, necrotizing factor and so on), which damage tissues, causing their necrosis ( death).

Routes of transmission of diphtheria

The source of infection can be a sick person ( the one who has obvious signs diseases) or asymptomatic carrier ( a patient in whose body Corynebacterium diphtheria is present, however clinical manifestations no diseases). It is worth noting that during an outbreak of a diphtheria epidemic, the number of asymptomatic carriers among the population can reach 10%.

Asymptomatic carriage of diphtheria can be:

Transitory– when a person releases corynebacteria into the environment for 1 to 7 days.
Short-term– when a person is contagious for 7 to 15 days.
Long lasting– a person is contagious for 15–30 days.
Protracted– the patient is contagious for a month or more.

The infection can be transmitted from a sick or asymptomatic carrier:

Airborne– in this case, corynebacteria pass from one person to another along with microparticles of exhaled air during a conversation, when coughing, when sneezing.
Contact-household way– this route of spread is much less common and is characterized by the transmission of corynebacteria through household items contaminated by a sick person ( dishes, bed sheets, toys, books and so on).
By food– Corynebacteria can spread through milk and dairy products.

It is worth noting that a sick person is contagious to others with last day incubation period and until corynebacteria are completely removed from the body.

Incubation period and pathogenesis ( development mechanism) diphtheria

The incubation period is the period of time from the introduction of a pathogenic agent into the body until the appearance of the first clinical symptoms diseases. With diphtheria, the incubation period lasts from 2 to 10 days, during which the infectious agent multiplies and spreads throughout the body.

The entry points for the causative agent of diphtheria are usually mucous membranes or damaged skin.

Corynebacterium diphtheria can enter the body through:

nasal mucosa;
mucous membrane of the pharynx;
laryngeal mucosa;
conjunctiva ( mucous membrane of the eye);
mucous membranes of the genital organs;
damaged skin.

After penetration into the human body, the pathogen lingers at the entrance gate and begins to multiply there, releasing an exotoxin consisting of several fractions ( that is, from several toxic substances).

The composition of diphtheria exotoxin includes:

1 faction ( necrotoxin). This substance secreted by the pathogen at the site of its penetration and causes necrosis ( death) surrounding epithelial tissues ( epithelium is the top layer of mucous membranes). Necrotoxin also affects nearby blood vessels, causing them to expand and increase the permeability of the vascular wall. As a result, the liquid part of the blood leaves the vascular bed into the surrounding tissues, which leads to the development of edema. At the same time, the substance fibrinogen contained in plasma ( one of the blood coagulation factors) interacts with necrotic tissues of the affected epithelium, as a result of which fibrin films characteristic of diphtheria are formed. It is worth noting that when the mucous membrane of the oropharynx is damaged, the necrotic process spreads quite deeply ( affects not only the epithelium, but also the underlying connective tissue). The resulting fibrin films are fused to connective tissue and are separated with great difficulty. The mucous membrane of the upper respiratory tract ( larynx, trachea and bronchi) has a slightly different structure, meaning that only the epithelial layer is affected by necrosis, and the resulting films are separated quite easily.
2nd faction. This fraction is similar in structure to cytochrome B, a substance found in most cells human body and providing the process of cellular respiration ( that is, absolutely necessary for cell life). Fraction 2 of the exotoxin penetrates the cells and displaces cytochrome B, as a result of which the cell loses the ability to use oxygen and dies. It is this mechanism that explains the damage to cells and tissues of the cardiovascular, nervous and other body systems in patients with diphtheria.
3 faction ( hyaluronidase). This substance increases permeability blood vessels, increasing the severity of tissue edema.
4 faction ( hemolyzing factor). Causes hemolysis, that is, the destruction of red blood cells ( red blood cells).

Types and forms of diphtheria

Symptoms of diphtheria are determined by the form of the disease, the site of entry of the pathogen, the state of the immune system of the infected person and the type of infectious agent. IN medical practice It is customary to distinguish several types of diphtheria, which are determined depending on several criteria.

Depending on the place of introduction of the pathogen, the following are distinguished:

diphtheria of the oropharynx;
diphtheria of the larynx;

respiratory tract diphtheria;
nasal diphtheria;
diphtheria of the eyes;
skin diphtheria;
diphtheria of the genital organs;
diphtheria of the ear.

It is immediately worth noting that in more than 95% of cases, oropharyngeal diphtheria occurs, while the remaining types of the disease account for no more than 5%.

Depending on the nature of the disease, the following are distinguished:

typical ( filmy) diphtheria;
catarrhal diphtheria;
toxic diphtheria;
hypertoxic ( fulminant) diphtheria;
hemorrhagic diphtheria.

Depending on the severity of the disease, there are:

light ( localized) shape;
diphtheria medium degree gravity ( common form);
heavy ( toxic) diphtheria.

Symptoms and signs of oropharyngeal diphtheria

As mentioned earlier, oropharyngeal diphtheria is the most common form of the disease. This is explained by the fact that in the area of the oropharynx there is important organ immune system - palatine tonsils ( glands). They are a collection of lymphocytes ( cells of the immune system responsible for recognizing and destroying foreign agents). When corynebacteria diphtheria penetrate with inhaled air, they settle on the mucous membrane of the tonsils and come into contact with leukocytes, as a result of which the development of the pathological process begins.

Diphtheria of the pharynx can occur in various clinical forms, which is determined by the strength of the pathogen and the state of the patient’s immunity.

Diphtheria of the pharynx can be:

localized;
catarrhal;
widespread;
toxic;
hypertoxic ( fulminant);
hemorrhagic.

Localized diphtheria

This form of the disease occurs predominantly in people who have been vaccinated against diphtheria. Clinical manifestations of the disease develop acutely, but rarely become severe or protracted.

The localized form of diphtheria can manifest itself:

Plaque on the tonsils. The formation of smooth, shiny, whitish-yellow or gray films located exclusively on the mucous membrane of the tonsils is a characteristic sign of a localized form of diphtheria. The films can be located in the form of islands or cover the entire tonsil. They are difficult to separate ( exposing the bleeding surface of the mucous membrane), and after removal they appear again quite quickly.
Sore throat. Pain occurs as a result of damage to the mucous membrane of the tonsils and the development of an infectious-inflammatory process in it, in which the sensitivity of pain receptors increases ( nerve endings responsible for the perception of pain). The sore throat is stabbing or cutting in nature and worsens when swallowed ( especially solid foods) and subsides slightly at rest.
Increasing temperature. An increase in body temperature is a natural protective reaction of the body, the purpose of which is to destroy foreign agents that have penetrated it ( many microorganisms, including Corynebacterium diphtheria, are sensitive to high temperatures ). The severity of the temperature reaction directly depends on the amount and danger of the pathogen or its toxin that has entered the body. And since in the local form of the disease the total affected surface is limited to the mucous membrane of one or both tonsils, the amount of toxin produced and entering the body will also be relatively low, as a result of which the body temperature will rarely rise above 38 - 38.5 degrees.
General malaise. Symptoms of general intoxication arise as a result of activation of the immune system and the development of infectious and inflammatory processes in the body. This may manifest itself as general weakness, increased fatigue, headaches, muscle pain, drowsiness, and loss of appetite.
Enlarged lymph nodes in the neck. Lymph nodes are collections of lymphocytes that are located in many tissues and organs. They filter lymph fluid flowing from tissues, preventing the spread of infectious agents or their toxins throughout the body. However, with the local form of the disease, the amount of toxin produced is relatively small, as a result of which regional lymph nodes may be normal or slightly enlarged, but painless on palpation ( palpation).

Catarrhal diphtheria

This is atypical ( rare) a form of oropharyngeal diphtheria, in which the classic clinical manifestations of the disease are absent. The only symptom of catarrhal diphtheria may be swelling and hyperemia of the mucous membrane of the palatine tonsils ( that is, its redness as a result of dilation of blood vessels and their overflow with blood). The patient may be bothered by minor pain in the throat, which gets worse when swallowing, but there are usually no symptoms of general intoxication.

It is worth noting that without timely treatment catarrhal diphtheria is prone to progression and transition to more severe forms diseases.

Common diphtheria

The main distinguishing feature of this form of the disease is the spread of plaque and films beyond the palatine tonsils, onto the mucous membrane of the palatine arches, uvula and back wall throats.

Other manifestations of common pharyngeal diphtheria may include:

Symptoms of general intoxication– may be more pronounced than with a localized form of the disease ( patients are lethargic, drowsy, may refuse to eat and complain of severe headaches and muscle pain).
Sore throat– more pronounced than in the localized form.
Increased body temperature– up to 39 degrees or more.
Enlarged cervical lymph nodes– they may be slightly painful on palpation.

Toxic diphtheria

The toxic form of diphtheria develops as a result of excessively rapid proliferation of corynebacteria and the entry large quantity toxins into the systemic circulation, as well as due to pronounced activation of the immune system.

Toxic diphtheria is characterized by:

A pronounced increase in temperature. From the first days of illness, the patient’s body temperature can rise to 40 degrees or more.
General intoxication. Patients are pale, lethargic, drowsy, complaining of severe headaches and aches throughout the body, severe general and muscle weakness. Lack of appetite is often noted.
Extensive damage to the oropharynx. From the first hours of the disease, the mucous membrane of the tonsils, oropharynx and uvula is sharply hyperemic and swollen. Swelling of the palatine tonsils can be so severe that they can come into contact with each other, almost completely blocking the entrance to the pharynx ( thereby disrupting the processes of swallowing, breathing and speech). By the end of the first or second day, a grayish coating appears on the mucous membrane, which is relatively easily removed, but then forms again. After another 2–3 days, the plaque turns into a fairly dense film covering almost the entire visible mucous membrane. The patient's tongue and lips are dry, and there is an unpleasant odor from the mouth.
Sore throat. Severe stabbing or cutting pain can torment the patient even at rest.
Enlarged lymph nodes. Absolutely all groups cervical lymph nodes enlarged, elastic and sharply painful when palpated, when turning the head or during any other movements.
Swelling of the cervical tissue. As the disease progresses, diphtheria toxin spreads to adjacent tissues. Damage to the blood vessels of the neck leads to the development of severe swelling of the subcutaneous tissue of this area, which significantly complicates breathing. Whenever he tries to move his head, the patient experiences severe pain.
Increased heart rate ( Heart rate). Normal heart rate healthy person ranges from 60 to 90 beats per minute ( in children the heart rate is slightly higher). The cause of tachycardia ( increase heart rate) in patients with diphtheria there is an increase in temperature ( When body temperature rises by 1 degree, heart rate increases by 10 beats per minute). It is worth noting that the direct toxic effect of diphtheria toxin on the heart in this form of the disease is rarely observed.

Hypertoxic ( fulminant) diphtheria

This is an extremely severe form of the disease, which is characterized by a lightning-fast course and without timely medical intervention leads to the death of the patient within 2 to 3 days.

Hypertoxic diphtheria is characterized by:

Increased body temperature ( up to 41 degrees or more).
Development of seizures. Cramps are involuntary, persistent and extremely painful muscle contractions. The occurrence of seizures in hypertoxic diphtheria is caused by a pronounced increase in temperature. This causes nerve cells in the brain to malfunction, causing them to send uncontrolled impulses to various muscles throughout the body.
Impaired consciousness. From the first day the patient's consciousness is impaired to varying degrees ( from drowsiness or daze to coma).
Collapse. Collapse is a life-threatening condition characterized by a pronounced decrease in blood pressure in the vessels. The development of collapse occurs primarily due to the entry into the bloodstream of a large amount of diphtheria toxin and the associated dilation of blood vessels. With a critical decrease in blood pressure ( less than 50 – 60 mmHg) blood supply to vital organs is disrupted ( including the brain) and the work of the heart muscle, which can lead to the death of the patient.
Damage to the oropharynx. The mucous membrane is extremely swollen, covered with dense gray films. It is worth noting that with this form of the disease, systemic toxic effects appear earlier than local manifestations.
Decreased amount of urine. Under normal conditions, a healthy adult excretes about 1000 – 1500 milliliters of urine per day. Urine formation occurs in the kidneys as a result of ultrafiltration of blood. This process depends on the value of blood pressure and stops when it drops below 60 mmHg, which is noted with the development of collapse.

Hemorrhagic diphtheria

Characterized by the development of multiple bleedings in the mucous membrane of the oropharynx ( films are soaked in blood), at injection sites. You may also experience nosebleeds, bleeding gums, gastrointestinal bleeding, hemorrhages on the skin. These manifestations occur 4–5 days after the onset of the disease, usually against the background of symptoms characteristic of the toxic form of diphtheria.

The cause of bleeding is a violation of the blood coagulation system. This is due to the toxic effect of diphtheria toxin on platelets ( blood cells responsible for stopping bleeding and normal functioning of the vascular wall), as well as dilation of blood vessels, increased permeability and fragility vascular walls. As a result, small vessels are easily damaged by the slightest physical impact and blood cells escape into the surrounding tissues.

With this form of the disease, signs of myocarditis develop quite quickly ( inflammatory damage to the heart muscle), which can cause the patient's death.

Symptoms and signs of other types of diphtheria

As mentioned earlier, extremely rarely, diphtheria can affect the mucous membranes of the respiratory tract, eyes, genitals and skin. However, these types of disease can also be severe and pose a danger to the patient’s health.

Diphtheria of the larynx and respiratory tract ( diphtheria croup)

Damage to the larynx and respiratory tract by diphtheria is characterized by the development of a necrotic process at the site of entry of the pathogen, resulting in swelling of the mucous membrane and the formation of characteristic diphtheria films. However, if, with damage to the oropharynx, these changes have little effect on the breathing process, damage to the upper respiratory tract can significantly complicate external breathing posing a threat to the patient's life. This is explained by the fact that the formation of diphtheria films in narrow respiratory tracts can lead to their partial closure, thereby disrupting the process of oxygen delivery to the lungs. This, in turn, leads to a decrease in the concentration of oxygen in the blood and insufficient supply to vital organs and tissues, which causes the clinical manifestations of the disease.

Nasal diphtheria

It develops if, during inhalation, the causative agent of diphtheria lingers on the mucous membrane of the nasal passages and does not penetrate the pharynx. This form of the disease is characterized by slow progression of symptoms and mild general manifestations. Serious threat Nasal diphtheria can only occur if corynebacteria spread to the mucous membrane of the pharynx or larynx with the subsequent development of the manifestations described above.

Nasal diphtheria can manifest itself:

An increase in body temperature to 37 - 37.5 degrees. It is worth noting that quite often the temperature remains normal throughout the entire period of the disease.
Impaired nasal breathing. Development this symptom associated with swelling of the nasal mucosa, which leads to narrowing of the lumen of the nasal passages.
Pathological discharge from the nose. At first, the discharge may be mucous in nature. In the future, periodic discharge of pus or blood may be observed, and, in some cases, only from one nostril.
Damage to the skin around the nose. Related to negative impact pathological discharge and may manifest as redness, peeling or even ulceration of the skin in the area of the nasolabial triangle and upper lip.

Diphtheria eyes

It is rare, and in the vast majority of cases, only one eye is affected by the pathological process. Local manifestations of the disease come to the fore, and signs of general intoxication are usually completely absent ( extremely rarely, an increase in temperature of no more than 37.5 degrees and slight weakness may be observed).

Diphtheria of the eye manifests itself:

Fibrin plaque on the conjunctiva of the eye. The plaque is grayish or yellowish in color and is difficult to separate. Sometimes the pathological process can spread to the eyeball itself.
The defeat of the centuries. Damage to the eyelids is associated with the development of an infectious-inflammatory process and the expansion of blood vessels in them. The eyelids on the affected side are swollen, tight and painful on palpation. Palpebral fissure at the same time narrowed.
Pathological discharge from the eye. At first they are mucous, and then bloody or purulent.

Diphtheria of the skin and genitals

Corynebacterium diphtheria does not penetrate normal, intact skin. The place of their introduction can be wounds, scratches, cracks, sores or ulcerations, bedsores and other pathological processes associated with a violation of the protective function of the skin. The symptoms that develop in this case are local in nature, and systemic manifestations are extremely rare.

The main manifestation of skin diphtheria is the formation of a dense fibrin film of grayish color that covers the wound surface. It is difficult to separate, and after removal it is quickly restored. The skin around the wound itself is swollen and painful when touched.

Diphtheria ear

Ear damage in diphtheria is rarely the initial form of the disease and usually develops as diphtheria of the pharynx progresses. From the pharynx into the middle ear cavity, corynebacteria can penetrate through the Eustachian tubes, mucous-covered canals that connect the middle ear to the pharynx, which is necessary for the normal functioning of the hearing aid.

The spread of corynebacteria and their toxins into the tympanic cavity can lead to the development of a purulent-inflammatory process, perforation of the eardrum and hearing impairment. Clinically, diphtheria of the ear can manifest itself as pain and decreased hearing on the affected side; sometimes patients may complain of tinnitus. When the eardrum ruptures, purulent-bloody masses are released from the external auditory canal, and upon examination, grayish-brown films can be identified.

Before use, you should consult a specialist.

Almost every resident of Russia can find a record of DTP or ADS on their vaccination certificate. These vaccines make a huge difference - they protect people from early age, from diphtheria. Before the introduction of their mass production, this acute infectious disease was one of the most common reasons child mortality in the world. Due to the lack of human immunity, corynebacteria toxins quickly affected various organs, leading to their failure, the development of shock and death.

Fortunately, in modern world diphtheria in children and adults has a completely different prognosis and course. Vaccination has radically changed the situation, significantly reducing the prevalence of the disease. Developed medicines and medical tactics make it possible to successfully cope with diphtheria in 96% of cases. Diagnosis of the disease is also not difficult, since the mechanism of development and the cause of this pathology are precisely known.

A little about bacteria

The causative agent of diphtheria is Corynebacteria diptheriae. It is quite stable (survives drying and low temperatures) and is well preserved in apartment conditions. To get rid of it, you will need to boil water for about 1 minute, and treat household items or walls with disinfectants (bleach, phenol, chloramines, etc.) for at least 10 minutes. There are many forms, but the symptoms and treatment of diphtheria do not depend on it.

Cause and predisposing factors

Diphtheria develops for only one reason - contact with a patient or carrier of the infection. It should be noted that in the first case (through contact with a patient), the probability of becoming infected is 10-12 times higher, but this situation occurs much less frequently. Since 97% of Russians, according to Professor V.F. Uchaikin, vaccinated, bacteria carriers are the main sources of diphtheria.

The infection is transmitted from the source in two ways:

Airborne: sneezing, coughing, blowing your nose, when droplets of sputum with bacteria fall on the mucous membranes or skin wounds of another person;
Contact and household: sharing common objects/clothing with an infected person, sharing food - due to the sedimentation of bacteria in the environment.

It should be noted that diphtheria does not affect healthy and vaccinated people. Predisposing factors that occur before infection are:

Lack of timely vaccination (vaccination - DTP or ADS);
Age from 3 to 7 years - during this period of development, the mother no longer feeds the child with milk, so he loses her antibodies. And your own immunity, at the moment, is just being formed;
Weakening of the immune system for any reason (at the end menstrual cycle; after past illness; the presence of hypothyroidism, HIV, blood tumors, etc.);
A large period of time elapses after vaccination without contact with patients (as immunity against diphtheria weakens). For an adult to get sick, this factor must be combined with a decrease in immunity.

The presence of the above factors leads to one of the forms of diphtheria. Since the disease is transmitted by airborne droplets, it spreads quickly in confined spaces and limited groups, in the presence of susceptible people.

Risk groups for the spread of infection are:

any organized groups where unvaccinated people predominate;
pupils of boarding schools and orphanages;
educational groups (both students of secondary and higher educational institutions, and schoolchildren);
persons serving in the army (usually recruits);
population of third world countries and refugees;
patients on inpatient treatment in psychoneurological dispensaries.

Since diphtheria spreads quite quickly, it is necessary to isolate the patient in a timely manner. It is placed in the wards of an infectious diseases hospital as a “half-box” - with its own bathroom and a tightly closed entrance.

When is a patient contagious?

The incubation period (time from infection to the appearance of the first symptom) can take up to 10 days. On average - about 2. The patient is dangerous to others, starting from the last day of the incubation period until the pathogen is completely removed from the body, which can only be proven by bacteriological examination.

Classification of diphtheria

In the latest revision of the international classification of diseases, diphtheria is divided only by location:

Unspecified - can only be in a preliminary diagnosis, since the doctor is obliged to determine the localization of the process;
Throats;
Nasopharynx;
Larynx;
Skin;
The other one includes rare forms that occur in 1-2% of cases (conjunctiva, eyes, ears, and so on).

However, such a classification is not enough to characterize the disease. Russian infectious disease doctors have developed their own principles of systematization, which are used in clinical practice and are used to formulate a diagnosis:

Principle of classification	Forms
By location	Diphtheria of the upper respiratory tract (larynx, oropharynx and nasopharynx) Diphtheria of the lower respiratory tract (diphtheritic croup). Occurs in less than 1% of cases, so upper respiratory tract involvement will be considered further.
By prevalence	Localized - limited to only one area (usually in the pharynx); Widespread - covers several areas.
Based on the presence of toxin in the blood and severity of symptoms	Non-toxic; Subtoxic (virtually absent - the body’s immunity successfully copes with the toxin); Toxic; Hypertoxic.

Separately allocate hemorrhagic form, which is accompanied by bleeding from the affected area. For successful treatment, it is important to understand that this is a sign of diphtheria, and not just a vessel injury. To do this, it is enough to pay attention to the patient’s condition and other symptoms.

Symptoms of various forms of diphtheria

Most vaccinated people have asymptomatic diphtheria. They become bacteria carriers and can infect an unvaccinated person, but this probability is 10-12 times less than during contact with a sick person. If bacteria get on the mucous membranes of a susceptible person, then the classic course of diphtheria begins. The first signs of diphtheria are usually:

redness of the tonsils;
acute pain when swallowing;
formation of a diphtheritic film: smooth, shiny, gray or whitish-yellow. It is not possible to separate it from the skin, since it is quite tightly fused with it. If the patient tears it off, a bleeding wound remains, which is re-covered with film.

Subsequently, other symptoms are added, on the basis of which they were identified various shapes diphtheria. It is important to distinguish them in order to correctly assess the danger to the patient’s life and choose adequate treatment tactics for diphtheria.

Localized diphtheria of the throat

This is a mild form of infection that mainly affects vaccinated children or adults with weakened immune systems. General health suffers slightly. Lethargy, loss of appetite, insomnia, and mild headache may develop. The temperature in 35% of patients remains normal, in the rest it rises to 38-39 o C. Distinctive feature this form of diphtheria – the disappearance of fever within 3 days while local symptoms persist, which include:

Maintaining good immunity

Diphtheria is a disease that is easier to prevent than to treat. Timely actions of parents to create good immunity in a child, will help him avoid acute infection in the future.

Nonspecific measures to prevent diphtheria include maintaining good immunity. To do this, you can use hardening (not earlier than 5 years), moderate physical activity, good nutrition (including vitamins, minerals and other nutrients in the diet), fresh air.

Frequently asked questions from patients (or their parents)

Will a child who has had diphtheria get it again?

The probability of recurrent disease is no more than 5%. And even if this happens, the child will endure light form diphtheria.

Is it necessary to remove the film that forms in the child’s mouth?

Absolutely not. After adequate treatment with antitoxin, it will separate on its own, and in its place there will be new mucous membrane. If a person removes it independently, a wound will form, which will soon be closed again with this film.

Why do some unvaccinated children develop the toxic form, while others develop only the common form?

This is determined by the state of the child’s immunity. If it is well developed and the child has not suffered from other infectious diseases in the near past, more likely development of a common form.

The vaccination is quite expensive, and they write on the Internet that it is ineffective - is it worth getting it at all?

Clinical studies by WHO and Russian infectious disease specialists have proven the effectiveness of DTP and ADS vaccines. This vaccination has an average cost of 600-800 rubles in Russia, which can become a problem for the family budget (especially large families). However, a child's coffin costs much more than DTP. And the likelihood that parents of a child without a vaccine will need it increases significantly.