Diphtheria - Causes, Symptoms and Treatment .MF .
Diphtheria - an acute infectious disease caused by Corynebcterium diphtheria (stick Leffler), manifested by inflammation of the oropharynx with the formation of fibrin films in the form of white flight and severe concomitant general intoxication.
Pathogen considerably stable in the environment: under standard conditions (15 days), is resistant to low temperatures (up to 5 months in the autumn-winter), water and milk is stored up to 3 weeks.In the treatment of disinfectant (chlorine) and boiling die within minutes.
The source of infection is a sick person or carrier of toxigenic strains (type of pathogen that causes the disease), and their number increases to 40% in the regional centers of infection.There is no carrier toxigenic strains (diphtheroids), ie they are not dangerous to others.Ways of infection: airborne, contact-household (through household items), food.Seasonality - autumn and winter, but it happens and the frequency of epidemics, rather than individual outbreaks, it is
• violation of vaccination - a major cause of epidemic outbreaks
• violation of the immune system •
relative stability of the pathogen in the environment.
Symptoms of diphtheria
Structure and properties of the pathogen always determines the dynamics of the disease, complications and outcome, and on the basis of this knowledge to create a vaccine and administered treatment.Also the case with diphtheria - it has about 12 pathogenic (causing symptoms) factors, due to which it is extremely dangerous infectious disease in terms of frequent complications and a high mortality rate.
main symptoms of diphtheria will be determined by a landmark (introduction, reproduction, distribution of the pathogen):
From the moment of infection until the first clinical manifestation is held from 2-10 days (the incubation period) - at the expiration of this period, sharply poyavlyayuts symptoms (Sturt form is rare).During the incubation period, there is penetration and propagation of the pathogen at the site entrance gate (oropharynx, respiratory tract, eyes, genitals and skin microdamages), more often it oropharynx.During this period, the diphtheria bacterium, getting on the mucosal epithelial cell layer begins to cause a separation between tissue cells and by blocking SIgA (secretory IgA) by suppressing the synthesis of protein fractions - ie there is a damage to the first line of defense.At the same time begins to act exotoxin (namely nekrotoksin) - he sacrificed tissues, causing swelling of the tissues with effusion of fluid (interstitial fluid), the exudate starts to turn to fibrin by the action of necrotic substances from dead epithelial cells, fibrin formation rests on the tissue, and, to separate it fromtissue is almost impossible, because exudation of fluid comes from glublezhaschih layers and transform it into fibrin occurs as well.It is manifested as an increase yellowish deposits on mucous membranes.
Fibrin plaque in diphtheria
Before the advent of the white-yellow fibrin plaque (film) on the tonsils, and other symptoms NoNo, but after - acute onset, accompanied by catarrhal symptoms (fever up to 38-39, malaise, moderate painin the throat when swallowing, a moderate increase in submandibular lymph nodes, swelling of the tonsils).
formation of this film is the "hallmark" of diphtheria, but the danger lies in the fact that the same fibrin film can cause damage to the underlying trachea bronchi, causing aspiration (blockage of the airways) and the mortality rate in this case is very high, because the filmwith the trachea and bronchi of the waste is easier because of the peculiarities of the structure of the epithelium.Symptoms in this case are growing rapidly, by the end of 4 days, death can occur if you do not take resuscitation, and at the forefront of the successive nature of cough: hoarseness, followed by its disappearance - a rough cough - barking cough - silent, with the accession of noisy breathing.
With the spread of the pathogen, regardless of the form of the disease (tonsils defeat trachea bronchial or combined lesions), there is a spread of the pathogen and its toxins in blood, affecting organs of the target (the myocardium, kidneys, peripheral nerves, the cell cortex and medulla of the adrenal glands) - causing the corresponding symptoms and complications of these organs.
Diagnosis "Diphtheria" primarily clinical, ie often enough oropharyngeal examination.Additional laboratory methods are needed when an atypical course and to determine the strains with the issue of withdrawal of the diagnosis.
• Bacteriological (taking a swab from the oropharynx at the border of healthy tissue and fibrin film) - this method is effective for 2-4 hours after taking the material and use it isolated the pathogen and determine its toxic properties.After this analysis and write, there is no or pathogen.
Vozbuditei diphtheria under a microscope
• Serological - for the determination of IgG and the M, which indicate the intensity of immunity, the definition of antitoxic antibodies, and anti-bacterial antibodies (using Phragmites).For a more precise definition antidiphtheria immunity, better use of ELISA, because it indicates greater sensitivity / intensity of immunity for post-vaccination, and for the natural.Also to differentiate between them - is determined, it is a natural immunity, or post-vaccination.Determination of IgG and M will be talking about the severity of the process: G- recently moved disease, M- ostroprotekayuschih.
• Genetic Method - PCR for detection of DNA of the pathogen.
also necessary and diagnosis of complications:
• If you suspect carditis: ECG, phonocardiography, ultrasound of the heart;Research laktatdegodroginazy activity of creatine phosphokinase, aspartate aminotransferase.
• If you suspect nephrosis: OAM, KLA, biochemical blood tests (urea and creatinine), renal ultrasound.
Treatment of diphtheria
1. Antitoxic diphtheria serum.The sooner it is prescribed, the less complications.It is especially effective in the first 4 days of the onset of symptoms, or even better if you suspect of being infected after contact with sick diphtheria.
2. Antibiotics from the macrolides, aminopenitsellinov, cephalosporin 3 generations.Course of antibiotics for 2-3 weeks
3. Local treatment: interferon ointment (immunomodulator) hemotripsinovaya ointment neovintin.These drugs are used to the disappearance of fibrin plaque.
4. Antihistamines (ketotifen tsitirizin)
5. Symptomatic treatment (depending on which impressed the organ or system)
8. Membranoprotektivnye antioxidants (membrane stabilizers that protect them from free radical oxidation)
9. Detoxification therapy putёmv conducting liquid media (reopoligljukin)
10. Hemosorption, plasmapheresis, corticosteroids (steroids - hormone replacement therapy).Paragraphs 8-10 are used in hospitals, resuscitation and intensive care.
Diet and rehabilitation in diphtheria
Strict bed rest for 3 weeks, then you need to register with a cardiologist to detect late complications.Gentle diet, with reduced application giperallergennyh products.
Complications of diphtheria
Myocarditis, toxic nephrosis, paresis of the soft palate, generalized polyneuropathy, toxic shock, brain swelling, pneumonia.
Nonspecific prevention involves hospitalization of patients and carriers of diphtheria bacilli.Recovered prior to admission into the team examined once.At the outbreak of the contact set mednablyudenie ill within 7-10 days of the single daily clinical examination bacteriological examination.Their immunization is carried out by epidemic indications and after determining the intensity of immunity (using serological method presented above).
• The use of DTP vaccine from 3 months of age, three times, at an interval of 1.5 months.And then after a year or 1.5 revaccination is carried out.When vaccination and revaccination Contraindications observe if there are contraindications to the use of DTP (pertussis transferred at the primary vaccination - if for any reason goes aged 4-6 years) - then use Td toxoid.
• Td is used for the planned age revaccination (6 years, 17 years, and every 10 years for adults) for the primary immunization of unvaccinated older than 6 years (make 2 vaccinations with 45 days interval, then revaccination after 9 months and over5 years, then every 10 years).Td is used for children with strong temperature responses to DT and DTP.
Doctor's consultation on diphtheria
Question: "Is it possible to treat yourself?»
answer is no, otherwise it can cause an epidemic and complications of target organs.To the doctor to address necessarily as similar raids can be with other pathogens, but their differentiation is required clinical experience.
Question: "What are the contraindications to vaccination and revaccination?»
Answer: when the lung manifestations of SARS vaccination can be carried out after the normalization of temperature;when srednetyazhёloy and severe - 2 weeks after recovery.Also it is impossible to vaccinate during the exacerbation of chronic diseases, it is necessary to wait for the remission.
therapists Shabanova I.E