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Diphtheria — an acute illness of infectious character which poses danger for human life. At diphtheria the inflammation of upper respiratory tracts develops, and also inflammatory process of integuments on site where there are grazes, inflammations and cuts can begin. However, diphtheria constitutes for the person danger not defeats of local character, and the general intoxication of an organism and the subsequent toxic defeat of nervous and cardiovascular systems. People know of this illness since the most ancient times. Diphtherias were at different times attributed the following namings: "the Syrian illness", "a fatal ulcer of a throat", "croup", "malignant quinsy". As an independent nosological form the disease with the name "diphtheria" was allocated in the nineteenth century. Later it received the modern name.
Causative agent of diphtheria
Infestant is the rhabdoid gram-positive bacterium of Corynebacterium diphtheriae. It can remain in external environment throughout a long time, being in dust and on a surface of objects. A source and the reservoir of such infection is the person who has diphtheria, or being the carrier of toxicogenic strains. Most often the people sick with stomatopharynx diphtheria become sources of an infection. The infection is transmitted in the airborne way, but nevertheless in certain cases it can be transmitted through dirty hands or household items, linen, ware, etc. also. Developing of diphtheria of skin, generative organs, eyes happens owing to transfer of the activator through kontaminirovanny hands. Sometimes also the outbreaks of diphtheria which arise as a result of reproduction of a disease-producing factor in foodstuff are fixed. The infection gets to a human body mainly through mucous membranes of a stomatopharynx, in more exceptional cases – through mucous a throat and a nose. Extremely seldom hit of an infection happens through a conjunctiva, generative organs, ears, skin.
Features of diphtheria
Diphtheria is the illness directly depending on the level of a privitost of the population. Today periodic rises in incidence which arise at the bad level of vaccinal prevention are fixed. Now often there is a shift of a disease from children's age: those which owing to a profession should be crossed with a large number of people have diphtheria adult, especially. At deterioration in an epidemiological situation the illness proceeds at people in more severe form and at the same time the quantity of lethal outcomes increases. Nevertheless, at people who received diphtheria inoculations earlier the disease proceeds benign and is not followed by complications.
Incubation interval duration at diphtheria makes from two to ten days. There are several options of diphtheria agrees with its clinical classification. Current options at such forms differ a little. In most cases (about 90-95%) both children, and at adults have a stomatopharynx diphtheria. If this form of diphtheria develops, symptoms are shown sharply. At the patient body temperature increases, varying from subfebrile to very high. It remains for two-three days. Symptoms of moderate intoxication of an organism are shown. The person complains of headaches, feeling of a febricula. At it skin turns pale, appetite decreases, periodically there is tachycardia. When the body temperature of the patient begins to fall down, local displays of diphtheria which are noted in the field of entrance infection atriums can become more intensive. In a stomatopharynx of the patient the congestive hyperthermia of diffuse type, moderate hypostases of almonds, handles and a soft palate is noted. On almonds there is a plaque which is located in the form of a film or separate islands. During the first hours courses of a disease the fibrinous plaque is similar to jellylike weight, later he resembles an arachnoid film. But for the second day of an illness the plaque becomes much more dense, has gray color and a nacreous reflection. If to try to remove that plaque by means of the pallet, then mucous begins to bleed. At the same time already next day on that place from where the film was removed to appear the new plaque. Besides, at diphtheria symptoms are expressed by increase and hypersensitivity of lymph nodes. Asymmetrical reaction or unilateral process on almonds and increase in regional lymph nodes is possible. Very seldom now catarral forms of the localized stomatopharynx diphtheria are registered. At this form of diphtheria the minimum of symptoms is noted. At the person only insignificant unpleasant feelings in the course of swallowing, a hypothermia of a mucous membrane of a stomatopharynx small are shown. In this case diagnosis can be complicated. At the correct approach to treatment the disease completely recovers. The common form of diphtheria of a stomatopharynx is rather seldom diagnosed. If to compare it to the localized form, then difference consists in distribution of a plaque not only on almonds, but beyond their limits. At this form of a disease at the person also more expressed intoxication of an organism and all symptoms corresponding to it is observed. At a subtoxic form of diphtheria organism intoxication symptoms also take place. The patient complains of pain when swallowing, sometimes pain is present also at area of a neck. On the almonds painted in crimson and cyanochroic color the plaque which the uvula and palatal handles can mention a little is observed. Also moderate hypostasis, morbidity and increase in lymph nodes takes place. Besides, feature of this form of diphtheria is existence of local hypostasis of hypodermic cellulose over regional lymph nodes. Often the toxic form of diphtheria of a stomatopharynx occurs among adults. Very rough progressing, sharp rise in body temperature is characteristic of it. At this form of diphtheria developing of pains not only in a throat, but also in a stomach, in a neck is possible. Besides, some patients have a vomiting, excitement, a delirium, nonsense. At the person skin turns pale, the expressed hypostasis of a mucous stomatopharynx, a diffusion hyperemia is observed. A plaque extend to all stomatopharynx, in development of an illness fibrinous films grow coarse. They do not pass for two weeks and more. If at the patient toxic diphtheria of the III degree takes place, then hypostasis can be shown on a face, on a neck behind, on spin. The expressed all-toxic syndrome takes place. If damage of a throat and nose joins toxic diphtheria of a stomatopharynx, then such disease will especially difficult respond to treatment. The most serious form of diphtheria is the hypertoxical form which mainly develops at the people having alcoholism, a diabetes mellitus, chronic hepatitis, etc. In this case body temperature very quickly increases, sharp symptoms of intoxication of an organism, tachycardia, decrease in the ABP, a low pulse are observed. There can be hemorrhages in integuments and bodies, fibrinous plaques are also impregnated with blood. At the patient infectious and toxic shock which can provoke a lethal outcome in one-two days after an onset of the illness very quickly develops. At a diphtheritic croup manifestation of the localized form of an illness is possible, at which the throat, and widespread when at the same time there is a damage of a trachea of a throat, bronchial tubes is surprised. Manifestation of a croup happens in three consecutive stages — disfonichesky, stenotic and asfiksichesky. For a disfonichesky stage characteristic rough cough, development of an osiplost of a voice. At a stenotic stage the patient's voice afonichny, and cough becomes silent. Gradually intensity of difficulty of breath increases, cyanosis, tachycardia is shown. In an asfiksichesky stage breath of the patient pure, at first superficial, then — rhythmical. The ABP, pulse threadlike falls, cyanosis accrues. The person has spasms, disturbance of consciousness and as a result a lethal outcome comes from asphyxia. Besides, diphtheria of a nose, an eye, generative organs, an ear meets. Similar states at patients are fixed infrequently.
Complications of diphtheria
As complications of diphtheria allocate a number of serious conditions: infectious and toxic shock, mono - and polyneurites, myocardites, a toxic nephrosis, damages of adrenal glands. Such complications sometimes develop at the localized stomatopharynx diphtheria, however most often they become an effect of more severe forms of a disease. Most often complications are shown at toxic diphtheria. It becomes most frequent complication of toxic diphtheria heavy myocarditis.
Diagnosis of diphtheria
At establishment of the diagnosis the specialist first of all pays attention to existence of the symptoms characteristic of diphtheria. If the filmy option of a disease takes place, then it is much easier to diagnose diphtheria thanks to existence of fibrinous character of plaques. At the same time it is the most difficult to diagnose ostrovchaty option of diphtheria of a stomatopharynx as symptoms at this state are similar to symptoms of quinsy of a coccal etiology. In the course of diagnosis of toxic diphtheria of a stomatopharynx it is important to differentiate an illness with necrotic quinsy, paratonsillar abscess, candidiasis. For statement of the diagnosis laboratory blood analyses, and also bacteriological researches are conducted. For this purpose the disease-producing factor is allocated from the center of inflammatory process then define its toxigenicity and type.
Treatment of diphtheria
If at the patient the diagnosis "diphtheria" is established, then he without fail needs to be hospitalized immediately. Depending on that how severe form of a disease takes place, duration of process of hospitalization of the patient is defined. The main moment in the course of treatment of diphtheria is introduction to the patient of anti-toxic antidiphtherial serum. Its influence consists in neutralization of toxin which circulates in blood. Therefore effect of such serum is most effective if to enter it as soon as possible. If there is a suspicion that at the patient the toxic form of an illness or a diphtheritic croup develops, then such serum should be entered at once. The positive take of skin test (so-called test of Chic) at the patient is contraindication to use of such serum at the localized diphtheria forms. In other cases serum is entered, in parallel appointing antihistamines and glucocorticoids. Administer this drug intramusculary and intravenously. Sometimes, in case of severe and long intoxication the drug can repeatedly be administered. Crystalloid and colloidal solutions intravenously are applied to carrying out disintoxication treatment at diphtheria. Sometimes, in especially hard cases, add to the specified drugs also introduction of glucocorticoids. The treatment complex also includes the vitamins desensibilizing medicines. At toxic diphtheria II and III degrees, the severe combined forms of an illness and hypertoxical diphtheria carry out a plasma exchange. Besides, at some forms of a disease (subtoxic, toxic), apply treatment by antibiotics. As auxiliary methods of treatment at diphtheria of a throat it is regularly important to air the room where the patient lies, to give it warm drink, to do inhalations by steam for which it is reasonable to use soda, a camomile, a hydrocortisone, an eucalyptus. If display of a hypoxia at patients with diphtheria takes place, for elimination of this phenomenon use the moistened oxygen through a nasal catheter, and also carry out removal of films by a suction machine. If at the patient a number of the phenomena testimonial of its serious condition is observed, use of surgical intervention (carrying out an intubation of a trachea, a tracheostomy) is possible. It is a tachypnea more than 40 in a minute, tachycardia, a hypercapnia, cyanosis, an anoxemia, respiratory acidosis. If at the patient infectious and toxic shock is shown, its further treatment is made in the intensive care unit.
Prevention of diphtheria
The main measure of prevention of diphtheria is coverage of the population vaccination. It is also important to carry out the regular epidemiological analysis, to predict epidemic process of a disease in the specific territory. Today vaccinal prevention remains the main control method of diphtheria. Diphtheria inoculations are carried out vaccineby AKDS to children, since third month of life. Children will receive diphtheria inoculations three times, at the same time the interval between vaccination makes 30-40 days. 9-12 months later after vaccination the revaccination is carried out. Diphtheria inoculations make also among adults now. First of all vaccination is carried out by that who is included into so-called groups of the increased risk. These are physicians, students, personnel of schools and children's institutions, etc. At vaccination of adults the vaccine of ADS-M is applied, inoculations do each ten years until the person was not 56 years old. Diphtheria inoculations do also to those people who had this disease in due time. For carrying out inoculations against diphtheria there are practically no contraindications. At the same time people who did not receive an inoculation in due time and contacted to the patient, it is necessary to immunize in the emergency order. Efficiency of prevention of diphtheria depends directly on coverage by vaccination of the population, and also on that how qualitative vaccine at the same time was used.
Section: Infectious diseases