Diphtheria

Description:

Diphtheria – an acute antroponozny infectious disease with the drop mechanism of transfer which is caused by diphtheritic korinebakteriya  and is characterized by a local fibrinous inflammation (more often than a mucous  membrane of a stomatopharynx) and the phenomena  of the general intoxication with preferential  defeat of a cardiovascular and nervous  system.

Diphtheria reasons:

Diphtheria is caused by bacteria of a type of Corynebacterium diphtheriae, differing in polymorphism, positive coloring on Gram and a full immovability. The microbe has 2 appearance of antigens – To (the surface antigen having the expressed thermolability) and About (thermostable antigen). Diphtheritic exotoxin on the force concedes only botulinic and tetanic. The heat-labile antigen represents the immune protein consisting of 2 fragments – And yes Century. Their lethal dose makes about 100 mg/kg of a body.
Diphtheria belongs to the so-called managed infections. A source of a diphtheritic infection is the patient or the carrier. This infection is transmitted in the airborne way, however the household way is not excluded. At wound diphtheria the contact way is stated. Entrance gate for korinebakteriya is the mucous membrane of almonds, is more rare – nasopharynxes, throats. There is a seasonality at a disease – the peak is noted in the winter and in the fall.
Modern epidemic process at diphtheria has the features:
- more often adults are ill;
- many patients have the atypical forms, with the lung erased by a current which are not diagnosed in time;
- are high incidence in the large cities.

Diphtheria symptoms:

Clinical classification of diphtheria assumes division into toxic, subtoxic, manifest and subclinical forms.
By defeat localization by diphtheritic process the disease is classified:
- diphtheria of almonds;
- nasopharyngeal diphtheria;
- diphtheria of front department of a nose;
- laryngeal diphtheria;
- other localization.
On the nature of the changes seen in the place of defeat:
- catarral (edematization, hyperemia, and then emergence of gentle web stratifications);
- insular;
- filmy.

At easy severity hemilesion is more often observed, the malovyrazhena intoxication phenomena, rises in temperature can not be observed. Difficulty of nasal breath is observed. At survey the bleeding sores are found.
At moderately severe diseases moderate intoxication, pallor of integuments is noted. Perhaps acute beginning with sharp rise in temperature, fibrous plaques on a mucous membrane are found. There is a serous and purulent discharge with blood, puffiness and cyanosis of mucous. At a heavy current plaques often extend to adnexal bosoms. The expressed intoxication, rough temperature reaction, puffiness of hypodermic cellulose under eyes, in cheeks and a neck is observed.

Diagnosis:

The manifesto of a disease is characterized by local inflammatory reaction, development of catarral process – hypostasis and a hyperemia. At penetration of toxin into cells the centers of a local necrosis are formed. Macrophages go to this moment in a zone of an inflammation. On the almonds, a stomatopharynx covered with a multilayer flat epithelium  there is a treatment of necrotic masses fibrin. Educated films hard separate from a mucous membrane, baring the bleeding surface. Films have grayish color, and at hemorrhagic treatment become black. If the throat and a trachea is involved in pathological process, the croupous inflammation develops. Here necrotic masses easily separates that can lead to asphyxia. Toxin gets to blood and is fixed to target cells. Many bodies are targets for a diphtheritic infection – heart, adrenal glands, kidneys. Approximately in 1 week the peripheral polyneuritis develops, in the same time myocarditis is surprised. In a cardiac muscle hemorrhages, blood clots, in a nervous system – disintegration of a myelin, in respiratory system – a filmy tracheobronchitis, congestive pneumonia are possible.

Treatment of Diphtheria:

The most important link of pathogenetic treatment of diphtheria is purpose of protidifteritichesky serum. At easy degree 30-40 000 PIECES once are appointed. The medium-weight course of a disease demands introduction of 50-70 000 PIECES 1-2 times, in the absence of effect of the designated dose introduction is repeated. Hard proceeding diphtheria – the indication for increase in a dose of serum which is entered by each 12-24 hours in total making 250-300 000 PIECES which should be entered within 2 days. Especially severe, so-called hypertoxical form, demands purpose of 300-450 000 PIECES within 2 days.
Besides, complex therapy of diphtheria includes purpose of antibacterial drugs – penicillin of 3-6 mln units, ampicillin of 4-6 g/days, tetracycline of 1,6 g/days, and other drugs. The course makes up to 1 week.
For the purpose of desintoxication carry out intravenous injections of Trisol solutions, a reamberin, resuscitation cocktail, a reosorbilakt and other drugs.
At suspicion it is necessary to appoint a bed rest to development of myocarditis, to carry out control of the entered liquid. Medicamentous therapy assumes use of steroid drugs, NPVS, metabolik (inosine, potassium оротат, an asparkam, Mildronate).