Diphtheria - Who Is The Causative Agent? What Are The Symptoms? Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Diphtheria: Symptoms and Treatments

Until the time when the vaccine against diphtheria was invented, a huge number of children died from this disease every year. With the introduction of the vaccine into the national vaccination calendar, the disease receded. The person has no own immunity to corynebacteria. These microorganisms are extremely dangerous. They are capable of damaging internal organs, provoking the development of shock and death of the patient.

Modern vaccines made it possible to cope with diphtheria in 96% of cases. Detection of the disease is not difficult, since the causes and symptoms of the pathology are well known.

Content:

• What is diphtheria?
• Causes of diphtheria
• Diphtheria symptoms, depending on the form of the disease
• Complications
• Diagnosis of diphtheria
• Diphtheria treatment
• Prevention of diphtheria
• Answers to popular questions

What is diphtheria?

Diphtheria is a dangerous infectious disease caused by the bacterium Corynebacterium diphtheriae. This microorganism is characterized by increased survival outside the human body. The microbe retains its activity after drying, it is not afraid of low temperatures, it feels great in an apartment. To kill bacteria that live in water, you need to boil it for at least a minute. It can be removed from household items only with the use of chlorine-containing agents, phenol or chloramine. Moreover, the processing should last at least 10 minutes. Diphtheria bacteria have various forms, but this does not affect the symptoms of pathology and the features of therapy.

The disease is spread by airborne droplets. It is accompanied by inflammation of the mucous membranes of the nasal and oropharynx, general intoxication. With diphtheria, the cardiovascular, nervous and

Causes of diphtheria

Diphtheria develops due to the penetration of a pathogenic microbe into the body. Occurs after contact with an infected person. If he suffers from acute symptoms of pathology, then the probability of infection is 10 times higher than in contact with a person carrying the infection. At the same time, Professor V. F. Uchaikin points out that about 97% of Russians are vaccinated against diphtheria, so contact with a patient with diphtheria can happen as an exception. Carriers of the infection remain the main sources of the spread of the disease.

There are 2 ways of transmission of pathology:

• Airborne. Bacteria are released into the environment along with sputum and mucus particles during conversation, coughing, blowing your nose. They get on the wounds of a healthy person and on his mucous membranes, causing illness.
• Contact and household. Infection occurs when using common household items, or the clothes of an infected person. Joint eating is dangerous in this regard, since microbes are able to settle on the surfaces of various objects.

People who receive the vaccine do not get diphtheria. The same applies to healthy individuals with normal immunity.

For the disease to develop, some predisposing factors are necessary:

• The vaccine was not delivered on time. This applies to DTP and ADS vaccinations.
• Children age from 3 to 7 years. At this time, the woman already stops breastfeeding and there are no protective antibodies in his blood. Own immunity during this period is just beginning to form.
• Weakening of immunity. This can happen for a variety of reasons: HIV, cancer, the end of the menstrual cycle, previous infections, etc.
• A significant period of time that happened after the vaccine was given, the lack of contact with sick people. All this weakens the immunity formed against diphtheria.

Bacteria are very stable in the external environment, therefore they quickly spread in collectives, passing from one person to another.

Risk groups for the spread of diphtheria:

• People without vaccination who are gathered in groups.
• Children in orphanages and boarding schools.
• University students, schoolchildren.
• People who serve in the army.
• Population of 3 countries of the world, refugees.
• People who are in hospitals and psychoneurological dispensaries.

Diphtheria spreads quickly, so the infected person should be isolated from society as soon as possible. Such patients are placed in semi-boxes. These wards have their own toilets and baths. In boxing conditions, the patient should be until the time when the bacteria from his body is completely removed.

When does a person become contagious?

The incubation period after an infection has occurred is 10 days. When the last day of the incubation period comes, the patient becomes contagious. It remains contagious until the bacteria are completely eliminated from the body. This should be confirmed by the test results.

Diphtheria symptoms, depending on the form of the disease

For many people, the disease does not manifest itself in any way, since they have a vaccine against it. After the bacteria enters the body, it simply lives in it. Such people pose a threat to healthy, unvaccinated individuals. However, the probability of infection by contact with them is 10 times less than by contact with a patient with acute diphtheria. When bacteria enters the body of a person who has not been vaccinated, an infection develops. Its initial symptoms are:

• Hyperemia of the glands.
• The occurrence of intense pain when swallowing food.
• Formation of diphtheria films. They are smooth and shiny and can be whitish, yellow or gray in color. It is difficult to remove the film from the surface, since it is firmly adhered to it. If a person still tears it off, then a wound with oozing blood will be visible under it. After a while, the film will appear on the skin surface again.

As the pathology progresses, the symptoms of diphtheria become more diverse. It depends on the specific form of the disease. They need to be distinguished in order to determine the optimal therapeutic regimen.

Localized pharyngeal diphtheria

With localized pharyngeal diphtheria, symptoms are mild. Most often children who have received the vaccine get sick with this form, but their own immunity is very weak. There is no pronounced deterioration in well-being. Perhaps increased lethargy, decreased appetite, lack of sleep. Patients complain of headache.

In 35% of people, body temperature remains within normal limits. In other cases, it can rise to 38-39 ° C. After 3 days from the onset of the disease, the body temperature returns to normal, and other symptoms of the disease persist.

These include:

• Sore throat that occurs when food is swallowed.
• Slight redness of the tonsils and their swelling.
• An increase in the size of the lymph nodes, their slight pain on palpation. This applies to those nodes that are located under the jaw and under the chin.
• The appearance of a film characteristic of diphtheria.

To palpate the lymph nodes, you need to put your fingers under the person's lower jaw. After collecting soft tissue, it will be possible to feel the lymph node, which is enlarged and painful. Palpation should be done carefully.

Localized pharyngeal diphtheria can be acute, in which the film does not completely cover the tonsils, but partially. The films themselves resemble the look of a head from a pin. There can be many such formations, or maybe 1-2 pieces.

The filmy form of the disease is characterized by the fact that the films completely cover the tonsils.

Coping with localized pharyngeal diphtheria is not difficult. After 14-18 days, the person fully recovers.

Pharyngeal diphtheria, common

In this form of the disease, the symptoms resemble those that are characteristic of localized pharyngeal diphtheria, but there are still differences. Common diphtheria does not develop often. It is mainly diagnosed in children aged 5-7 years. As a rule, they were not vaccinated.

A distinctive feature of common diphtheria is the abundance of films that extend beyond the glands. They move to the palatine arches, to the uvula, to the soft palate and to the pharynx.

Body temperature always rises to feverish levels. It develops 4-5 days after the onset of the disease. A person suffers from severe intoxication of the body, his desire to eat disappears, his head hurts badly.

The prognosis for recovery is favorable, but only on condition that the treatment is provided in full.

Subtoxic pharyngeal diphtheria

The subtoxic form of the disease is more severe than the previously described types of diphtheria. A person has intense headaches, the body temperature rises to febrile levels and lasts for 5 days (if the patient was not injected with antitoxic serum).

Lymph nodes hurt a lot, swell, and become larger in size. The film extends beyond the tonsils and covers the surrounding mucous membranes.

The patient is placed in a box for up to 30 days, but not less. In this case, he will need to comply with bed rest for 25 days. It is possible to cope with the subtoxic form of diphtheria, but earlier than 30 days, the symptoms of the disease cannot be stopped.

Pharyngeal diphtheria toxic

If the child has not been vaccinated and has weak immunity, then there is a possibility of developing toxic pharyngeal diphtheria.

In the first days from the development of the disease, a significant amount of toxins enter the bloodstream, which provoke the onset of symptoms such as:

• A sharp jump in body temperature. It reaches 39 ° C. At the same time, parents can tell exactly when the temperature began to rise. Accuracy comes to the minute.
• Immediately a film forms on the patient's tonsils.
• The person suffers from severe weakness, vomits, intense headaches develop.
• The heartbeat becomes more frequent and reaches 90 beats per minute.
• The skin becomes pale, chills develop.
• On the 3rd day of illness, the neck swells, lymphadenitis develops. The first degree of its severity is characterized by swelling of the tissues reaching the middle of the neck, 2 degree of lymphadenitis is characterized by edema up to the clavicles. In the third degree of lymphadenitis, edema spreads to the chest.
• Other symptoms that occur in a person, starting from the 3rd day of diphtheria, include: slurred speech, wheezing during breathing, sweetish odor from the mouth.

If the patient is injected with antitoxic serum on time, then most often it is possible to avoid his death. When no treatment is available, death cannot be ruled out. It happens due to the development of complications.

Pharyngeal diphtheria hypertoxic

This form develops in those children who have not received the vaccine against the disease. Hypertoxic diphtheria is characterized by a severe course and is often fatal.

The symptoms of the disease develop from the first day. The body temperature rises to a critical 40 ° C. An intoxication symptom is accompanied by fainting, delirium, intense vomiting (it happens up to 40 times a day), convulsions.

A few hours after the jump in body temperature, the organs begin to work intermittently. Blood pressure drops sharply and the heart beats very rapidly. Blood rushes to vital organs to keep them functioning. This applies to the lungs, brain and heart. The skin becomes pale, cold and tight.

A characteristic film appears in the mouth, its sizes vary. Most often it spreads to the pharynx, tonsils and palate.

A person dies in the first 2 days from the development of the disease. The cause of death is cardiac or renal failure. It is not possible to cope with the hypertoxic form of the disease, since there are no effective therapeutic methods.

Pharyngeal diphtheria hemorrhagic

The disease develops sharply, accompanied by the appearance of a film on the tonsils. Complications from the heart and blood vessels develop slowly, so a person dies 12-21 days after the onset of the disease. Despite the treatment received, the patient's life is often not saved.

A distinctive feature of the disease is the appearance of bleeding, which have different localization. They appear on the 3-5th day of illness. The film on the tonsils and the skin over the lymph nodes acquire a crimson color, as it is soaked in blood.

Localized nasopharyngeal diphtheria

With diphtheria of the nasopharynx, a person is not disturbed by painful sensations while swallowing food. Difficulties in nasal breathing come to the fore. This is due to the fact that the film does not cover the tonsils, but the nasal mucosa, but it is impossible to see it on your own.

Since the nasopharynx is abundantly supplied with blood vessels, bacteria easily penetrate the systemic circulation and provoke intoxication of the whole body. At the same time, the body temperature rises to 39 ° C, weakness increases, the head starts to hurt, and appetite worsens.

Sometimes the symptoms of intoxication of the body appear first, and only then a diphtheria film forms. The prognosis for recovery is favorable.

Localized croup

Diphtheria of the larynx has the worldwide name "localized croup". The disease occurs no more often than in 0.5% of cases. It develops only in those people who have not been vaccinated.

There is no intoxication of the body with this form of the disease, but the danger of pathology lies in other symptoms. As a result of damage to the larynx by pathogenic flora, it narrows, which affects the breathing process.

Stages of development of diphtheria croup:

1. Catarrhal stage. The voice becomes hoarse, the body temperature rises to 38 ° C, a cough appears with sputum. These symptoms appear 1-2 days after infection.
2. Stenosis stage. The voice disappears, the person can only speak in a whisper. The cough is dry, without sound, weakness worsens. The rib cage is retracted in the subclavian fossa and between the ribs in the jugular fossa. The skin becomes pale. These symptoms appear on the second day of the development of the disease. They can last from several hours to several days.
3. Preasphic stage. Breathing becomes weak, the heart begins to beat faster, the patient's anxiety increases. The chest in the areas described above is pulled in even more. The patient sweats, the skin becomes very pale. This stage lasts no more than 2 hours. If the patient does not perform tracheal intubation, then he will develop asphyxia.
4. Asphyxiation stage. A person cannot move, since the body suffers from hypoxia, fainting develops, the heart begins to beat less often, after which it stops altogether and the patient dies. The skin becomes cyanotic, the pulse is not heard, the chest remains motionless. This stage lasts about 2 minutes, maximum - 20 minutes.

Common croup

With the common form of diphtheria croup, not only the larynx, but also the trachea, as well as the bronchi are involved in the pathological process. Pathology has a severe course.

Symptoms of respiratory failure appear already in the first days from the onset of the disease, among them:

• Shortness of breath that occurs even when a person is at rest.
• Pallor of the skin.
• Shallow breathing with a frequency of 40-60 breaths per minute.
• The heart starts to beat fast.

Then the patient begins to cough. Films and blood leave the respiratory system together with mucus. A person does not suffer from symptoms of intoxication. Death happens quickly, in a few days. Cope with common croup is very difficult, and the chances of survival are extremely low.

Complications

The toxic and hypertoxic form of diphtheria can lead to complications such as:

• Nephrotic syndrome. This condition does not pose a threat to the patient's life. It manifests itself by changes in blood and urine parameters. No other pathological symptoms accompany nephrotic syndrome. After a person recovers, nephrotic syndrome completely disappears.
• Nerve damage.

The complication can occur in 3 variants:

1. Cranial nerve palsy (partial or complete). It is difficult for the patient to swallow food, he chokes on liquids, possibly drooping of the eyelid and double vision.
2. Polyradiculoneuropathy. The hands and feet lose normal sensitivity, and the arms and legs may be paralyzed. Symptoms of damage to nerve tissues will be completely stopped after 3 months after recovery.
3. Damage to the heart muscle. If the first signs of myocarditis occur 1 week after the development of diphtheria, then the patient rapidly develops heart failure. It often becomes the cause of death. When myocarditis occurs 2 weeks after the onset of the development of diphtheria, it is often possible to completely cope with the manifestations of pathology.

In addition to the listed health problems, a person may develop anemia, which is a companion of the hemorrhagic form of the disease. It can be detected by the results of a blood test.

Diagnosis of diphtheria

The first stage of diagnosis is the collection of anamnesis and examination of the patient. It is necessary to pay special attention to the condition of the cervical lymph nodes, as well as the presence of neck edema. To do this, press it with your finger for a few seconds, and then release it. If a fossa appears in this place, which does not disappear immediately, then there is edema.

Studies to which a person with suspected diphtheria is referred:

• Blood donation for general analysis. ESR and neutrophil levels increase significantly.
• Delivery of urine for general analysis. This eliminates kidney damage. The presence of a pathological process in the organs of the urinary system will be indicated by symptoms such as the appearance of protein, erythrocytes and renal casts in the urine.
• Delivery of a swab from the nasopharynx. It is examined for bacteria. The results will become known after 5 days.
• Electrocardiography. This simple study allows you to assess the function of the heart and detect abnormalities in its work in a timely manner.
• Blood donation for biochemical analysis. The liver function is assessed by the level of ALT, AST and bilirubin. urea and creatinine provide information about kidney health.

Blood count	Normal values
AST	Up to 45 IU / L
ALT	Up to 40 IU / L
Total bilirubin	5.1-17 μmol / l
Urea	2.8-7.5 mmol / l
Creatinine	The norm for a man: 74-110 μmol / l. The norm for a woman is 60-110 μmol / l.

If required, the doctor will prescribe additional studies to the patient at his own discretion.

Diphtheria treatment

The earlier the patient is injected with antitoxic serum, the better the prognosis for recovery. It is used for any form of diphtheria.

Antibiotics may not be used, but if the doctor deems it necessary, he can prescribe them. WHO recommends using a drug called Josamycin to treat children. Clindamycin can be taken for adults. The frequency of admission and dosage is determined on an individual basis.

Be sure to direct efforts to remove intoxication from the body. For this, a physiological solution of sodium chloride or glucose is injected intravenously. Hemodez or Reopolyglucin can also be used. They are shown in the case when a person feels very bad.

If complications of the disease develop, then the therapeutic scheme is expanded. There are certain standards for the treatment of myocarditis and polyneuritis, which are quite effective. However, the possibilities of medicine are still limited and severe forms of the disease with pronounced intoxication syndrome can end in death.

Prevention of diphtheria

In order to prevent the development of the disease, it is enough to give the child the vaccine on time. Now 2 types of vaccines are used - DTP and ADM. They are highly effective and give a minimal set of side effects.

DTP vaccine is administered at 3, 4.5 and 6 months. It is impossible to shorten the period between vaccinations, but it is permissible to slightly lengthen the interval. After the injection is done, you need to stay under a doctor's supervision for half an hour. This is necessary so that you can get help if your child has an allergic reaction.

Another preventive measure to reduce the likelihood of developing diphtheria is to maintain immunity at the proper level. In many ways, the child's health depends on the parents. Therefore, you need to be in the fresh air as often as possible, temper, give the child's body physical activity. The kid must eat properly and fully.

Answers to popular questions

• If a child once had diphtheria, can he get sick again? The chance of re-infection is 5%. The second time the disease will have an uncomplicated course.
• Do I need to remove the film that forms in the mouth? No, this is prohibited. After treatment, it dissolves on its own. Fresh mucous membrane will be visible under it. If you remove it mechanically, then a wound will remain in its place, which will again be covered with a film.
• Why do some patients develop a toxic form of the disease, while others are common? It all depends on the state of the child's immunity.
• Vaccination is expensive, should it be given? They write on the Internet that it is ineffective. The DPT and ADS vaccine has proven efficacy. The cost of one vaccination is 600-800 rubles. However, the child's funeral will cost the parents more. A child who has not received the vaccine is extremely likely to get diphtheria.
• Are There Any Side Effects of DPT? After the vaccine is given, the child's body temperature may rise to 38 ° C, and weakness increases. Redness and swelling appear at the injection site. This is where the side effects are limited.
• Does an adult need to get the DPT vaccine? No, there is no such need. However, if there is contact with an infected person, the vaccine can be given. First you need to determine the level of antibodies to corynebacterium in the blood.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".