Diphtheria and dysentery differences. Diphtheria: symptoms, diagnosis, causes, treatment, vaccination

Diphtheria is an acute infectious disease that is caused by Lefler's bacillus and is most often manifested by inflammation of the oropharynx and severe general intoxication.

The causative agent of the disease is quite resistant to the external environment: under normal conditions, it lives up to 15 days, in the autumn-winter period - up to 5 months, in milk and water it can persist for 3 weeks. Dies when boiled and treated with disinfectants.

Diphtheria is most common in children aged 1-8 years.

Causes of diphtheria

Transmission of the disease from patients with diphtheria or bacteria carriers occurs by airborne droplets, sometimes through contaminated objects.

After infection with diphtheria, the severity of the disease is determined by the amount of toxin formed at the site of infection and carried by the blood throughout the body.

The seasonality of the spread of the disease is autumn-winter. But epidemics of the disease can also occur due to neglect of vaccination by both medical workers and the population.

Thus, the causes of infection with diphtheria are:

• resistance of the causative agent of the disease to environmental conditions;
• violation of vaccination;
• weakening of the immune system.

Forms and symptoms of diphtheria

The most common form of the disease is oropharyngeal diphtheria (90-95% of cases).

Diphtheria in children and adults begins with symptoms resembling acute respiratory disease. The phenomena of intoxication are moderate. The patient experiences headache, malaise, no appetite; tachycardia appears, the skin turns pale, the tonsils and palate swell. On the tonsils there is a fibrous coating (light film), which resembles a cobweb. On the second day, as diphtheria develops, the plaque acquires a gray tint, thickens; It is quite difficult to remove the film, since the mucous membrane can bleed. After 3–5 days, the film becomes looser and can be easily removed; at the same time, there is an increase and an increase in the soreness of the lymph nodes.

Thus, the specific symptom of diphtheria is the formation of a diphtheria film.

Another form of diphtheria - diphtheria croup - is represented by: diphtheria of the larynx and diphtheria of the larynx, bronchi, trachea. The most pronounced symptoms of diphtheria occurring in this form are hoarseness, severe barking cough, shortness of breath, pale skin, cyanosis, and palpitations. The patient's pulse becomes weaker, blood pressure drops, consciousness is disturbed. After convulsions appear, a person may die from asphyxia if resuscitation measures are not taken.

Nasal diphtheria is accompanied by minor intoxication. Symptoms of diphtheria in this case are manifested in shortness of breath, discharge of pus or ichor, swelling of the nasal mucosa, the appearance of erosions, sores, films.

Diphtheria of the eye is characterized by inflammation of the conjunctiva, weak secretions, and a slight increase in temperature. The eyelids of the patient swell, there is a secretion of a bloody-purulent secret. Symptoms of eye diphtheria develop rapidly, while other parts of the eye may be affected, acute purulent inflammation of all membranes and tissues of the eye, lymphadenitis may develop.

Quite rarely there are such forms of the disease as diphtheria of the ear, skin, genital organs. Most often they develop simultaneously with diphtheria of the pharynx or nose. In this case, swelling of the affected area occurs with the appearance of a diphtheria film on it, the lymph nodes become denser.

Genital diphtheria is accompanied by bloody discharge, pain during urination.

Skin diphtheria occurs more often with skin cracks, eczema. At the same time, a gray fibrous plaque appears at the site of the lesion.

Diagnosis of diphtheria

To make a diagnosis of diphtheria, a doctor only needs to examine the patient's oropharynx. Laboratory diagnostic methods are used in the case of an atypical course of the disease and in order to determine the strain when deciding whether to withdraw the diagnosis.

As laboratory methods research is used:

• bacteriological (smear from the oropharynx). Using this method, the pathogen is isolated and its toxic properties are established;
• serological. Ig G and M are determined, indicating the intensity of immunity, which indicate the severity of the ongoing inflammatory process;
• PCR method is used to determine the DNA of the pathogen.

Diagnosis of complications caused by diphtheria is also required.

Treatment of diphtheria

The main treatment for diphtheria in children and adults is currently anti-diphtheria antitoxic serum. The sooner it is introduced, the less likely there are complications. The use of serum is effective in the first 4 days from the onset of the first symptoms of diphtheria or if diphtheria infection is suspected.

Therapeutic serum administered to a patient with diphtheria is absorbed into the blood, where it neutralizes the toxin of diphtheria microbes. With timely administration, the serum quickly has the desired effect. A day later, the fever subsides, raids in the throat decrease, the patient feels better.

In addition to anti-diphtheria serum, diphtheria treatment includes:

• The use of antibiotics from the group of macrolides, 3rd generation cephalosporins, aminopenicillins for 2-3 weeks;
• Local treatment with interferon, chemotripsin ointments;
• The use of antihistamines;
• symptomatic treatment;
• Antipyretics;
• Membrane protective antioxidants;
• Multivitamins;
• detoxification therapy;
• hemosorption, hormone therapy, plasmapheresis.

A patient with diphtheria must observe strict bed rest, especially for seriously ill patients. Throughout the entire period of the disease, it is necessary to control the work of the kidneys, heart, nervous system sick. Therefore, the treatment of diphtheria is carried out only in a hospital. In order to prevent possible complications The patient must remain in the hospital until complete recovery.

During the recovery period, the patient needs good nutrition, fresh air and vitamins.

Prevention of diphtheria

Nonspecific prophylaxis of diphtheria involves hospitalization of carriers of diphtheria bacillus and patients with diphtheria. Before being admitted to the team, those who have recovered are examined once. Within 7-10 days in the outbreak, contact patients are under medical supervision with daily clinical examination and a single bacteriological examination. Immunization is carried out after determining the intensity of immunity according to epidemic indications.

Specific prevention of diphtheria is the timely implementation of vaccinations against diphtheria.

Vaccinations against diphtheria with the help of DTP vaccine are given starting from the age of 3 months, with an interval of one and a half months three times. Revaccination is carried out in a year and a half. When vaccinating and revaccinating, contraindications must be observed.

In order to prevent diphtheria in the future, children are given one more vaccination against diphtheria at 6 and 17 years of age. Thereafter, vaccinations should be repeated every 10 years.

Diphtheria in adults familiar to mankind for many centuries and the symptoms of the disease are similar to a sore throat. Previously, this disease had the character of epidemics, the symptoms appeared instantly, the mortality rate reached 60%.

Now the level of immunization of the population of most countries is so high that you will meet infrequently diphtheria. But anti-vaccine movements pose some danger in this regard.

Therapist: Azaliya Solntseva ✓ Article checked by Dr.

Diphtheria - symptoms in adults

Diphtheria is an acute infectious disease. The disease is caused by penetration into the human body of corynebacterium diphtheria - corynebacterium diphtheriae. Infection occurs most often by airborne droplets or household contact (toys, furniture) when bacteria enter the mucous membranes of the mouth, nose, and upper respiratory tract.

Symptoms of the disease vary depending on where the pathological focus is located. It is worth noting that in the early stages the disease is difficult to diagnose, there are also asymptomatic and asymptomatic forms.

Symptoms that are observed in all patients include:

• elevated body temperature for several days, which then reaches 39-40 ° C;
• malaise, weakness, headaches;
• pallor of the skin, which occurs due to spasm of small vessels;
• decline blood pressure;
• chills and fever;
• an increase in the size of the lymph nodes;
• discharge from the affected mucous membranes, their swelling and soreness.

Basically, this is how the process of intoxication of the body, triggered by diphtheria toxin, is expressed.

Treatment of diphtheria in adults

Treatment of diphtheria is mandatory and is carried out in the inpatient department of the hospital's infectious diseases department. This helps to avoid the spread of a dangerous disease.

Treatment includes the following methods:

1. Etiotropic therapy - the introduction of serum against diphtheria, since the main cause of the severity of the disease is diphtheria toxin. In each case, the attending physician prescribes a certain dosage, which depends on many factors.
2. Antibiotics are used as part of complex therapy, which is aimed at combating the pathogen.
3. Local treatment of inflammation.
4. Glucocorticosteroids - are prescribed for severe intoxication of the body, often in combination with various saline solutions and vitamin C.
5. Prednisolone and plasmapheresis - in some cases.
6. Intubation and tracheostomy - with the threat of asphyxia or airway obstruction.

The patient is prescribed bed rest, as well as a diet high in calories and vitamins.

Prevention of diphtheria and vaccinations

Prevention plays an important role in stopping the spread of such a serious disease as diphtheria. Since the infection is transmitted by airborne droplets, contact with sick people should be avoided in the first place.

If the patient is found, the place where he appeared must be treated with a disinfectant. Timely admission to the hospital and isolation of the patient is an important step in prevention.

Vaccination and DTP vaccination - we prevent tetanus and diphtheria

Most effective tool Prevention remains the conduct of periodic vaccination of diphtheria in adults. In Russia, this is a vaccine called DTP.

It is placed free of charge in the clinic, starting from the age of 3 months. Next, you should follow a specific revaccination schedule - it is built on diphtheria, tetanus separately.

How often is revaccination needed?

Adults are vaccinated every 10 years. Vaccination will not protect against accidental infection, but will facilitate the course of the disease. The immune system has developed protection, so the fight against diphtheria bacillus begins immediately.

Side effects of vaccination for the patient

On DTP are noted side effects. Among them: temperature increase, change in behavior due to feeling unwell, capriciousness, redness and induration may be noted at the injection site. Symptoms usually resolve within 3 days.

Stages of development of diphtheria

The disease does not reach its peak of development in 1 day, but passes through several stages.

Incubation period for infection

After the pathogen enters the human body and before the first symptoms appear, on average, it takes from 2 to 10 days - this is the incubation period. By the end of this period, there slight temperature, general weakness and malaise. In the classical form, itching and sore throat occur, the lymph nodes closest to the site of inflammation increase.

How does the inflammatory period manifest itself?

It is characterized by pronounced symptoms as the body fights off the infection. Signs of intoxication are clearly manifested, high temperature due to diphtheria toxin poisoning the body. During this period of time, signs inherent in a certain type of disease are revealed in varying degrees of severity. Most often, the acute period lasts about 3 days.

Patient recovery and detoxification

Gradually released toxins are removed, due to which the temperature drops. But other signs, such as plaque and discharge, may continue to disturb, up to 8 days. The swelling of tissues and the size of the lymph nodes gradually decrease.

Characteristic features of the disease

Since the disease manifests itself in an atypical form, this makes it difficult to diagnose, and, accordingly, hospitalization. About 90% of all cases are localized diphtheria.

Due to mass vaccination, serious cases of intoxication usually do not occur, and the disease itself passes with a slight deterioration in well-being.

But this does not mean that treatment is not needed. At an advanced stage, for example, croup, the inflammation can go lower, which will cause asphyxia and death.

Given the severity of the condition and the severity of the symptoms, the forms of diphtheria are divided as follows:

1. Non-toxic - the disease is relatively easy. This happens when a person is vaccinated.
2. Subtoxic - all signs of serious intoxication appear slightly.
3. Toxic is the most common. It develops rapidly: all stages of the disease up to acute intoxication develop literally within 3 days. It is expressed in severe swelling that affects the neck and surrounding tissues, and may be disturbed by pain in the abdomen.
4. Hypertoxic - symptoms of intoxication are very pronounced. In this case, swelling and high temperature accompanied by convulsions, the person loses consciousness, suffers from fever. If left untreated, death can occur as a result of heart failure.
5. Hemorrhagic - diphtheria affects the hematopoietic system. This is a very severe form, in which hemorrhagic rashes occur throughout the body, hemorrhages can occur in the gastrointestinal tract and mucous membranes.

The last 3 forms are very dangerous and require urgent medical attention to prescribe the necessary treatment.

Forms of diphtheria or types of disease

Depending on the location of the bacterium, there are several types of this disease.

How diphtheria of the oropharynx manifests itself

This variety is considered classic, since 90% of sick people suffer from this form.

When a bacterium enters the oropharyngeal mucosa, it becomes inflamed and further necrotic. The process is accompanied by the appearance of severe edema and jelly-like discharge on the tonsils.

Soon they are replaced by dense fibrinous films of a grayish color. Mechanically, plaque is poorly removed, and if it succeeds, then the tissue bleeds. Within a day, it reappears.

The buildup of plaque and swelling can reach such a size that breathing problems occur. This process is able to spread to neighboring tissues.

Diphtheria croup of the larynx, trachea, bronchi

Defeat occurs respiratory system, due to which the problem of this form becomes coughing. The voice is hoarse, breathing is difficult, pallor of the skin appears, a violation of the heart rhythm.

There is confusion, a drop in blood pressure and heart rate. A combination of factors leads to loss of consciousness, suffocation and death.

Nasal diphtheria - developmental process

It is manifested by pronounced shortness of breath through the nose, as well as secretions of ichor and purulent-serous. In this case, the nasal mucosa is affected and swells, covered with sores and fibrinous film, separated by flaps.

Scabs and irritation may spread around the nose. This form almost never manifests itself on its own, but goes in combination with damage to the larynx, oropharynx or eyes.

Diphtheria of the eye - basic provisions

A rare phenomenon, and often expressed only by redness of the eyes.

There are 3 varieties:

1. Catarrhal - the conjunctiva becomes inflamed, while small sanious discharge may be observed. Intoxication does not occur, and body temperature is within normal limits, or slightly elevated.
2. Membranous - the tissues of the eye swell and become covered with a fibrinous film, purulent-serous discharge may be present. The temperature rises slightly, and intoxication is mild.
3. Toxic - occurs rapidly and is manifested by swelling of the tissues of the eye and eyelids. In addition to the conjunctiva, inflammation affects other parts of the eye, as well as neighboring tissues. Intoxication manifests itself quite strongly.

Diphtheria of rare localization - types of damage

Occasionally there are lesions:

1. Genital organs: in men - this is the foreskin, in women - the labia. There is swelling and sanious discharge, the process of urination is painful. Infection can also affect neighboring tissues.
2. Damaged skin: wound, diaper rash, crack, etc. A gray film and purulent-serous discharge form on the wound. Intoxication is mild, but the wound heals slowly - from a month or more.

Diagnostics and research

Diagnosing diphtheria is difficult for doctors, not to mention self-diagnosis. The problem is that the symptoms are easily confused with other diseases - sore throat or stomatitis. Because it appears dangerous consequences for the body and death, the correct diagnosis saves lives.

For this, laboratory tests are assigned:

• bacteriological smear from the oropharynx - determines the causative agent of the disease;
• serological - helps to determine the severity of the inflammatory process;
• PCR - determines the DNA of a bacterium.

Due to the large number of possible complications, an additional examination of other organs and systems is carried out.

Treatment with folk methods

Folk remedies are designed to initially alleviate local symptoms and support immunity with decoctions for drinking and rinsing, compresses, etc.

A popular remedy is cranberry, lingonberry and lemon. It is recommended to drink the juice of plants in a warm form and lubricate them with raids in the throat. Rinse is also effective.

Features of the course in pregnant women and the elderly

Infection with diphtheria of a pregnant woman has a number of features and difficulties associated with its treatment. Her position imposes many restrictions on taking medications.

In addition to the consequences of the disease, which are typical for everyone, pregnant women experience:

• damage to the genitals, which can cause obstruction of the vagina;
• infection of the fetus - it will be immune for some time at birth - vaccination is also effective;
• on early term miscarriage may occur.

The severity of the disease in the elderly is due to reduced immunity. It should be borne in mind that the vaccine has a temporary effect. Every 10 years, revaccination is carried out, since often age is not a hindrance to infection.

With timely access to medical institution, as well as the beginning of treatment, the prognosis for the course of the disease is favorable. This is also facilitated by mass vaccination of the population, which begins at the age of 3 months. If there is a severe form of toxic poisoning and not timely treatment a lethal outcome is also possible. At the moment, mortality is no more than 5% of the total number of cases.

Diphtheria is an infectious disease provoked by a bacterium that is transmitted by airborne droplets. This disease has been known since the works of Hippocrates. He described diphtheria as a "suffocating disease" that caused an epidemic and thousands of human deaths. In 1923, the French scientist and biologist Gaston Ramon put an end to the spread of diphtheria and discovered the toxoid, which began to be used as an inoculation.

Causes of diphtheria

The main causative agent of the disease is the non-motile rod-shaped bacterium Corynebacterium diphtheriae. Diphtheria is transmitted by airborne droplets (sneezing, coughing), contact-household (through cuts, injuries, abrasions), food (consumption of infected food) ways. The incubation period for this disease is from 2 to 10 days from the moment the infection enters the body. The favorite place of a dangerous bacterium is the oropharynx. But there are other parts of the body on which the disease often settles, including: trachea, bronchi, nasal mucosa, eyes, genitals.

The spread of infection throughout the body occurs with the help of blood and lymphatic vessels. It begins to literally poison the body, causing signs of intoxication, tissue swelling, various disorders of the cardiovascular and nervous systems. In a more severe form, the patient develops swelling of the palatine uvula, arches and tonsils, which provokes a narrowing of the passage of the pharynx.

Symptoms

The manifestation of diphtheria has general symptoms that may vary depending on the location of the infection:

• An increase in the palatine uvula, arches, tonsils, as well as a possible membranous plaque on them, most often gray-white;
• Hyperemia (redness) and swelling of the throat;
• slight sore throat, especially when swallowing;
• Increase cervical lymph nodes, swelling of the neck;

• An increase in body temperature, up to 41 ° C;
• General weakness, lethargy, malaise, increased drowsiness;
• headache, dizziness;
• Nausea, sometimes with vomiting;
• Paleness of the skin

Types of diphtheria

When classifying diphtheria, 4 main types are distinguished.

1. Diphtheria of the oropharynx. This is the most common form of the disease, characterized by a plaque on the tonsils that can be present for 6 to 8 days. Depending on the degree of damage, there are: localized, widespread, subtoxic and hypertoxic diphtheria.
2. Diphtheria croup. This type is most often diagnosed in adult patients. It is usually associated with oropharyngeal diphtheria. Accompanied by a severe paroxysmal cough, pallor of the skin and difficulty breathing with noise.
3. Diphtheria of other organs:

• Nasal diphtheria. It manifests itself through difficulty in nasal breathing, purulent or sanious discharge from the nose.
• Diphtheria of the eye. Accompanied by inflammation of the conjunctiva of the eyes and scant discharge from the organs of vision, normal or slightly elevated body temperature, absence of regional lymphadenitis and other signs of intoxication.
• Diphtheria of the genitals. It is usually localized in the area of ​​the foreskin of men and the labia with the vagina in women, the perineum and the area anus those and others.

Diagnostics

The diagnosis of diphtheria itself is clinical, which makes it possible to calculate the disease at the stage of visual examination. Regarding additional diagnostic methods, they are used mainly to identify atypical and less common forms of the disease. This can be done using the general or biochemical analysis blood, urinalysis, electrocardiography, or swab of the infected area.

Treatment

Treatment for diphtheria is made, including the following items:

• hospitalization of the patient;
• medication prescribed by a doctor;
• detox therapy;
• maintenance therapy;
• surgical intervention if necessary.

Prevention

Vaccination. This is the main and most effective method diphtheria prevention. Vaccinations are used that contain adsorbed diphtheria toxoid (DTP-anatoxin, DPT-vaccine, ADS, ADS-m) and combined analogues. The purpose of vaccination is to create long-lasting and strong immunity against diphtheria bacillus. Vaccinations are done from 3 months of age, every 30-40 days. Adults are vaccinated every 10 years.

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Also, for prevention, a scheduled annual examination by a doctor should be carried out. In addition, in matters of preventing such a disease, it is important to observe the rules of personal hygiene and prevent contact of dirty hands with the face and mucous membranes.

One of the heaviest infectious diseases is diphtheria. What it is is known to many. This disease, which affects both adults and children, is difficult not only to treat, but also to diagnose. Vaccination against diphtheria is mandatory and 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 severe complications are possible.

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

With this disease, the mucous membranes of the nasopharynx and oropharynx are affected. In addition, general intoxication develops, nervous and cardiovascular systems. Inflammation is accompanied by the appearance of fibrin films, resembling a white coating. Diphtheria can be benign, without severe intoxication.

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

Causes

The causative agent of the disease is Leffler's bacillus, which is very resistant to external influences. Under standard conditions, stability is maintained 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 get infected by airborne droplets from a person with diphtheria or from a healthy carrier of the bacterium. Upon contact with the mucous membranes of the nasopharynx, lightning multiplication of diphtheria bacillus occurs. In this case, an exotoxin is released, which, spreading with 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, food products.

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

Species and flow

Depending on the localization, diphtheria of the oropharynx, respiratory organs, and nose occurs. In rare cases, eyes, genitals, skin are affected. If several organs are affected at the same time, then 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, aching joints and bones appear, headache, weakness, skin turns pale, appetite decreases.

Oropharyngeal diphtheria is localized, widespread and toxic, hypertoxic.

Most often, the disease occurs in a localized (mild) form. Visual examination at the beginning of the disease reveals a white coating on the tonsils with clear boundaries and a smooth structure, the mucous membrane is bright red. After a while, the plaque becomes gray or yellowish gray. It cannot be removed. If you try to do this with tweezers, a bleeding wound will remain. Pain in the throat manifests itself 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 tongue, the walls of the pharynx, the swelling and redness are more pronounced, the pain is moderate. The plaque disappears in 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 pain in the abdomen, severe headaches, drowsiness, apathy, the affected organs swell, the skin turns pale. A white coating can be found on the tongue. With the development of the disease, a barking cough appears, due to swelling of the larynx, it is difficult for the patient to breathe, and there is a loss of voice.

The hypertoxic form is characterized by more pronounced symptoms of intoxication. The person is in an unconscious state. If treatment is not started on time, death is possible. The circulatory system is damaged, 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 course of the disease depends on the degree of respiratory failure.

Signs of diphtheria of the larynx develop gradually. In the catarrhal period, the patient develops a barking cough, the temperature rises slightly. After one or two days, the cough becomes worse, breathing is difficult, a whistling sound is heard during inspiration.

In the second period - stenotic, the patient suffers from attacks of spasmodic cough, which lasts from 2 to 30 minutes. In this case, the face becomes bluish, there is a pallor of the nasolabial triangle, increased sweating.

This is followed by an asphyxial period, which is characterized by drowsiness, apathy, pale skin, convulsions, low blood pressure. If the patient is not given 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 difficult. It is characterized by the appearance of a purulent rhinitis, the nasal mucosa is covered with sores, plaque, the face swells into the cheeks and eyes. The temperature is either within the normal range, or slightly elevated, there is no intoxication. The area around the nose is irritated, weeping and crusting appear. 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 eyelid conjunctiva. 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, the temperature is slightly elevated. The toxic form has an acute onset. The eyelids swell, there are discharges of a sanious-purulent nature. Areas of the skin around the eyes are irritated and get wet, the tissue around the orbit swells.

Diphtheria of the skin, genital organs, ear

Such forms of diphtheria are rare and most often develop in combination with other types of this disease. All of these options have manifestations common to this disease: edema, 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, capture 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 on which diaper rash, wounds, eczema or fungus are concentrated. A dirty-gray plaque appears on the skin and serous-purulent discharge. General intoxication is not observed.

Separately, one can single out such a form of the disease as hemorrhagic diphtheria. What it is? 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 a visual examination of the presence of characteristic films, shortness of breath with a whistling noise on inspiration, a barking cough, a diagnosis of diphtheria is made. Diagnostics includes and additional methods studies that are used in order to identify specific strains, to diagnose atypical forms of the disease.

In such cases, it is used which consists in the fact that a smear is taken from the patient for diphtheria from the pharynx. This method allows you to isolate the pathogen and study its toxic characteristics.

The serological method is necessary to determine the degree of immunity tension, 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 observe bed rest. In order to neutralize diphtheria exotoxin and stop the intoxication of the body, enter (PDS). The drug should be administered as early as possible, this will 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, due to which the number of the pathogen decreases, the symptoms of intoxication decrease. Usually use "Ampicillin", "Amoxicillin", "Cefalexin", "Oxycillin". If necessary, hormones (prednisolone preparations), antihistamines (Diazolin, Suprastin, etc.), antipyretics, and vitamins are prescribed.

To prevent stenosis, the ward must be well ventilated, the patient is prescribed a warm drink in the form of tea or milk with soda, steam inhalations. To reduce hypoxia, humidified oxygen is administered using 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, urgent measures must be taken to remove the films. For this purpose, forceps, electric suction are used. Too severe cases can not do without surgery. The patient is injected with a breathing tube into the 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 bloodstream, which causes severe and dangerous complications. They are specific (toxic) and non-specific.

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

Myocarditis can be early and late. Early may occur at 1-2 weeks of illness. The course is severe, heart failure progresses. Patients experience abdominal pain, vomiting, increased pulse. There is a systolic murmur in the heart, rhythm disturbances, a sharp decrease in blood pressure. 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 paralysis may develop. cranial nerves. The patient's voice becomes nasal, there are difficulties in swallowing, the absence of a reflex with soft palate. Sometimes the patient cannot read and does not distinguish between small objects.

After 4-5 weeks, late tendon reflexes may occur, muscle weakness, and coordination disorders are noted.

If the muscles of the neck and trunk are affected, a person cannot be in a sitting position, it is difficult for him to keep his head. Perhaps the development of paralysis of the larynx, pharynx, diaphragm. This leads to loss of voice and the appearance of a silent cough, it is difficult for the patient to swallow, the stomach is drawn in.

In the acute stage of the disease, an increased amount of protein is observed in the urine, erythrocytes and leukocytes are above the norm. In this case, the function of the kidneys is not disturbed.

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

Forecast

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

On the second to fifth day of the disease, death can occur mainly with the toxic form of diphtheria. The reason is infectious-toxic shock and asphyxia. After two to three weeks from the onset of the disease, death can occur from severe myocarditis.

Prevention

The disease is better to prevent than to cure, especially such a dangerous one as diphtheria. What it is, we have already found out, but how to protect yourself? The main measure of prevention 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 the National Immunization Schedule. Use the DTP vaccine or others containing diphtheria toxoid. Adults need revaccination 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.

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

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

A person who has had a disease develops unstable immunity. Ten years later, he may fall ill again, but the disease will be mild.

If the timing of vaccination and revaccination is not observed, the intensity of antidiphtheria immunity decreases, and prerequisites for the development of the disease are created. In vaccinated people, diphtheria occurs in mild form, complications are rare.

Diphtheria is hardening, moderate exercise stress, good nutrition, stay in the fresh air.