Diphtheria wand building. Difteria in children and adults - symptoms, treatment and prevention

Diphthery is an acute infectious disease caused by the CoryneBacterium Diphtheriae bacterium. The disease is characterized by such symptoms as the development of the inflammatory process at the site of the deployment of the pathogen and the toxic damage to the nervous and cardiovascular systems. Previously, this disease was more often observed in children, but in recent years there has been a persistent increase in the number of patients among adults. The diphtheria is more often sick people aged 19-40 years (sometimes the patients are revealed and 50-60 years old). That is why the first plan for the degree of importance comes out the prevention of diphtheria both among children and in adults. About the treatment of this disease and about everything that you need to know about it, we will tell in this article.

Diffeter classification

On localization of the introduction of diphtheria Cornobacteria in the body, infectious diseases distinguish such forms of diphtheria:

• upper respiratory diffraction;
• diphtheria croup;
• nasal difftheria;
• eye difftheria;
• difteria is rare localization (wounds and genital organs).

By severity of flow, this infectious disease may be the following types:

• non-toxic: Such a clinical picture is more characteristic of graft people, the disease occurs without serious symptoms of intoxication;
• suboxy: intoxication is expressed moderately;
• toxic: accompanied by strong intoxication and development of swelling of soft neck tissues;
• hemorrhagic: accompanied by bleeding of various intensity (from the nose, mucous membranes of the mouth and other organs) and severe symptoms of intoxication, after 4-6 days, ends with a fatal outcome;
• hyperstoxic: symptoms of the disease grow up lightning and characterized by a heavy flow, a fatal outcome occurs after 2-3 days.

Difteria can be:

• uncomplicated;
• complicated.

Causes and ways of transfer

The causer of diphtheria is a cinnobacterium (diphtheria stick), which, in the process of reproduction, highlights a particularly toxic diphtheria exotoxin. The infection can penetrate the human body through the mucous membranes of the respiratory organs or through the skin and ears.

The sick person or a bacteria carrier becomes the source of this pathogenic pathogen. Most often, diphtheria sticks are applied to air-droplet, but there is also a likelihood of infection through infected items (dishes, towels, door handles) and food (milk or meat).

The development of diphtheria can contribute:

• ORVI and;
• chronic diseases of the upper respiratory tract;

After transferred diphtheria in the human body, temporary immunity is formed, and the person has already been infected with the diphtheria stick again. Vaccinations from this disease are practically not protected from infection, but vaccinated people carry diphtheria in much easier form.

After the introduction of diphtheria cinnobacteria, the focus of inflammation appears on the site of its penetration. The affected fabrics are inflamed, swelling, and on the site of the pathological process, fibrinous films of light gray colors are formed, which are tightly soldered with a wound surface or mucous membranes.

In the process of reproduction of the pathogen, a toxin is formed, which with a blood current and lymph is distributed throughout the body and causes the defeat of other organs. It is most often affecting the nervous system, and adrenal glands.

The degree of severity of local changes in the place of introduction of diphtheria cinnobacteria may indicate the severity of the course of the disease (i.e. the degree of general intoxication of the body). The most commonly entrance gates of infection becomes the mucous membranes of the rotogling. The incubation period during diphtheria ranges from 2 to 7 days.

Symptoms

Characteristic signs of the disease are pain in the throat with difficulty swallowing and intoxication.

Symptoms of diphtheria can be divided into two groups: intoxication and inflammation at the injection site of infection.

Inflammation of the mucous membranes of ZEVA and almonds are accompanied by:

• redness;
• difficulty in swallowing;
• sore throat;
• voting weight;
• o'clock;
• shake.

Already on the second day of infection at the site of the introduction of the pathogen of diphtheria, smooth and shiny fibrinous films of gray-white color with clearly defined edges appear. They are poorly removed, and after their branch of the fabric begin to bleed. Through a small segment of time, new films appear in their place.

With a serious flow of diphtheria, the swelling of inflamed tissues extends to the neck (up to the clavicle).

The reproduction of the pathogen in which diphtheria toxin is distinguished, causes symptoms of the body intoxication:

• general malaise;
• an increase in temperature to 38-40 ° C;
• pronounced weakness;
• headaches;
• drowsiness;
• pallor;
• tachycardia;
• inflammation of regional lymph nodes.

It is intoxicating the body that can provoke the development of complications and a fatal outcome.

Diphthery of other organs proceeds with the same symptoms of intoxication, and local manifestations of the inflammatory process depend on the place of deployment of the pathogen.

Diphtheria

With this form of the disease, may be affected by:

• throat and larynx;
• fuchery and bronchi (more often diagnosed in adults).

With diphtheria cruel, such symptoms are observed:

• pallor;
• intense and pasta cough;
• happiness;
• difficulty breathing;
• cyanosis.

Nose Diphthery

Such a kind of infectious disease occurs against the background of moderate intoxication of the body. The patient is experiencing the difficultness of nasal respiration and complains of the appearance of the discharge from the nose of a purulent or succulent nature. On the mucous membrane of the nose cavity, areas of redness, swelling, ulcers, erosion and diphtheria films are found. Such a form of illness can accompany the diphtheria of the upper respiratory tract or eye.

Difteria eye

Such a kind of infectious disease may occur in:

• catarrhal form: the patient inflates the conjunctivation and minor submarine discharge from the eyes appear, the signs of intoxication are not observed, and the body temperature remains normal or slightly rises;
• fibinid film, conjunctiva tissue fabrics are formed in the lesion focus of the lesion, the purulent-serous contents are isolated, the subfebrile temperature, and the signs of intoxication are expressed moderately;
• toxic shape: It begins rapidly, accompanied by intense increase in intoxication and regional lymphadenitis, eyelids swell, and edema can spread to nearby fabrics, the eyelids becomes inflamed, and the inflammation of the conjunctiva may be accompanied by inflammation of other departments of the eye.

Difteria of rare localization

This form of diphtheria occurs quite rarely and affects the field of genital organs or wound surfaces on the skin.

When infected with the genital organs, inflammation applies to the extreme flesh (in men) or sex lips and vagina (in women). In some cases, it can spread to the anus and crotch area. The affected areas of the skin become hyperemic and edema, suction discharge appears, and urination attempts are accompanied by pain.

In case of skin diphtheria, the causative agent of infection is introduced in the place of the wound surface, cracks, scaffolding, diarming or skin sections. In the foci of infection, a dirty-gray film appears, from under which serous-purulent allocations. Symptoms of intoxication with this form of diphtheria are expressed slightly, but local symptoms are regressed for a long time (the wound can be healing for a month or more).

Complications

The diphtheria toxin released during the reproduction of the causative agent can lead to the development of severe complications, which determine the risk of diphtheria. With a localized form of the disease, the course of the disease may be complicated in 10-15% of cases, and with a more severe picture of infection (subtoxic or toxic), the likelihood of possible complications is growing steadily and can reach 50-100%.

Complications of diphtheria:

• infectious toxic shock;
• DVS syndrome;
• poly- or mononeuritis;
• toxic nephrosis;
• defeat of adrenal glands;
• polyorgan deficiency;
• respiratory failure;
• cardiovascular failure;
• otitis;
• paratonic abscess and others.

The appearance of the complications described above depends on the type of diphtheria and the degree of its severity. For example, toxic myocardits may develop for 2-3 weeks of the disease, and neuritis and polyradiculoneuropathy - against the background of the disease or 1-3 months after complete recovery.

Diagnostics

Diagnostics of diphtheria, in most cases, is based on an epidemiological history (contact with the patient, the appearance of diseases in the area of \u200b\u200bliving) and examination of the patient. Such laboratory diagnostic techniques can be assigned to the patient:

• general blood analysis;
• bacteriological smear from the focus of infection;
• blood test for determining the titer of antitoxic antibodies;
• serological blood tests (ELISA, RPGA) to detect antibodies to diphtheria causative agents.

Therapeutic treatment

Treatment of diphtheria is carried out only under the conditions of a specialized infectious branch, and the duration of the bedding and the period of patient's stay in the hospital is determined by the severity of the clinical picture.

The main method of treatment of diphtheria is the introduction into the organism of a patient of contradictional serum, which can neutralize the effect of the toxin allocated by the pathogen. Parenteral (intravenously or intramuscularly) The administration of serum is carried out immediately (when the patient is received in the hospital) or not later than the 4th day of the disease. The dosage and frequency of administration depend on the severity of the symptoms of diphtheria and is determined individually. If necessary (the presence of an allergic reaction to serum components), antihistamines are prescribed the patient.

For the disintellation of the patient's body, various ways can be applied:

• infusion therapy (polyionic solutions, refooliglucin, glucose-potassium mixture with insulin, freshly frozen blood plasma, asking acid, ascorbic acid, vitamins B) are added, asking for injected solutions;
• plasmorosis;
• hemosorption.

In the toxic and suboxy forms of diphtheria, antibiotic therapy is prescribed. For this, the preparations of a group of penicillin, erythromycin, tetracycline or cephalosporins can be recommended for patients.

Patients with diphtheria of the respiratory organs are recommended frequent ventilation of the chamber and humidification of air, abundant alkaline drink, inhalation with anti-inflammatory agents and alkaline mineral waters. When increasing respiratory failure, the appointment of euphilline, antihistamine and saluretics can be recommended. In the development of diphtheria and increasing the stenosis, intravenous administration of prednisolone is carried out, and during the progression of hypoxia, artificial ventilation of the lungs with moistened oxygen (through nasal catheters) is shown.

The extract of the patient from the hospital is permitted only after the clinical recovery and the presence of two-time negative bacteriological analysis from the zea and nose (the first analysis is carried out 3 days after the abolition of antibiotics, the second - 2 days after the first). The diphtheria carriers after extracting from the hospital are subject to dispensary observation within 3 months. Observation of them performs a precinct therapist or an infectious behalf of polyclinic at the place of residence.

Surgery

Surgical treatment of diphtheria is shown in difficult cases:

• with diphtheria cruel: with the help of special surgical instruments, diphtheria films are removed, which the patient cannot pump out independently (manipulation is performed under general anesthesia);
• with a sharp progression of respiratory failure: trachea intubation or tracheostomy is performed, followed by artificial lung ventilation.

In ancient times, the diphtheria said - a suffocating disease. In some sources, it is described as a "deadly pharynx ulcer" due to a specific film raid in the throat and a large number of deaths. But with the appearance and active introduction of vaccines against diphtheria, this infectious disease has rarely meet, and the number of deaths from it is practically not observed.

What is diphtheria, and how is it treated? What is dangerous for this disease, even today and what prevention measures will be removed from infection with it? Let's find out it.

What disease - diphtheria

What group of infectious diseases includes diphtheria? This is a bacterial acute infectious process or a disease that affects the upper respiratory tract. Difteria causative agents are Corinbacteria (CorineBacterium Diphtheriae) or Leflare wand.

As the infection occurs

There are three basic types of bacteria causing the disease of the language. The most dangerous of them and more often leads to an acute infectious disease - CorineBacterium Diphtheriae GRAVIS, emitting exotoxin in the human body.

The source of infection is a sick person or a bacteria carrier. Starting from the moment of active manifestation of diphtheria and until complete recovery, a person highlights the bacteria into the environment, so if you find a sick person in the house you need to isolate it. Bacteriamers are a serious threat, as pathogenic microorganisms can be separated for a long time.

The causative agent of the disease is resistant to many factors, but quickly dies when exposed to moisture and light or disinfectant solutions. Boiling clothes with which a person invested with a sick diphtheria, kills Leflare wand for a few seconds.

How is the diphtheria? The disease is transmitted by air-droplet by a sick person to healthy or through objects during contact with infected material. In the latter case, the hot climate plays a big role and the lack of regular full-fledged cleaning indoors. Allocate another way of transmitting infection - food through infectious products. So, it often happens if a dish of a bacterial carrier or a patient with an acute infectious process is a person.

Difteria is not a viral disease, only bacteria lead to its development.

Diffeter classification

Depending on the site of propagation of infection, several forms of diphtheria are isolated.

1. Localized when manifestations are limited only by the place of introduction of bacteria.
2. Common. In this case, the tax goes beyond the almonds.
3. Toxic difftheria. One of the most dangerous forms of the disease. It is characterized by a stormy course, the edema of many tissues.
4. Diffhechies of other localization. This diagnosis is placed if the entrance gate of infection was nose, leather, genitals.

Another type of classification - by type of complications accompanying diphtheria:

• defeat heart and vessels;
• appearance of paralysis;
• nephild syndrome.

Non-specific complications are the attachment of secondary infection in the form of pneumonia, bronchitis or inflammation of other organs.

Symptoms of diphtheria

The incubation period of diphtheria can range from two to 10 days, on average - 5 days. This is exactly the time in the development of the disease, when there are no pronounced clinical manifestations, but bacteria have already fallen into the human body and began to affect the internal organs. From the last day of the incubation period, a person becomes contagious for those surrounding people.

The classical course of the disease is localized difterey. It is characterized by the following symptoms.

1. Weakness, general malaise, lethargy, decreases appetite.
2. Headaches appear and minor difficulties in swallowing food.
3. Increases body temperature up to 38-39 ° C. Its feature of it in this disease - it passes on its own after all three days, regardless of the presence of other signs of the disease.
4. The symptom of diphtheria in an adult during the development of the disease is the formation of a random of almonds. It happens a few varieties in the form of a gray smooth brilliant film, there may be small islands of white or grayish color. The raids are tightly tightly with the surrounding tissues, it is hard to remove it, since blood drops arise in this place. The raid appears again after a while after trying to get rid of it.
5. The catarrhal form of diphtheria is characterized by redness and increase almonds.

Another important type of diphtheria is a toxic form of the disease. It has its own characteristics.

Complications

Complications of toxic diphtheria are more often developed by 6-10 days of the disease.

Complications may be the following.

1. Inflammation of the heart muscle or myocarditis. Sick people are weak, complain about the appearance of pain in the abdomen, periodic vomiting. The pulse is studied, the heart rhythm is disturbed, blood pressure is reduced.
2. Peripheral paralysis. Develop in the second or fourth week of the course of the disease. This is more often the paralysis of the soft nose and the accommodation violation (the ability to see items at different distances). The sick person complains about violation of swallowing and vision disorder.
3. Nettle syndrome, when in urine analysis there are pronounced changes, but the main fungus functions are saved.
4. In severe cases there are deaths due to shock or asphyxia.

Treatment

Because of the high probability of complications, the treatment of diphtheria should be carried out only in the hospital. Treatment by folk methods - inefficient!

Treatment of diphtheria in children and adults is to introduce antitoxic anti-diaphteric serum (PDS). The dosage depends on the course of the disease.

Additionally, depending on the testimony, antibiotics are prescribed (but they are not always effective), more often when developing a secondary infection. Apply antiseptics for rinse throats, disintellation therapy with toxic form. If the croup is developing - blocking the respiratory tract, then the sedatives are prescribed, and in T
Short cases apply hormonal drugs.

The outcome of treatment depends on the timely early appeal to doctors.

Diffeter prevention

The main prevention of diphtheria is the detection of bacteria carriers and timely planned vaccinations. They introduce them in childhood in complex vaccines - (from diphtheria, cough and tetanus). Immunization is carried out by all children except when it is contraindicated.

At what age make vaccinations from diphtheria? The first vaccine is introduced three months after the birth of the child, then 4.5 and 6 months. In 18 months, the first revaccination is carried out, the following must be carried out at 6 years, and the third in 14. The vaccination calendar in recent decades has undergone some changes. Therefore, in some cases, the last revaccination in adolescence could be carried out in 15 or 16 years.

When is the vaccination against diphtheria adults? With all previously embarrassing adults or those who have no data on vaccinations conducted (they are considered unavailable in this case), ads-m-anoxin are introduced twice. This is 0.5 ml of the drug with a reduced antigen content, which is injected intramuscularly or deep subcutaneously. The interval between the administration of the drug is 1.5 months, the reduction is not allowed. If it did not work out to introduce the drug in the required time, vaccination is carried out soon. Adult diphtheria revaccination in this case is carried out once in 9-12 months. Then the vaccine-philaxis is carried out every 10 years, planning it in advance. If earlier for revaccination, the maximum age was 66 years, then there are currently no such restrictions.

When and where do the vaccination of diphtheria adults? Vaccination is carried out in the clinic, behind which a person is assigned in the case when it is completely healthy.

What are the vaccines from diphtheria?

1. Children under 6 years old ADH is introduced.
2. ADS - adsorbed diphtheria-tetanus anatoxin.
3. AD-M is diphtheria antecisin with a reduced antigen content.

Each of these vaccines is introduced according to strict indications.

Diphtheria is a dangerous disease that is afraid even in our time. It is difficult to predict its consequences, especially if the diagnosis was not exhibited in a timely manner. To get rid of infection forever - you need to carry out prevention.

The cause of diphtheria is the diphtheria stick (Corynebacterium Diphtheriae, the lefball wand), producing exotoxin, which determines the whole complex of clinical manifestations of this disease. Symptoms of diphtheria are determined by localization, immune status of the patient and the degree of severity of the body poisoning toxic products of pathogens.

Difteria is preserved predominantly children aged 2 - 6 years. Air-drip - the main way of transmission of infection.

Patients and bacteria carriers are the main sources of infection.

Fig. 1. In the photo of the difterey of the language.

Differy manifestations in children and adults

The mucous membranes of the nose and pharynx, eye, genital organs in girls, skin cover and wounds are entrance gates for diphtheria sticks.

Latent (hidden) period of the disease (incubation period) lasts from 1 to 7 - 12 days. At the end of the incubation period, the patient becomes dangerous to others.

At the site of the introduction of bacteria, inflammation is multiplied and caused inflammation with the formation of fibrinous films, tightly soldered with a submucosal layer. When spreading inflammation on the lads and bronchi develops swelling. The narrowing of the respiratory tract leads to asphyxia. Toxin, which is isolated by bacteria is absorbed into the blood, which causes severe intoxication, the defeat of the heart muscle, adrenal glands and peripheral nerves.

The maximum intensity of the release of pathogenic bacteria is noted in patients with diphtheria of the oz, larynx and nose.

Forms of diphtheria

• Difteria can flow in an atypical (catarrhaal) form.
• In the typical form of diphtheria, inflammation develops with the formation of fibrinous films, tightly soldered with a submucosal layer. The typical form of the disease can occur in the form of a localized form, common and toxic.
• 90% and more cases of the disease constitute the difterey of the language. Significantly less often - larynx, nose and respiratory tract. In isolated cases, diphtheria of eyes, leather, genital organs, wounds and ears is registered. Diffex inflammation may simultaneously be addressed by several organs (always in combination with the diphtheria of the oz).

Fever

Fever with diphtheria is short-term. The temperature often does not exceed 38 o C. After 2 to 4 days, the body temperature comes back to normal. With the toxic form of the disease, the temperature is higher and lasts until 5 days. Next, the infectious process proceeds with normal temperatures.

Fig. 2. In the photo of the difteria of the oz (localized form).

Inxication syndrome

Lost, drowsiness, adamope and arterial hypotension - characteristic symptoms of diphtheria in children and adults. Symptoms of intoxication, characteristic of most infectious diseases (octs, headache, muscle and articular pains) for diphtheria are not characteristic. A common form of diphtheria proceeds with more pronounced symptoms of intoxication. The toxic form of diphtheria flows with a high body temperature (up to 40 ° C), severe headache, chills, vomiting and stomach pain.

Local defeat syndrome

At the site of the introduction of diphtheria sticks (entrance gates), fibrinous films are formed on the surface of the mucous membranes, tightly connected with the epithelial layer. Especially deeply film penetrate the epithelium on the almond sloths, as they are covered with a multilayer flat epithelium. When trying to separate the films, the damaged space begins to bleed.

The color of diphtheria films is with a gray tint. The more the film is soaked with blood, the more darker. As the diphtheria films are recovered independently peel.

Diffex films have a dense consistency, they are not treated on the glass glass, they do not dissolve and drown in water.

The formation of the films is influenced by the degree of immunity of the patient. In the presence of partial immunity, the films are often not formed.

Fig. 3. Film dirty and white, located on the soft sky - a classic sign of diphtheria.

Subcutaneous fat fiber swelling swelling

Hyaluronidase and diphtheria toxin increase the permeability of capillaries, which leads to the exit to the intercellular space of the liquid part of the blood. The swelling of the mucous membrane of the oxide and subcutaneous fatty fiber of the neck is developing. Edema is developing most often in children over 6 years old, the infection of which has occurred highly toxic strains of diphtheria sticks.

For intoxication of the 1st degree, the spread of edema to the first cervical fold, the 2nd degree is the spread of edema to the clavicle, the 3rd degree - the spread of edema below the clavicle.

Fig. 4. In the photo of the diphtheria in a child and an adult. The expressed swelling of the subcutaneous fatty fiber of the neck "Bull Neck" - a frequent symptom of diphtheria in adults and children.

Sore throat

The pain in the throat during diphtheria is most often moderate. Strong pain is noted with a toxic version of the disease.

Increased lymph nodes

Lymphatic nodes in diphtheria are increased and moderately painful. In the toxic forms of the disease, perinodular swelling is noted, the lymph nodes are acquiring a tough consistency.

Rare forms of diphtheria, which were in the past in 1 - 5% of all forms of diphtheria, almost disappeared in the modern world and constitute no more than 1%.

Diffhery Zev

90% and more cases of the disease constitute the difterey of the language. The wide conduct of active immunization led to the fact that the forecast of the disease in many cases becomes favorable. Often, the difterey of the 13th flows under the mask catarrhal or. In 90% of all cases, the difterey of the 13th occurs in the form of a local form.

Symptoms and symptoms of the diphtheria of the occasion with the subclinical form of the disease

Thorough pain insignificant. Temperature subfebrile duration of no more than 2 days. Almonds hyperemic. The submandibular lymph nodes are increasing slightly.

Symptoms and symptoms of the diphtheria of the oz during localized form

The body temperature rises to 38 o C. lethargy, drowsiness, adamope and arterial hypotension - characteristic symptoms of diphtheria. Pains are noted when swallowing. Almonds hyperemic and female. On their surface, the film raids are appear on their surfaces or the raids in the form of islands located outside the lacuna. The films are firmly connected to the epithelial layer and, when trying to separate them, the damaged place begins to bleed. Beyond the tonsils of the film do not go out.

The submandibular lymph nodes are increasing slightly. With a favorable course, the disease passes within 4 days.

Fig. 5. In the photo of the difteria of the child in a child, a localized form. On the right in the photo are visible raids in the form of islands, located outside Lakun - a characteristic sign of diphtheria.

Symptoms and symptoms of the diphtheria of the occasion in common form

This form of the disease is either a continuation of the localized form of the disease, or it occurs primary. The patient worries lethargy, drowsiness, adamine and arterial hypotension. Headaches are noted, sometimes vomiting. Body temperature rises to 38 o C. Moderate.

Almonds hyperemic and female. On the almonds, the pavements, the tongue and the soft sky appear the film raids.

The submandibular lymph nodes increase to 3 cm in diameter, their moderate pain is noted. Sweet fiber edema does not develop.

With a favorable course, the disease passes within 7 - 10 days.

Fig. 6. In the photo of the difteria of the language, a common form. On almonds, skydigates, the tongue and the soft sky are visible to the film raids.

Signs and symptoms of diphtheria of the oz during toxic form

The patient's condition is severe. The body temperature rises to 40 o C - 41 o C. lethargy, drowsiness, adamus and arterial hypotension are pronounced. The child has multiple vomiting and abdominal pain.

The almonds are significantly increased, the zois area is completely closed. Almonds, skydly almonds, tongue and soft sky are covered in large in size of dirty color with thick interfachable films. When distributing diphtheria films on the larynx and the trachea develops downward croup. In the gangrenous decay of diphtheria films, the sall smell is emanated from the mouth of the patient, sucrovic sections appear from the nose. Breathing is difficult, sometimes snoring. It is a nasal shade.

The submandibular lymph nodes are increased to 4 cm in diameter, moderately painful. The seam of cervical fiber applies to the clavicle and below.

In the second week, severe complications appear later: myocarditis, polyneurite, defeat of adrenal glands and kidneys.

Fig. 7. In the photo of the swelling of the subcutaneous fatty tissue of the neck with the toxic form of the difteria of the oz in the child.

Symptoms and symptoms of the diphtheria of the oz during hypecoxic form

The beginning of the disease is sudden and stormy. The body temperature rises significantly. Multi-time vomiting, disorders of consciousness and convulsions are registered.

Difterine films capture zev, larynx and throat. Developed diphtheria croup leads to asphyxia.

The seam of cervical fiber applies to the clavicle and below.

The death of patients comes on 2 - 5 days from the developed infectious-toxic shock. With a favorable course of the disease, recovery comes slowly.

Fig. 8. The pronounced swelling of the subcutaneous fatty fiber of the neck in the child with the toxic form of the disease.

Symptoms and symptoms of the diphtheria of the oz during hemorrhagic form

The most severe form of diphtheria, in which multiple hemorrhagic rash appears on the skin and extensive hemorrhages. From gums, nose and gastrointestinal tract marked bleeding. Diffex films are impregnated with blood.

The toxic and hemorrhagic forms of diphtheria are complicated by myocardians, which are manifested by phenomena of severe heart failure. For 2 - 4 weeks, polyradigonevrit develops. Particularly dangerous for the patient are the damage to the nerves, innervating heart, aperture and larynx, which leads to paresis and paralymp. Complications, as a rule, develop due to improper treatment of the patient, when the difterey of the ZEVA is erroneously taken for the angina and the anti-informy serum is administered late. Early administration of serum leads to a rapid improvement in the overall condition of the patient, the disappearance of the symptoms of intoxication, the rejection of diphtheria films occurs after a week.

Difteria larynx. Diphtheria

Currently, due to a decrease in the incidence of diphtheria, diphtheria croup (acute inflammation of the larynx) is rare, mainly in children 1 - 3 years. The primary croup (insulated damage to the larynx) is rare. Diffheses of the larynx and trachea (common croup) and downward croup are registered more often than the inflammation is distributed from the larynx on the trachea and bronchi.

Promote the development of the stenosis of the respiratory tract of muscle spasm and swelling of the larynx mucous membrane, which is detected during larying and bronchoscopy. The severity of the disease depends on the degree of obstruction of the respiratory tract.

Diffex croup in its development takes several stages.

Signs and symptoms of diphtheria cereals in the stage of catarrhal inflammation

The stage of catarrhal inflammation (dysphony stage) is characterized by the appearance of a coarse "barking" cough and spelliness of the voice. The duration of the dysphonic stage is about 7 days in adults and 1 - 3 days in children. If there is no specific treatment, then after 1 to 3 days, this stage passes into the second - the wall phase.

Fig. 9. In the photo of the difteria of the larynx. On the right shows the film collected on the voice circuit.

Signs and symptoms of diphtheria cereals in the wall

In the transmission stage, the voice becomes husky and soon disappears (Aphony), silent cough, breathing becomes noisy, an auxiliary musculature begins to take part in the act of breathing. The duration of the wall stage is from several hours to 2 - 3 days. With no specific treatment, asphyxia is developing rapidly. To prevent chopping, tracheostomy or intubation is used.

Symptoms and symptoms of diphtheria cereals in the asphy

In the asphyge stage, breathing is read, the pulse becomes filamentous, blood pressure is reduced, cyanosis develops, convulsions appear. Death comes from choking.

The narrowing of the larynx may occur even with a light degree of diphtheria, when the exhaust films prevent air from entering the respiratory tract

Fig. 10. In the photo, a child with diphtheria croup. To prevent chopping, tracheostomy or intubation is used.

Nose Diphthery

Diffex rhinitis is rare. The disease is mainly registered in young children.

Signs and symptoms of diphtheria rhinitis

• The nasal diffraction begins with minor mucosa seals. Gradually, the separation of the nose acquire serous-blood and further serous-purulent character. Diffex films appear on the surface of the mucous membrane.
• Nasal breathing is difficult. Gnush's voice.
• Erosions and cracks appear on the skin of the upper lip and around the nasal strokes.
• Often the child comes unpleasant odor.
• The body temperature is more likely subfebrile.
• With toxic forms, the body temperature increases significantly, the edema of soft tissues of the nose and face develops.
• The disease is prone to a protracted flow.

Rososcopic pattern of diphtheria rhinitis

In case of inspection of the cavity of the nose and the nasopharynx, the hyperemic mucous membrane is visible, on the surface of which diphtheria films are located.

With the catarrically ulcerative form of the diphtheria of the nose, the film is not formed. When rososcopy on the mucous membrane of the nose, you can see erosion and bloody crusts.

Belated diagnostics of the diphtheria of the nose is associated with slow suction of toxin and weak severity of general disorders.

Fig. 11. In the photo of the nose diftere. On the skin of the upper lip, erosion and cracks are visible. In the nasal cavity - diphtheria films.

Skin difftheria

Skin diphteria is most often found in countries with a hot climate. The disease is a greater epidemic hazard. Surface skin diphteria is more often registered with young children. The lesion is localized in the folds of the skin of the neck, inguinal folds, armpits, and behind the ears. Newborn, specific inflammation can develop in the field of umbilical wound. Diffex inflammation in the field of wounds and abrasion occurs more often in older children. A deep form of the disease is more often registered in the field of genital organs in girls.

Signs and symptoms of skin diphtheria

Most often, the diphtheria lesion of the skin flows along the type of impetigo, when papulas appear on the skin surface, on the site of which bubbles filled with serous fluid appear. Bubbles burst quickly. Strips appear in their place. Diffex films are often not formed. The surface form of the disease can flow through the type of eczema. Regional lymph nodes increase. They are dense and painful.

Symptoms and symptoms of deep skin diphtheria

Deep skin difftheria may be a consequence of the subsequent development of the surface form, or arises as an independent disease. Nazis, phlegmonous and gangrenous lesions are noted. The disease begins with the formation of a dense infiltration, which over time is subject to necrosis. At the scene of necrosis, an ulcer is formed covered with a greenish-gray bloom. The ulcer has a rounded shape and infiltrated rim along the periphery. When healing, rotational scars are formed. Deep skin diphteria is often localized on the genitals. With a common form, the pathological process affects the area of \u200b\u200bthe perineum and anus and is accompanied by severe swelling of subcutaneous fiber, including abdomen and hips.

Fig. 12. In the photo of the skin of the skin of the shin in an adult.

Difteria eye

Diffinery conjunctivitis is a severe disease that requires serious attention. The eye difftheria is usually registered as an independent disease, but sometimes the disease flows against the background of the nasopharynx diphtheria, zea and larynx. The children most often suffer.

Symptoms and symptoms of eye diphtheria

The catarrhal form of conjunctivitis is registered most often in newborns and the children of the first year of life and proceeds easily. The diphtheritic form of the disease occurs hard.

At the beginning of the disease, the edema of the century is registered, which quickly acquires dense consistency and blue painting. The conjunctive shell swells, hemorrhage appears on it. In the zone of the transitional folds of the conjunctiva of the eyelids, gray-colored films appear. They are tightly soldered with subject to tissues and when trying to remove them, bleeding occurs. Gradually, the films begin to undergo necrosis. A purulent-blooded liquid is distinguished from the eyes. "Star" scars appear on the spot of the films. The defeat of the cornea leads to the death of the eye. Early diagnosis and timely treatment prevent complications.

Fig. 13. In the photo, diphtheria conjunctivitis.

Fig. 14. In the photo of the effects of diphtheria conjunctivitis - parenchymal xerophthalmia (dry eye). The inflammation of the conjunctiva is complicated by the formation of connective tissue scars.

Difteria Esche

Own sink and an outer hearing pass for diphtheria is amazed again. The infection is transmitted through dirty fingers and objects.

Symptoms and symptoms of diphtheria ears

The disease is characterized by severe pain. In case of decomposition of diphtheria films, an unpleasant smell appears. The external auditory passes is distinguished by purulent blood fluid. In small children, the diffraction of an external auditory passage is complicated by the destruction of auditory bones and a predominant process, intracranial complications are developing.

Fig. 15. In the photo of the diffraction of the external auditory passage.

Today there are no outbreaks of epidemics of this disease, but it continues to worry many people. It is important to be aware of this issue to score anxiety at the very first cases of detection of a characteristic laid or affected mucous membranes. Consider what diphtheria is symptoms and differences in the signs of the disease in an adult and child.

What is diphtheria

In general, the disease is characterized by inflammation of the organs of the upper respiratory tract, lesion of the skin and other sensitive zones of the body. When diphteria is observed - the symptoms of it can accurately determine a few. The character of the ailment is infectious, but this disease is dangerous not so much by local manifestations, how many consequences for nervous and cardiovascular systems. The cause of their damage is toxin poisoning produced by diphtheria pathogens - Corynebacterium diphteriae. These bacteria are transmitted by air-droplet.

Views

Difteria is distinguished depending on the location of the acute infection. Affected by breathing tracks, eyes, skin, ears and genitals are affected. According to the nature of the flow, the disease is typical or a film, catarrhal, toxic, hypecoxic, hemorrhagic. There are several stages pointing to the severity of the disease:

• light (localized) form;
• average (common);
• heavy stage (toxic diphteria).

Clinical manifestations of diphtheria

Independently diagnose the disease is difficult. Diphtheria - local symptoms can be similar to manifestations of angina, and not dangerous infectious inflammation. Definition is determined by testing the mucous membranes. The pathogen falls on the vulnerable areas of the skin, where he begins to multiply, creates foci of inflammation. Locally occurs epithelium necrosis, hyperemia appears.

Exotoxin or diphtheria toxin produced by diphtheria bacteria is propagated by the blood and lymphatic paths, contributing to the general intoxication of the body. In the presence of autoimmune processes, complications aimed at the nervous system can develop faster. After recovery in the body, the signs of diphtheria disappear and antibodies appear, but they do not always reduce the risk to infect again.

In adults

In recent years, cases of such infectious diseases among adults have become more frequent. At the same time, several organs can be amazed. The most common form is the disease of the mucousness of the pharynx, so it is often confused with an angina. The patient has an increase in temperature, chills and severe sore throat. There is a swelling of tonsils, and on their surface you can see the film flaw, missing in healthy people. It is preserved even after the temperature is normalized.

If a person abuses alcohol, it increases the risk of developing toxic and hyperstoxic form. They provoke the spread of edema throughout the body, cause convulsions. These processes occur rapidly. After a few hours, the patient drops blood pressure and toxic shock occurs. These events often lead to death. Symptoms of diphtheria in adults are often pronounced stronger than in children.

In children

In order to minimize the severity of symptoms in infecting children, they make vaccinations for diphtheria prevention. The degree of symptoms will depend on whether pre-immunization was performed. Children without vaccinations are in the risk area of \u200b\u200bdangerous complications and death. In newborns, the localization of inflammatory processes is observed in an umbilical wound. At the age of breastfeeding, the area of \u200b\u200bthe lesion may be nose, after a year - the shell of the larynx and the shell of the rotogling.

Symptoms of rotogling diphtheria

These are the most frequent manifestation of the disease (95% of cases). The incubation period ranges from 2 to 10 days. When the oral mucosa strikes diphteria - symptoms are similar to manifestations of angina. A characteristic feature is the appearance of a dirty white plaque on the almonds. The degree of severity of how symptoms appear depends on the form of diphtheria, so at first suspicions it is important to consult a doctor for analyzes.

With common form

If the form is common, then the diphteria is its local symptoms to see at an early stage, because it affects not only almonds, but also neighboring fabrics. There is a risk of the following manifestations of intoxication:

• the diphtheria film on the almonds, the tongue and the throat is difficult to remove the spatula, and the blood appears on the place of removal;
• the body temperature rises to 38-39 ° C;
• headache occurs, pain when swallowing;
• lack of appetite, general malaise.

Toxic

This form of the disease occurs in children who have not passed the vaccination procedure. It is characterized by acute principle when the temperature sharply rises to 40 degrees. The patient refuses meals, suffers from vomiting. The pallor of the skin is noticeably expressed, the spasm of chewing muscles occurs. The enemy of the rotogling and neck develops. Flip on the fabrics from translucent turns into a dense, with clear edges. The greatest danger of all symptoms are convulsions.

Hypertoxic

In the risk group of the development of hyperstoxic form are patients having an adverse premorbid background (for example, diabetes, alcoholism, chronic hepatitis form). With the onset of this stage, a rapid temperature increase occurs. All signs of intoxication are observed. Progresses violation of the cardiovascular system. Tachycardia is present, pressure drops, subcutaneous hemorrhages are formed. With such characteristic clinical paintings, the fatal outcome may occur after 1-2 days.

Diphtheria cereal

The manifestations of diphtheria in bruboral form or diphtheria croup has recently been observed among adult patients. Half has three stages that develop consistently:

• divoric - characteristic features is the cough, huskiness;
• stenotic - voice loss, silent cough, but respiration noisy, tachycardia, pale leather;
• asfixic - surface frequent breathing, increases cyanosis, pressure drops, consciousness is disturbed, convulsions arise. The last stage is the most dangerous, since the flow of oxygen into the body and a person can die from asphyxia.

Symptoms of localized diphtheria

Almost any manifestation of the disease has a similar clinical picture. If a person is suspected of diphtheria - local symptoms are important to discuss with the doctor as early as possible. This will prevent its development in the early stages. The toxin allocated by bacteria in the lesion zones is distributed throughout the body, but at a local form, the foci of infection is immediately noticeable. It can be:

• nose and nasopharynk;
• the mucous membranes of the eye are affected;
• genital fabrics;
• leather, wounds and breaks of epithelial cover.

Difteria eye

The incubation period is 2-10 days. Children at the age of 2-10 years old are often subject to diphtheria. This is a rare form of a disease that arises against the background of the diphtheria of the oz, nasopharynx and other zones. A characteristic feature is hyperemia of the skin of the eyelids, the occurrence of transparent bubbles, which blowing up, form on its places. Gradually, he develops into a painless ulcer. Distinguished diphtheria, bitter and catarrhal forms. In some cases, scars can lead to the deformation of the eyelids.

Nose

We'll figure it out in the following: nasal difftheria - symptoms and features. The manifestation happens isolated or on his background can be amazed by larynx, trachea. Sometimes the raids apply to downward paths. Moreborn and children under 2 years old are suffering from this form. As in the cases described above, the patient has an increase in temperature, weakness and apathy. There is a nasal congestion, succinous discharges, dermatitis of affected skin. There is inflammation of the mucous membrane, it is covered with ulcers, fibrinous raid.

Genital organs and skin

Loosen areas can be sexual organs, skin sections. If diphteria is diagnosed in such cases - which will be the local symptoms? This form also has a complex nature and arises against the background of the disease of the oz. In rare cases, an isolated manifestation is observed. The patient feels pain when urinating, light itching in the intimate zone. It is noticeably redness, swelling of the mucous membrane, adjacent tissues. Due to the reproduction of bacteria, cells occurs, there is a raid and ulcers in their place. There is an increase in lymph nodes in the groin zone.

Wound surfaces

If deep wounds are present on the skin surface, the causative agent of infection may fall there. Due to the struggle of the body with infection, the temperature rises, the wound swells, becomes more painful. There is a white and yellow raid, which in a few days will develop into a dense film. Even the patient has shine in the eyes, redness of the cheeks.

Symptoms of specific complications

When the patient detects diphtheria - the external symptoms can excite doctors less than the symptoms of intoxication or the occurrence of complications. After all, with proper treatment, you can cope with external manifestations at an early stage. Due to the toxic lesion of the entire body through blood and lymphatic channels, recovery may be accompanied by complications that have a specific nature and affecting all organism systems:

• cardiovascular - the work of adrenal glands, heart muscle is disturbed, toxic myocarditis develops;
• nervous - can be damaged by sympathetic and autonomous ganglia, wandering and tongue nerve, in rare cases - the nerve endings in their hands and legs, which often leads to paralysis;
• the separation - frequent complication is toxic nephrisus, especially those who have not received anti-diamifteric serum;
• blood-75% of patients may suffer from leukemia, monocytosis is fixed in 31%, and 66% increased ETE indicators. Anemia or thrombocytopenia may occur.

Video

Diphtheria - acute anthroponous bacterial infection with general-oxygen phenomena and fibrinous inflammation at the entrance gate of the pathogen.

Brief historical information
The disease is known since the times of deep antiquity, hypocrat, Homer, Galen, mentioned in their writings. For many centuries, the name of the disease has repeatedly changed: "deadly pharynx ulcer", "Syrian disease", "Palace Loop", "malignant angina", "croup." In the XIX century P. Bretonno, and later his student A. Trusso presented a classic description of the disease, having highlight it as an independent nosological form called "diphtherite", and then "diphteria" (Greek. Diphthera - film, membrane).

E. Klebs (1883) discovered the pathogen in film films from the rotogling, a year later F. Löffler allocated him in a clean culture. A few years later, a specific diphtheria toxin was isolated (E. Ru and A. Yersen, 1888), antitoxin in the patient's blood was found and antitoxic contradiform serum was obtained (E. Ru, E. Bering, Sh. Kitazato, Ya.Yu. Bardakh, 1892 -1894). Its use made it possible to reduce mortality from diphtheria 5-10 times. Ramon (1923) developed anti-informitian anatoksin. As a result of the immunoprophylaxis, the incidence of diphtheria decreased sharply; In many countries, it was even eliminated.

In Ukraine, since the late 70s, and especially in the 90s of the 20th century, against the background of a decrease in collective antitoxic immunity, primarily the incidence of diphtheria increased in the adult population. This situation was determined by defects of vaccination and revaccination, the change of the beawners of the pathogen to more virulent and deterioration of the socio-economic conditions of the population.

What provokes diphtheria

Difteria causative agent - Gram-positive fixed chopstick bacterium Corynebacterium Diphtheriae. Bacteria have maw-shaped thickening at the ends (Greek. Sogne - Bulava). When dividing the cells diverge at an angle to each other, which causes the characteristic arrangement of them in the form of spreading fingers, hieroglyphs, Latin letters V, Y, L, parquet, etc. Bacteria form Volyututin, the grain of which is located on the poles of the cell and are detected when staining. According to Niiser, the bacteria are painted in brown-yellow color with blue thickened ends. There are two main beaws of the pathogen (GRAVIS and MITTS), as well as a series of intermediate (intermedius, minimus, etc.). Bacteria are whims and growing on whey and blood media. The largest propagation was obtained by a television medium (for example, Clauberga II medium), since the pathogen is resistient to a high concentration of potassium or sodium teleuritus, inhibiting the growth of contaminating microflora. The main factor of pathogenicity is diphtheria exotoxin, attributable to highly active bacterial poisons. It is inferior only to botulinum and tetanus toxins. The ability to toxinization exhibit only the leased strains of the pathogen infected with the bacteriophage carrying the tox gene encoding the structure of the toxin. Non-etoxy strains of the pathogen are not able to cause a disease. Adhesiveness, i.e. The ability to attack the body's mucous membranes and multiply, determines the virulence of the strain. The pathogen remains for a long time in the external environment (on the surface of objects and in dust - up to 2 months). Under the influence of a 10% hydrogen peroxide solution, it dies after 3 minutes, when processing with 1% solution with a solution, 5% phenol solution, 50-60 ° ethyl alcohol - after 1 min. Resistant to low temperatures, when heated to 60 ° C dies after 10 minutes. Inactivating effects also have ultraviolet rays, chlorine-containing drugs, lysol and other disinfectants.

Reservoir and source of infection - a sick person or a carrier of toxic strains. The greatest role in the spread of infection belongs to the patient diphtheria, especially with the erased and atypical forms of the disease. Reconvalues \u200b\u200bare distinguished by the causative agent for 15-20 days (sometimes up to 3 months). Great danger to others represent bacteria carriers that distinguish the pathogen from the nasopharynx. In various groups, the frequency of long-term carriers varies from 13 to 29%. The continuity of the epidemic process provides long-term carriages even without incorrect.

Mechanism of transmission - Aerosol, transmission path - drip. Sometimes contaminated hands and objects of the external environment can become factors of transmission (item item, toys, dishes, linen, etc.). Difteria of the skin, eye and genital organs occurs when transferring the pathogen through contaminated hands. Also known food flashes of diphtheria, due to the reproduction of the pathogen in milk, confectionery creams, etc.

Natural susceptibility of people High and determined by antitoxic immunity. The blood content of 0.03 AE / ml of specific antibodies provides protection against the disease, but does not prevent the formation of the carriage of pathogenic pathogens. Diffex antitoxic antibodies transmitted transplacentar protect newborns from the disease during the first half of life. Urbled diphtheria or properly vaccinated people produces antitoxic immunity, its level is a reliable criterion for protectedness from this infection.

Main epidemiological signs. Difteria as a disease, which is dependent on the population, according to WHO specialists, can be successfully monitored. In Europe, broad immunization programs have begun in the 40s, and the incidence of diphtheria quickly decreased to isolated cases in many countries. A significant decrease in the immune layer always accompanies the increase in the incidence of diphtheria. This happened in Ukraine in the early 1990s, when against the background of a sharp decline in collective immunity, an unprecedented incidence of morbidity was noted, first of all adults. Following the increase in the incidence of adults, the children who did not have antitoxic immunity were involved in the epidemic process, often as a result of unreasonable taps from vaccinations. Migration of the population in recent years also contributed to the widespread pathogen. Periodic (in perennial dynamics) and autumn-winter (intra-annual) incidence lifting are also observed during vaccine defects. Under these conditions, the incidence can "shift" from the children's for an older age with a predominant defeat of people of threatened professions (transport workers, trade, services, medical workers, teachers, etc.). The sharp deterioration in the epidemiological situation is accompanied by a more severe course of the disease and an increase in mortality. The incidence of incidence of diphtheria coincided with an increase in the latitude of gravis and intermedius bifted circulation. Among the diseases are still dominated by adults. Among the grafted diphteria proceeds easily and is not accompanied by complications. The supply of infection into somatic hospital is possible in hospitalization of a patient with an estate or atypical form of diphtheria, as well as a carrier of a toxic pathogen.

Pathogenesis (what happens?) During diphtheria

The main entrance doors of infection- The mucous membranes of the rotogling, less often - nose and larynx, even less often - conjunctiva, ears, genitals, leather. The reproduction of the pathogen occurs in the field of entrance gate. Toxy bacteria strains allocate exotoxin and enzymes, provoking the formation of the focus of inflammation. The local action of diphtheria toxin is expressed in the coagulative necrosis of the epithelium, the development of hyperemia of blood vessels and blood of blood in capillaries, increasing the permeability of vascular walls. Exudate containing fibrinogen, leukocytes, macrophages and often red blood cells, goes beyond the limits of the vascular bed. On the surface of the mucous membrane, as a result of contact with thromboplastin of necrotic fibrinogen tissue turns into fibrin. The fibrin film is firmly fixed on a multi-layer epithelium of the ocean and pharynx, but is easily removed from the mucous membrane covered with a single-layer epithelium, in the larynx, trachea and bronchi. At the same time, with an easy course of the disease, inflammatory changes can be limited only by a simple catarrhal process without forming fibrinous bending.

The neuraminidase of the pathogen will significantly potentiate the action of exotoxin. Its main part is histotoxin, blocking protein synthesis in cells and an inactivating transferase enzyme responsible for the formation of a polypeptide bond.

Differic exotoxin is propagated by lymphatic and blood vessels, caused by the development of intoxication, regional lymphadenitis and the edema of surrounding tissues. In severe cases, the edema of the nebogo tongue, the chickens and almonds sharply narrows the entrance to the throat, the severity of the cervical fiber is developing, the degree of which corresponds to the severity of the disease.
Toxinomy leads to the development of microcirculatory disorders and inflammatory-degenerative processes in various organs and systems - cardiovascular and nervous systems, kidneys, adrenal glands. The binding of toxin with specific cell receptors passes in the form of two phases - reversible and irreversible.
- In the reversible phase, the cells retain their viability, and toxin can be neutralized with antitoxic antibodies.
- In the irreversible phase of the antibody can no longer neutralize toxin and do not prevent the implementation of its cytopathogenic activity.

As a result, nationous reactions and phenomena of sensitization are developing. In the pathogenesis of late complications from the nervous system, autoimmune mechanisms can play a certain role.

Antitoxic immunity, developing after transferred diphtheria, does not always protect against the possibility of re-illness. Antitoxic antibodies have a protective effect in tutors at least 1:40.

Symptoms of diphtheria

Incubation periodlasts from 2 to 10 days. The clinical classification of diphtheria divides the disease to the following forms and flow options.
Rotoglot Diphthery:
o rotoglotype diffraction is localized with catarrhal, islets and film options;
o rotogling diffraction common;
o Diftera of the rotogling of the subtaxic;
o rotogling difftheria toxic (I, II and III degrees);
o rotogling difftheria hypecoxic.
Diffex croup:
o Large diftere (diphtheria, localized diphtheria);
o Difteria of the larynx and trachea (rubber distributed);
o Diphetia Large, trachea and bronchi (downward croup).
Nose difftheria.
Genital difcthery.
Eye difftheria.
Skin difftheria.
Combined forms with simultaneous lesions of several organs.

Rotoglotka difftheria
The rotogling difftheria is 90-95% of all cases of the disease in children and adults; In 70-75% of patients, it flows in a localized form. The disease begins acutely, elevated body temperature from subfebrile to high preserves 2-3 days. Inxication moderate: Headache, malaise, decreased appetite, skin pallor, tachycardia. When the body temperature decreases, local manifestations in the field of entrance gate are saved and can even increase. The intensity of the pain in the throat when swallowing corresponds to the nature of the changes in the rotoglot, which is noted by a non-rigid stagnant spilled hyperemia, a moderate enemy of the almonds, a soft nose and a mead. The raids are localized only on the almonds and do not go beyond their borders, are located separate islands or in the form of a film (iso-bell or film options). Fibrinous raids in the first hours of the disease look like a jelly-like mass, then like a thin web-like film, but already on the 2nd day of the disease, they become dense, smooth, grayish color with pearl gloss, with difficulty, when they are removed with a spatula, the mucous membrane is bleeding. The next day, a new one appears on the site of the remote film. The filmed fibrinous film, placed in water, does not break and sinks. With a localized form of diphtheria, typical fibrinous raids observe no more than 1/3 adult patients, in other cases, as well as in a later date (3-5th day of the disease), the raids are loose and removed easily, the bleeding of the mucous membrane when removing them is not expressed. Regional and submandibular lymph nodes are moderately increased and sensitive during palpation. The process on almonds and the reaction of regional lymph nodes can be asymmetric or one-sided.

Catarial optionthe localized rotogotage diphtheria is rarely recorded, it is accompanied by minimal common and local symptoms. With a normal or short-term subfebrile body temperature and weak manifestations of intoxication, there is an unpleasant feeling in the throat during swallowing, a small hyperemia of the mucous membrane of the ointment, the solvent of the almonds. Diffinery Diagnosis In such cases, it is possible to put only taking into account the history of the history, an epidemic situation and the results of a laboratory survey.

The flow of localized rotogling diphtheria is usually benign. After the normalization of the body temperature is reduced and then disappears the pain in the throat, while the raids on the almonds can be saved 6-8 days. However, in the absence of treatment, the localized form of rotogling diphtheria can progress and move to other, more hard forms.

Complete form of rotogling diphtheria. Meet relatively rare (3-11%). It differs from the localized form by the spread of the attack beyond the tonsils on any areas of the oral mucosa. Symptoms of general intoxication, the enemy of the almonds, the soreness of the submandibular lymph nodes is usually more pronounced than with a localized form. The subcutaneous cell of the neck does not happen.

The suboxy form of rotogling diphtheria. There are no intoxication phenomena, pronounced pain when swallowing and sometimes in the neck area. Almonds of crimson-cyanotic color with a climb carrying a localized character or slightly propagating in breadth and tongue. The enemy of the almonds, the student, tongue and soft sweeping moderate. There is an increase, soreness and density of regional lymph nodes. A distinctive feature of this form is the local edema of subcutaneous fiber over regional lymph nodes, often one-sided.

Toxic form of rotogling diphtheria. Currently meet quite often (about 20% of the total number of patients), especially in adults. It can develop from an uncutaneous localized or common form, but in most cases it occurs immediately and rapidly progresses. The body temperature is usually high (39-41 ° C) from the first hours of the disease. Headache is celebrated, weakness, severe throat pain, sometimes in the neck and stomach. Vomiting may occur, the painful triumism of chewing muscles, euphoria, excitement, nonsense, delirium. Skin pale (with toxic diphtheria III degree is possible hyperemia of the face). Diffuse hyperemia and a pronounced edema of the oxide mucous membrane, with toxic diphtheria II and III degrees, a fully closing lumen of the ZEV, precede the appearance of fibrinous bending. The resulting waves quickly apply to all chipboard departments. In the future, fibrin films become thicker and rougher, keep up to 2 weeks or more. The process is often unilateral. Regional lymph nodes increase early and significantly, becoming dense, painful, develops periathenitis.

Local manifestations in the toxic rotogloty diphtheria differ from all other forms of the disease by the presence of a painless testing edema of subcutaneous fiber of the neck, reaching it of its middle with toxic diphtheria I degree, the clavicle - at the II degree. With III degree, the edema descends below the clavicle, can spread to the face, the back surface of the neck, back and quickly progresses.

It is expressed by the general oxygen syndrome, the cyanosis of lips, tachycardia, decrease in blood pressure. When the temperature of the body decreases, the symptoms remain pronounced. From the mouth of patients, a specific illustrative smell occurs, the voice acquires a vile shade.

The toxic rotogling diffraction is often combined with larynx and nose lesions. Such combined forms are distinguished by a difficult course, they are difficult to amenable to therapy.

Hyperstoxic form - The most severe manifestation of diphtheria. More often develops in patients with an unfavorable premorbid background (alcoholism, diabetes, chronic hepatitis, etc.). The body temperature with chills rapidly increases to high numbers, intoxication is sharply expressed (weakness, headache, vomiting, dizziness, signs of encephalopathy). The progressive disorders of hemodynamics are tachycardia, a weak pulse, a decrease in blood pressure, pallor, acricyanosis. Skin hemorrhages arise, organic bleeding, the impregnation of fibrinous bells, which reflects the development of the DVS syndrome. In the clinical picture, signs of a rapidly developing infectious-toxic shock are dominated, capable of causeing the death of the patient for the 1st day of the disease.

Diphtheria
Localized (larynx diphter) and common (with simultaneous damage to the larynx, trachea and even bronchi) forms. A common form is often combined with the rotogling diphtheria, the nose. Recently, this form of diphtheria is quite often met in adult patients. Clinically croup is manifested in the form of three consistently developing stages - dysphonic, wallotic and asphisic - with moderately pronounced phenomena of intoxication.
- The leading symptoms of the dysphonic stage are a rude cough and an increasing probing voice. In children, it lasts 1-3 days, in adults - up to 7 days.
- In the transmission stage (continues from several hours to 3 days), the voice becomes africa, cough - silent. The patient pale, is worried, respiration is noisy, with an elongated breath and retracting plots of chest. The growth of signs of difficulty breathing, cyanosis, tachycardia is considered as indications for intubation or tracheostomy, which prevents the transition of diphtheria in the asphisical stage.
- In the asphisical stage, breathing becomes frequent and superficial, then rhythmic. Cyanosis increases, the pulse becomes filamentous, the blood pressure drops. In the future, consciousness is disturbed, convulsions appear, death comes from asphyxia.

By virtue of the anatomical peculiarities of the larynx in adults, the development of diphtheria cereals takes more time than in children, the increase in the fascinating beds may be absent. In part in cases, the only signs of this form of the disease are becoming probed voices and a sense of lack of air. At the same time, paying attention to the pallor of the skin, the weakening of breathing, tachycardia, reducing the oxygen voltage in the study of the acid-alkaline state. Unconditional assistance in diagnosis has a laryngoscopic (in some cases and bronchoscopic) research, revealing hyperemia and sanding of larynx, films in the field of voice ligaments, defeat trachea and bronchi.

Nose Diphthery
Silent intoxication is characterized, the difficulty of nasal respiration, serous-purulent or succinous discharge (catarrhal). The mucous membrane of the nose is hyperemic, extinguished, with erosions, ulcers or fibrinous overlays in the form of easily removable "konayev" (film option). On the skin near the nose, irritation, mock and crust appear. The nose diffraction is usually developing in combination with the lesion of the rotogling and (or) larynx, sometimes eyes.

Difteria eye
It may proceed in catarrhal, film and toxic versions.

When the cataroile, there is an inflammation of the conjunctiva (more often one-sided) with non-volatile secretions. Body temperature is normal or subfebrile. No symptoms of intoxication and regional lymphadenitis are absent.

Under the film, a fibrin film on a hyperemic conjunctival is formed by a film and weak general oxygen phenomena, the ebony edema increases, serial-purulent sections appear. The process first is one-sided, but in a few days can go to another eye.

Toxic eye diffraction has a sharp beginning, it has a rapid development of symptoms of intoxication, eyelid edema, abundant suction-purulent secret, irritation and mocking of the skin around the eye. Owl spreads, capturing various fields of subcutaneous fiber of the face. The film conjunctivitis often accompany the defeats of other departments of the eye, up to the panophalmia, as well as regional lymphadenitis.

Ear difftheria, genital organs (anal genital), leather
These states are rare; Usually they develop in combination with the diphtheria of the oz or nose. General features of these forms - edema, hyperemia, infiltration, fibrinous beam in the field of lesion, regional lymphadenitis.

In the diphtheria genital organs in men, the process is localized in the area of \u200b\u200bthe foreskin. In women, it can become common and capturing the sexual lips, the vagina, the crotch and the area of \u200b\u200bthe rear passage, are accompanied by serous-bleeding discharge from the vagina, difficult and painful urination.
- Skin difftheria develops in the field of wounds, diaper disposals, eczema, fungal lesions with skin cracks, where dirt-gray raids are formed with serous-purulent separated. General toxic phenomena are insignificant, but the local process regresses slowly (up to 1 month or more).

The development of these forms contribute to traumatization of sections of mucous membranes or skin, driving pathogens with hands.

In persons who moved diphtheria or never sobbed, you can observe asymptomatic carriage, the duration of which varies significantly. The formation of carriages contributes to the concomitant chronic nasophaling diseases. Antitoxic immunity does not prevent the development of carriage.

Complications
The pathogenetically determined complications of diphtheria include infectious-toxic shocks, myocardits, mono- and polyneurite, including lesions of cranial and peripheral nerves, polyradiculoneuropathy, adrenal damage, toxic nephrisosis. The frequency of their development during the localized form of the rotogling diphtheria is 5-20%, with more severe forms, it increases significantly: with subtoxic diphtheria - up to 50% of cases, with different degrees of toxic diphtheria - from 70 to 100%. The development time of complications, considering from the beginning of the disease, is primarily dependent on the clinical form of diphtheria and the severity of the process. A heavy myocarditis, which is the most frequent complication of toxic diphtheria, arises early - at the end of the first or early 2nd week of the disease. Medicate and light myocardits detect later, on the 2-3rd week. Toxic nephrosis as a frequent complication of only toxic diphtheria is detected according to the results of urine analyzes in a sharp period of the disease. Manifestations of neurites and polyradiculoneuropathy may arise both against the background of clinical manifestations of the disease and after 2-3 months after recovery.

Diagnostics of diphtheria

The localized and distributed rotogotage diphtheria is differentiated with angins of various etiologies (cokkoy, simanovsky-vesany-plat, syphilitic, tularemia, etc.), infectious mononucleosis, behanet syndromes, stomatitis. It is distinguished by moderate intoxication, the pallor of the skin, the neuropal hyperemia of the oral togging, the slow regression of manifestations of angina with a decrease in body temperature. Under the film, the variant makes it much easier for the diagnosis of the fibrinic nature of the bells. The most difficult to differential diagnosis is the island variant of the rotogling diphtheria, often clinically not distinguishable from Kokkkk etiology.

When diagnosing the diagnosis of the toxic diphtheria, a differential diagnosis with paratonic abscess, necrotic angns for blood diseases, candidiasis, chemical and thermal burns of the oral cavity are necessary. For the toxic rotogling diphtheria, fast-propagating fibrinous bending, the edema of the oxide mucous membrane and the subcutaneous fiber of the neck, pronounced and rapidly progressive manifestations of intoxication are characterized.

Diffesers differentiate from a false cereal during Corey, ORVI and other diseases. The croup is often combined with the rotogling or nose diphtheria, clinically manifests itself in the form of three consistently developing stages: dysphonic, wallotic and asphisical with moderately pronounced inxication phenomena.

Laboratory diagnostics
In the hemogram, during localized form, the diphtheria is moderate, and with toxic forms - high leukocytosis, neutrophilia with a leukocytic formula shift to the left, the increase in ESP, progressive thrombocytopenia.

The basis of laboratory diagnostics is bacteriological studies: the selection of the pathogen from the focus of inflammation, the definition of its type and toxiety. The material is taken with sterile cotton swabs, dry or moistened (before sterilization!) 5% glycerol solution. When storing and transporting, the tampons are protected from cooling and drying. The material should be sown no later than 2-4 hours after taking. In patients with angina, former in contact with patients with diphtheria, as well as in individuals with typical clinical manifestations of diphtheria, the diagnosis is made even with a negative result of bacteriological research.

The auxiliary value is determined by the definition of antitoxic antibodies in paired serum during Ring. Toxic formation is detected using rf with anti-erythrocyte diagnosticum. To detect diphtheria toxin, it is proposed to use PCR.

Treatment of diphtheria

All patients with diphtheria or suspicion are subject to hospitalization. The time of stay of patients in the hospital and the duration of bed regime depends on the shape and severity of the disease. The main in the treatment of diphtheria is the introduction of antitoxic anti-diaphteric serum. It neutralizes toxin, circulating in the blood, therefore, has the greatest effect in early use. If the toxic form of diphtheria or diphtheria chill, serum is administered immediately, in other cases it is possible to exagge into constant observation of patients in the hospital. In patients with a localized form of diphtheria, later the 4th day, serum is trying not to apply that, according to modern data, significantly reduces the possibility of developing remote complications of the disease. The positive results of the skin sample (samples of chic) \u200b\u200bare a contraindication to the administration of serum only with localized forms, in all other cases in this situation, serum must be administered under the cover of antihistamine preparations and glucocorticoids.

Anti-dialect serum can be administered both intramuscularly (more often) and intravenously. Repeated serum administration is possible with continuing intoxication. Currently, the doses of serum are reviewed both towards zoom and towards the decrease, depending on the form of diphtheria.

Conducting disinfecting therapy with crystalloid and colloidal solutions intravenously (polyionic solutions, glucose-potassium mixture with the addition of insulin, refooliglyukin, freshly frozen plasma). In severe cases, glucocorticoids are added to the injected solutions (prednisolone at a dose of 2-5 mg / kg). At the same time, these drip infusion contributes to the correction of hemodynamic disorders. Apply desensitizing drugs, vitamins (ascorbic acid, vitamins of group B, etc.).
Toxic diphtheria II and III degrees, hyperstoxic shape and heavy combined forms of the disease - indications for plasmapheresis. Develop new efficient detoxing paths, such as hemosorption, affine sorption, immunosorption.

Under the suboxy and toxic forms, it is recommended that the purpose of antibiotics that have etiotropic effects on the accompanying cocktle flora: penicillin, erythromycin, as well as ampicillin, ampiox, tetracycline preparations and cephalosporins in average therapeutic doses.

In case of larynx diphtheria, frequent ventilation of the chamber, warm drink, steam inhalation with chamomile, soda, eucalyptus, hydrocortisone (125 mg per inhalation). Ehufillin, saluretics, antihistamines are prescribed patients, while the stenosis phenomena increases - prednisolone intravenously 2-5 mg / kg / day. In phenomena of hypoxia, moistened oxygen is used through the nasal catheter, remove films using electrotoxos.

The testimony for surgical intervention is the progression of signs of respiratory failure: Tahipne is more than 40 per minute, cyanosis, tachycardia, motor anxiety, hypoxemia, hypercupnia, respiratory acidosis. In this case, in the localized croup, the trachea is intubated, with a common, descending criterion and combinations of cereals with heavy forms of diphtheria - tracheostomy with subsequent IVL.

In the occurrence of signs of infectious-toxic shock, the patient is transferred to the intensive care unit. Along with the active therapy by intravenous infusion solutions increase the dose of prednisolone to 5-20 mg / kg. In addition, dopamine (200-400 mg in 400 ml of a 10% glucose solution intravenously drip at a rate of 5-8 ml / kg / min), trental (2 mg / kg intravenously drip in 50 ml of 10% glucose solution), Trasilol or Contractal (up to 2000-5000 U / kg / day intravenously drip), saluretics, andadrine.

Clindamycin 150 mg is used to rehanging the bacteriaters 4 times a day, the benzylpenicillin-novocaine salt is 600,000 units 2 times a day intramuscularly, as well as cephalotin and cephaleandol parenterally in medium therapeutic doses. Course duration 7 days. It is advisable to the simultaneous treatment of chronic pathology of ENT organs.

Diffeter prevention

Epidemiological supervision Ensures the collection of information on the basis of which appropriate prevention measures can be taken. It includes not only the observation of the incidence and coverage of vaccination, but also the study of the immunological structure of the population, monitoring the circulation of the pathogen among the population, its biological properties and antigenic structure. Epidemiological analysis and evaluation of the effectiveness of activities carried out, predicting the intensity of the epidemic process of diphtheria in a particular area.

Preventive actions
Vaccinoprophylaxis remains the basic way to control diphtheria. The immunization scheme of children involves the immunization of the DCD vaccine since 3 months of life (vaccinated 3 times with an interval of 30-40 days). Revaccination is carried out after 9-12 months after completed vaccination. For revaccination in 6-7, 11-12 and 16-17 years old, an ads-m is used. In some cases, for example, in contraindications to a pertussic component of ADCs, an ADS-M is used for vaccination. In a modern epidemiological situation, the immunization of adults has gained special significance. Among adults are primarily vaccinated by persons from increased risk groups:
- persons living in a hostel;
- service workers;
- medical workers;
- students;
- teachers;
- school staff, medium and higher special institutions;
- Employees of children's preschool institutions, etc.

For adult vaccinations, ADS-M is used in the form of planned immunization every 10 years to 56 years inclusive. Persons who suffered diphtheria are also subject to vaccinations. The disease of the diphtheria of any form in unvaccasted children and adolescents is regarded as the first vaccination, who received one vaccination in the disease - as a second vaccination. Further vaccinations are carried out according to the existing vaccination calendar. Children and adolescents, vaccinated against diphtheria (received finished vaccination, one or more revaccinations) and by the light form of diphtheria without complications are not subject to additional vaccination after the disease. The next age revaccination is carried out in accordance with the intervals provided for by the vaccination existing calendar.
Children and adolescents vaccinated against diphtheria (received a complete vaccination, one or more revaccinations) and transferred toxic forms of diphtheria, should be vaccinated by the drug depending on the age and health status - once in a dose of 0.5 ml, but not earlier than 6 months After the suffering disease. Adults previously grafted (received at least one vaccination) and lost diphtheria in light shape, additional vaccination against diphtheria are not subject to. When they are transferred to the toxic form of diphtheria, they should be immunized against diphtheria, but not earlier than 6 months after the suffering disease. Their revaccination should be carried out in 10 years. Persons with unknown vaccine history are subject to serological examination for antitoxic antibodies. In the absence of a protective titer of antitoxins (more than 1:20), they are subject to vaccination.

The effectiveness of diphtheria vaccination depends on both the quality of vaccine drugs and coverage of susceptible to this infection of the population. In the adopted WHO, the enhanced immunization program states that only 95 percent coverage of vaccinations guarantees the effectiveness of vaccination.

The propagation of diphtheria is preventing the early detection, insulation and treatment of patients and carriers of toxygenic diphtheria sticks. A large preventive value has the active identification of patients with diphtheria, which provides for the annual planned inspection of children and adolescents in the formation of organized teams. In order to early detect diphtheria, the district doctor (a pediatrician, a physician) is obliged to actively observe the patients with a thicketer with pathological impositions on almonds within 3 days from the primary treatment with the obligatory conduct of bacteriological surveys on diphtheria during the first day.

Events in the epidemic focus
Patients with diphtheria are subject to hospitalization, and with a delay in hospitalization, 5000 mene contaminated serum is emergency. Patients with heavy shapes of angina, patients with children's institutions with a permanent stay of children (children's homes, orphanages, etc.), hostels living in unfavorable living conditions, persons related to country risk contingents of diphtheria (medical workers, children's preschool institutions, Wellness and educational institutions, trade workers, catering, transport), should be hospitalized with a provisional goal. Hospitalization is also subject to sore thoroughfish with horses or crop from the focus of diphtheria.

An extract from the hospital is allowed after clinical recovery and obtaining a 2-fold negative result of a bacteriological survey of a mucus from a zea and nose for the presence of a diphtheria causative agent, conducted with 2 days intervals, and not earlier than 3 days after the abolition of antibiotic therapy. The extract of the carrier of the toxygenic diphtheria sticks is carried out after receiving a 2-fold negative result of bacteriological examination. After discharge from the hospital of patients and carriers of toxygenic diphtheria sticks, they immediately admit to work, study and in children's institutions with a permanent stay of children without additional bacteriological surveys. If the carrier of toxygenic diphtheria sticks continues to allocate the pathogen, despite the holding of two courses of the antibiotics, it is allowed to work, study and children's preschool institutions. In these teams, all persons previously not vaccinated against diphtheria should be vaccinated according to the current immunization scheme. This team again takes only those grafted against diphtheria.

Reconvalues \u200b\u200bof diphtheria and diphtheria stick carriers are subject to dispensary observation for 3 months after discharge from the hospital. District therapist and doctor of the Cabinet of infectious diseases in the clinic at the place of residence are carried out by the dispensarization.

The doctor who has established a diagnosis immediately sends an emergency notice to the Center for Sanitary and Epidemiological Supervision. When insulation, the source of infection is carried out wet cleaning with the use of disinfectants, the final disinfection of toys, bedding, linen. Bacteriological examination of communications with patients is carried out once. Serological examination in the foci of diphtheria infection is subject to only persons who have direct contact with patient or carrier of toxic strains C. DyPhtheriae, in the absence of documentary confirmation of the fact that they are vaccinated against diphtheria. Medical observation of them (including an inspection of a otolaryngologist) continue within 7 days. The identified patients and carriers of toxygenic diphtheria sticks are hospitalized. Non-toxigenic strains are not subject to treatment with antimicrobial drugs, they show the consultation of the otolaryngologist, the identification and treatment of pathological processes in the nasophal. In a focus of infections, persons who are not vaccinated against diphtheria, as well as children and adolescents, who have occurred to another vaccination or revaccination. Among adult vaccinations are subject to persons who, according to medical records, since the last vaccination passed 10 years and more, as well as persons with low antibodies (less than 1:20), which is detected in RPGA.

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