Severe forms of diphtheria occur in children. Who is at risk? Genital diphtheria

Diphtheria   - An acute infectious disease characterized by fibrous inflammation at the site of the entrance gate and intoxication phenomena that cause (in the absence of adequate treatment) myocarditis, polyneuritis, toxic shock, nephrosis and other complications.

The evolution of the clinical picture of the disease against the background of a sharp decrease in the incidence creates real difficulties for early diagnosis, moreover, the rarity of diphtheria in modern conditions dulls the doctor’s vigilance regarding this pathology. Nevertheless, it should be remembered that with a negligible incidence, mortality from toxic diphtheria is still preserved, due to the late (after the 3rd day of illness) administration of antidiphtheria serum and the absence of complex pathogenetic therapy.

Etiology.   The causative agent of diphtheria was discovered at the end of the last century by T. Klebs and F. Leffler. Diphtheria bacteria look like thin, slightly curved rods, up to 8 microns in length, with club-shaped thickenings at the ends. The stick is gram-positive, when stained according to Neisser in the thickenings, bright blue grains of volutin stand out.

The pathogenic properties of diphtheria bacillus are determined by the exotoxin produced by it.

Diphtheria bacillus is stable in the environment, tolerates low temperatures (up to -20 ° C), can be stored for a long time on objects used by the patient. In dried mucus, it remains viable for several weeks, at the same time it quickly dies when boiled and exposed to disinfectants (phenol, chloramine, hydrogen peroxide, etc.).

Epidemiology.   The source of infection are patients with diphtheria and convalescents that continue to secrete the pathogen, as well as healthy carriers of toxigenic strains of diphtheria bacteria.

The transmission route for diphtheria is airborne. The transferred disease leaves stable immunity.

Pathogenesis.   The entrance gate for the causative agent of diphtheria is the mucous membranes and the wound surface of the skin. In the process of life, diphtheria bacilli produce exotoxin, neuraminidase, hyaluronidase, necrotizing and diffusion factors. The leading factor in the pathogenicity of diphtheria bacteria is diphtheria toxin.

Changes occur not only at the site of the primary production of the toxin. Lymphogenic and hematogenous distribution of the latter leads to damage to other organs and systems.

The clinical picture.   The incubation period lasts from 2 to 10 days. Localization of the primary inflammatory process determines the clinical forms of diphtheria. By localization, diphtheria of the pharynx, nose, larynx, trachea and bronchi, external genitalia, and skin are isolated (in newborns, umbilical diphtheria). When combining several of these locations, they speak of a combined form of diphtheria. Common to diphtheria of any localization is the inflammatory process at the site of introduction of the pathogen with the formation of dense fibrinous deposits.

Diphtheria pharynx. In modern conditions, up to 95-98% of all cases of diphtheria. The disease begins with a sore throat, malaise, fever, that is, signs that are devoid of any specificity. From the first hours, hyperemia and swelling of the mucous membrane of the tonsils are noted, areas of whitishness appear, which gradually take on the form of raids characteristic of diphtheria. On the second day of the disease, the raids have a smooth surface, clearly defined edges that seem to float slightly on the nearby mucous membrane and stand above its surface. The raids are tightly bound to the underlying tissue, their color is grayish-white. Simultaneously with the formation of plaque, regional lymph nodes located at the corner of the lower jaw increase and become painful, the appearance of cervical tissue edema.

A parallelism between the intensity of local inflammatory changes and the clinical manifestations of intoxication is characteristic. According to the severity of local and general (toxic) phenomena, diphtheria of the pharynx is divided into localized (mild), widespread (moderate), and toxic (severe).

With a localized form, the inflammatory reaction in the tonsils and the increase in regional lymph nodes are weak, plaques are present only on the tonsils, body temperature rarely exceeds 38-38.5 ° C, and intoxication is minimal. Depending on the extent of the raids, there are point-islet and film (tonsillar) forms. With the latter, on the tonsils there is one or 2-3 large areas covered with a film. A catarrhal form of localized diphtheria of the pharynx is also possible, in which no raids are noted at all, there is only mild hyperemia of the tonsils, there is no intoxication, and the body temperature is subfebrile or normal. The absence of the main sign of diphtheria (fibrinous film) in this form allows us to consider the catarrhal form atypical. They diagnose it only with the appropriate laboratory data.

The common form is characterized by the appearance of typical: raids not only on the tonsils, but also on the palatine arches, tongue, soft palate. Signs of intoxication (malaise, headache, sleep disturbance, anorexia, vomiting, fever) and the reaction from the lymph nodes are more pronounced than with the localized form. Without the introduction of anti-diphtheria serum, this form becomes toxic.

The main difference between the toxic form in the midst of the disease (on the 2-3rd day of the disease) is edema of the subcutaneous fat. In this case, there is always swelling of the tonsils, tongue, the edges of the soft palate and extensive raids. They completely cover the tonsils and tongue, often spreading to the soft palate. Swelling of the soft tissues of the pharynx can be expressed so sharply that the tonsils touch each other, pushing the tongue posteriorly. Nasal breathing can be difficult, the voice acquires a nasal tone, a sweet-putrid odor from the mouth occurs. Due to edema of the subcutaneous fat, the contours of the lower jaw are smoothed out. When striking over the site of edema, a fluctuation is detected (the symptom is “jelly”), while collecting the skin in the fold, the symptom of “slipping” is noted. The skin fold at the site of edema is thickened, the skin color is not changed. General phenomena are expressed sharply: fever reaches 39.5-40 ° C, repeated vomiting, lethargy, lack of appetite are observed.

In toxic diphtheria of the pharynx, there is a parallelism between the duration of the raids, the severity of local edema of the soft tissues, the prevalence of edema of the subcutaneous fatty tissue of the neck and the amount of toxin entering the bloodstream - the main damaging factor in this disease. The more toxin is fixed by the tissues, the more likely the possibility of complications that overshadow the prognosis with the late administration of antitoxic serum.

In accordance with the extent of the edema, toxic forms of diphtheria of different severity are distinguished. With the spread of edema to the middle of the neck, toxic diphtheria of the pharynx of the first degree is diagnosed. If edema reaches the clavicle, then toxic diphtheria of the II degree should be noted. With the III degree of severity, edema often performs jugular and subclavian fossa, descends below the clavicle to the II-III ribs and below. Sometimes in such cases, edema is present on the posterolateral surface of the neck and upper back.

With the subtoxic form, edema of the subcutaneous fat is observed only in the region of the tonsillar lymph nodes, and its unilateral localization is also possible. In such cases, changes in the throat are most pronounced on the corresponding side.

At the beginning of the disease, when cervical tissue edema is still not detected, for indicative judgment about the severity of pharyngeal diphtheria, one should take into account the severity of intoxication and swelling of the mucous membranes of the oropharynx, the length of the raids, the degree of increase in regional lymph nodes, as well as the dynamics of pathological manifestations. The rapid development and sharp severity of these symptoms already on the first day of the disease suggest hypertoxic or toxic diphtheria of the throat of the III degree. In such cases, even before the appearance of edema of the cervical tissue, an infectious toxic shock of the first degree develops, which rapidly progresses without specific treatment, reaching a second-degree illness on the 2nd-3rd day, and the 3rd-4th degree on the 4th-5th day. The correct assessment of the severity of the condition during the formation of the clinical signs of diphtheria is important for the timely appointment of adequate therapy and save the patient's life.

Diphtheria of the nose. It proceeds without severe symptoms of intoxication and can begin unnoticed. Suspicion of diphtheria usually occurs with persistent sucrose discharge from the nose and skin irritation at the entrance to the nasal cavity. When rhinoscopy on the nasal septum, erosion, bloody crusts or fibrous film are detected. In the absence of specific therapy, the process can spread to the mucous membranes of the pharynx, larynx, and skin.

Diphtheria of the larynx. In this case, along with a general malaise, croup syndrome develops: a “barking” cough, voice change, inspiratory dyspnea. At first, only a slight hoarseness and a rough cough pay attention. After 1-2 days, the symptoms of croup increase. Difficulty in breathing and retraction of compliant places of the chest during anxiety (stenosis of the larynx of the first degree) are more clearly indicated. In the future (in the absence of specific therapy), stenosis of the II degree develops - noisy breathing persists constantly and even during sleep does not completely pass. Coughing becomes silent (aphonia).

With stenosis of the III degree, inspiratory dyspnea is pronounced, the child is restless, rushing around, cannot sleep. Breath is heard from a distance; there are gross retracts of the jugular fossa, intercostal, lower part of the sternum; sternocleidomastoid muscle is tense. Sweating, cyanosis of the nasolabial triangle, tachycardia, loss of pulse on inspiration appear, breathing is poorly performed. Symptoms of grade III stenosis indicate impending asphyxiation and are an indication for immediate surgery (nasotracheal intubation or tracheotomy). Otherwise, asphyxia occurs (grade IV stenosis) - cyanosis intensifies, weakness, muscle hypotension, confusion, cramps, bradycardia, a barely perceptible pulse appear, and death occurs when surgery is delayed.

In addition to the localized (mainly moderate form) laryngeal diphtheria, a common process is possible (descending diphtheria croup), when along with lesions of the true vocal cords, fibrinous films form in the trachea (common diphtheria of larynx A) or in the trachea and bronchi (common diphtheria of larynx B). The threat of developing asphyxia in such cases is especially great (severe form of diphtheria).

Diphtheria of the eyes, skin, external genitalia, navel. Observed in modern conditions is extremely rare.

Diagnosis. Diagnosis of diphtheria is difficult, mainly because it must be carried out in the early stages, when all the characteristic signs of the disease have not yet fully manifested. The formation of a fairly typical clinical picture of diphtheria occurs in the first 2-3 days. The great variability of symptoms and the variety of clinical forms of the disease disorient the doctor during a single episodic examination of the patient. Given that the final results of bacteriological studies are often late and may be negative, and the introduction of antidiphtheria serum in the late stages of the disease is not effective, it is necessary to strive to recognize diphtheria according to clinical data during the first 2-3 days of the disease, even before receiving the results of a laboratory study.

The most important early diagnosis of the toxic form of diphtheria pharynx. The main criterion in this case is swelling of the mucous membranes of the oropharynx combined with extensive plaques, which tend to condense, merge, and pass from the tonsils to nearby sections of the mucous membrane. It is important to take into account other features characteristic of diphtheria plaque: a smooth surface, a grayish-white color, an influx into the unchanged nearby mucous membrane, and a close connection with the underlying tissue. It should be remembered that the listed symptoms are formed gradually, the corresponding dynamics can be caught during repeated examinations of the pharynx within a few hours. Early access to a doctor and active monitoring of the patient are crucial for timely diagnosis. Edema of the subcutaneous cervical tissue, detected on the 2nd day of the disease, is a strong argument in favor of toxic pharyngeal diphtheria. This diagnosis should not be abandoned even in the case of a patient sometimes feeling better (not a condition!) By the 3rd day of illness due to normalization of body temperature and reduction of sore throat. The decrease in pain is most likely due to the analyzing effect of the toxin on the nerve endings in the tonsils and pharyngeal mucosa. Some help in the diagnosis can be provided by changes in the color of the mucous membranes of the pharynx; by the 2-3rd day of the disease, due to paresis of capillaries, hyperemia is replaced by cyanosis.

Thus, on the 2-3rd day of the disease, when all the characteristic features of toxic pharyngeal diphtheria appear, diagnosis is quite possible according to clinical data. The results of bacteriological studies in most cases confirm the diagnosis established in the early stages (according to clinical data). A single negative result of bacteriological examination does not exclude the diagnosis of diphtheria in such cases.

For the success of bacteriological studies, the correct sampling of the material (from the edges of the plaque, on an empty stomach, without first rinsing the pharynx), its quick transportation to the laboratory, the use of an appropriate nutrient medium, and the determination of the toxigenicity of the selected culture are necessary.

In rare cases, a patient's blood serum test for antitoxin content can be used to diagnose diphtheria. So, for example, the diagnosis of a catarrhal form of localized diphtheria of the pharynx is impossible without the indicated serological examination. In foci of diphtheria, where the indicated form of the disease is suspected, carriage of diphtheria bacteria is also possible. The non-specific catarrhal state of the mucous membranes of the pharynx in the carrier may serve as a reason for the erroneous assumption of the catarrhal form of localized diphtheria of the pharynx. A reliable diagnosis in such cases is possible with an increase in the antitoxin titer from numbers lying below the protective level (less than 0.03 AU / ml) to several times higher than this level.

In addition to a laboratory examination, the final diagnosis should take into account the epidemiological situation and the totality of clinical data throughout the disease.

Treatment.   Patients with diphtheria are subject to mandatory hospitalization. In treatment, antitoxic antidiphtheria serum is crucial. The antitoxic effect is achieved with the earliest possible introduction of serum, since in this case it is possible to prevent tissue fixation of massive doses of toxin. With hypertoxic diphtheria, to prevent death, serum therapy should be started in the first hours of the disease, with other forms - no later than the 3rd day of illness. Early administration of serum prevents the development of complications, and with diphtheria of the larynx, surgical intervention can be avoided.

Diphtheria serum is obtained from the blood of horses hyperimmunized with diphtheria toxin. In order to avoid anaphylactic reactions to a foreign protein, a test for sensitivity to horse protein is carried out before the necessary dose is administered. For this, 0.1 ml of diluted 1: 100 serum is injected intradermally. If after 20 minutes no reaction is observed at the injection site or a papule with a diameter of not more than 9 mm is formed, then OD ml of undiluted serum is administered and, in the absence of reaction, after 1 h, the prescribed dose (intramuscularly). In the case of an anaphylactic reaction to test doses, the treatment of toxic forms of the II-III degree, hypertoxic form is carried out under the protection of anesthesia and hormonal drugs.

In severe condition, the presence of signs of infectious toxic shock, along with anti-diphtheria serum, the introduction of large doses of prednisone (5-20 mg / kg) or hydrocortisone (20-75 mg / kg per day) is necessary. To restore the volume of circulating blood, the introduction of albumin (5-10%), reopoliglukin up to 10-15 ml / kg, first jet (until the collapse is eliminated), and then drip alternating colloidal solutions with 10% glucose solution (in the ratio 1: 2). At the same time, lasix or mannitol is prescribed. Vitamins C, B6, cocarboxylase are shown. Antihistamines, trental, aminophylline are also used to improve microcirculation. In DIC, heparin, freshly frozen plasma, and protease inhibitors are prescribed. With diphtheria of the larynx, along with serum therapy, a gentle regimen is necessary, eliminating the excitement of the child, since anxiety enhances the phenomenon of stenosis due to spasm of the muscles of the larynx. Sedatives, a hot bath, steam inhalation are indicated. It may be useful to stay the patient in an atmosphere of high humidity in special tents. The appointment of corticosteroid hormones reduces swelling of the mucous membrane of the larynx.

A patient with croup should be under the constant supervision of medical personnel. With an increase in stenosis, surgical intervention may be required. Indications for surgical care are persistent, pronounced retraction of the compliant places of the chest, anxiety of the child, sweating, loss of pulse, weakening of respiratory sounds, emerging cyanosis of the lips, pallor. The presence of these signs indicates the danger of asphyxiation. With localized diphtheria of the larynx and widespread croup A, nasotracheal intubation with plastic tubes is performed, with a descending croup B, a tracheostomy is performed followed by suction of the rejected films. The development of severe cardiovascular disorders in toxic forms of diphtheria requires the appointment of a strict bed rest, the duration of which depends on the course of the disease. In the absence of complications, bed rest should be observed depending on the severity of diphtheria 3-6 weeks, with complications - until the restoration of impaired functions.

With the onset of myocarditis symptoms, in addition to the strictest bed rest, strychnine nitrate is prescribed orally and subcutaneously up to 5-6 times a day by intravenous administration of a 20% solution of glucose, ascorbic acid, cocarboxylase, riboxin, prednisone inside (2-4 mg / kg per day), according to indications - chimes, trental, heparin (for the prevention of thromboembolic complications).

With the development of polyneuritis, B vitamins and strychnine nitrate are administered parenterally, and proserin and galantamine are prescribed. If swallowing is disturbed, feeding through a tube is performed, if mucus accumulates in the airways, it is drained and then sputum is aspirated, and with a sharply limited excursion of the chest and oxygen deficiency, hardware breathing is performed.

Antibiotics are of limited use. They are certainly indicated in cases of toxic toxic shock, with croup, as well as common polyneuritis with impaired respiratory musculature for the prevention and treatment of pneumonia.

Diphtheria in children is an acute infectious disease that poses a serious danger to the child's body. The disease is characterized by extensive inflammation of the airways, skin, genitals, or eyes. It is important to consult a doctor at the first sign of a disease. If left untreated, death is possible. To determine the disease, a swab from the throat is taken.

A timely vaccination can save the baby from hospitalization and other unpleasant consequences.

The causative agent of diphtheria is corynebacterium. Another name is diphtheria bacillus. It can tolerate drying and low temperatures for a long time. On household items, the microbe will last a long time. Boiling kills him in less than a minute. Disinfection - with the help of hydrogen peroxide, chloramine and other means, is detrimental to corynebacteria when exposed for more than 10 minutes. A swab from the throat helps identify the bacterium.

The source of infection is the patient or carrier of the disease. The incubation period of the disease is usually 3 days.. The child is contagious to others from the moment the first signs appear until complete recovery.

The main route of transmission is airborne. Rarely, infection is transmitted through household items. Corynebacterium penetrates into the body of the child most often through the mucous membrane of the nose or larynx.

Kinds

Depending on the place of occurrence of inflammation, there are infections of the larynx, nose, ear, eyes and genitals.

Laryngeal diphtheria

Young children suffer from this type of disease most often. Diphtheria in children develops both in isolation and as a result of a disease of a different location. In this case, the film gradually reaches the larynx, spreads to the glottis, blocking it and making breathing difficult. For diagnosis, a swab from the throat is taken.

In the early days, as with diphtheria of the nose, the temperature rises (up to 38), a cough occurs, the baby's voice becomes hoarse. Further coughing fits become barking. After 2-3 days, wheezing appears, with a difficult breath.

If the disease is not treated, the temperature drops, but this is a sign of disease progression.   The child’s breathing becomes arrhythmic. In the future, involuntary bowel movements and urination are possible. The child may lose consciousness, convulsions occur throughout the body. Lack of medical care at this stage leads to death from a lack of oxygen.

Diphtheria of the nose

Diphtheria of the nose is often recorded at an early age. Manifestation of diphtheria of the nose as follows:

• Temperature rise;
• Shortness of breath, inflammation of the nose, the mucous membrane of which is noticeably swollen;
• From one nostril, a fluid resembling a sucrose is secreted.

Symptoms

Symptoms of diphtheria of the larynx and nose in children are similar to common signs of infectious diseases. The child has an increase in temperature, weakness occurs throughout the body, and appetite disappears.   A characteristic sign is pain in the throat.

Fibrous film

During the examination of the oral cavity, severe inflammation of the tonsils is noticeable. A gray film appears on them, which is difficult to remove - this is a diagnostic sign of diphtheria.

There are 2 main forms of the disease: insular and film. In the first case, the film covers only small sections of the tonsils, in the second - it captures them completely.

For different types of disease, it appears on the tongue, posterior pharyngeal wall and palate. First, a transparent film forms, then it acquires a whitish hue, becomes more dense.

Other symptoms

Common and easily recognizable symptoms include the following symptoms:

• Swollen lymph nodes;
• Heat;
• Swelling of the neck;
• Apathy, immobility of the child;
• Headache.

Swelling of the soft tissues of the neck extends to the clavicle. The lower the swelling spreads, the worse the condition of the patient. In this case, the child's lips dry, the skin begins to turn pale, there is a noisy and frequent breathing, leakage of fluid from the nose. One of the most serious signs of danger is seizures.

Vaccinated and unvaccinated child

An unvaccinated child   diphtheria is very difficult from the first days of the manifestation of the disease. Symptoms of the disease are developing rapidly. In most cases, serious complications appear.

The vaccinated child   a bacterium may not provoke a disease - it becomes a carrier. If he becomes ill, symptoms are limited. The incubation period of diphtheria lasts from 2 to 10 days.

How to distinguish diphtheria from angina

A characteristic sign of diphtheria is the covering of the tonsils with a white film. With tonsillitis, tonsils are very sore and have a reddish tint. Sometimes pus is visible on them - a yellowish coating. In addition, a plaque appears on the tongue and redness of the pharynx, the tongue swells.

The main differences:

• With diphtheria, inflammation spreads to the palate, and is not limited only to tonsils, as in the case of angina;
• Pain in the throat when swallowing during a sore throat is quite strong - because of them, the patient refuses food. With diphtheria, there is no pain, only discomfort is manifested.

Such obvious signs will help distinguish angina from diphtheria, and determine the condition of the child in advance.

Self-medication is life-threatening even for a vaccinated baby, so at the first sign it is necessary to go to the doctor. Determine the nature of the disease will help a swab from the throat for analysis.

Complications

Diphtheria belongs to the list of those diseases whose consequences are quite serious. The lack of treatment promotes the penetration of diphtheria bacillus toxin into various organs. This is more true for children who have not been vaccinated. It causes:

• Damage to the kidneys;
• Negative effects on the nervous system;
• Toxic shock - manifests itself in the form of a sharp increase in temperature, dizziness, fainting, vomiting, aching muscles;
•   - severe pneumonia;
• Myocardial damage (middle muscle layer of the heart).

Each complication from this list is dangerous for the health and life of the child. If the first symptoms appear, going to the doctor is the only right decision.

Treatment

Each patient with suspected diphtheria is placed in the infectious ward. It is worthwhile to make predictions for recovery only after the introduction of diphtheria serum.

With the development of a complex and severe form, more concentrated serum is introduced. Dosage is prescribed by a doctor. When diagnosing diphtheria, serum is introduced at the first dose, a sample of fluid from the pharynx is taken.

When the plaque gradually disappears, the child is drunk with antibiotics, which suppress pathogenic microbes.

Prevention

Medicine has developed effective methods to combat diphtheria. Immunization (vaccination) is the main and most effective of them. Prevention of diphtheria in children is an important aspect of maintaining the health of the whole family. The child is vaccinated with a weakened diphtheria toxoid. Vaccination is carried out at a certain age:

• To a 3-month-old baby - three times, the vaccination is done at intervals of one and a half months;
• 1.5–2 years - the vaccination is repeated;

After vaccination, such signs appear - an increase in body temperature, swelling at the injection site (as in the photo).

There may be a deterioration in well-being. This occurs as a result of the struggle of the immune system with weakened microbes that the vaccine contains.

What is the likelihood of a small child getting diphtheria? Many young parents, kindergarten teachers and even some doctors will answer that the risk of catching such a dangerous disease at such a young age is minimal. And make a fatal mistake.

It is children under 3-4 years old who account for the lion's share of all cases of diphtheria. And therefore, everyone needs to know what it is and how to deal with its manifestations.

Diphtheria infection occurs when the causative agent - the bacterium Corynebacterium diphtheriae, a pathogenic exotoxin that is one of the strongest bacterial poisons - enters the child's body.

Infection can occur through:

• mucous membranes of the oropharynx and nose;
• thin, covering the eye conjunctiva;
• genitals
• skin if it is damaged.

It is easy to determine the site of infection. At the place where bacteria enter the body, various irritations and purulent discharge immediately begin to form.

As for the causes of infection, the disease spreads predominantly by airborne droplets, especially when children are in direct contact with a patient with diphtheria or its carrier.

However, you can also receive a similar “gift”:

• through the surrounding objects touched by the infected;
• with the use of milk and dairy products, in which the pathogen can sometimes be found.

Symptoms of the disease

As such, it is difficult to distinguish features of the course of diphtheria in children. In many ways, its symptoms are similar to the manifestation of the same disease in adults.

There are still slight differences, however, in order to identify them, it is necessary to initially determine the form of the disease according to the affected area.

Oropharyngeal diphtheria

Being the most common disease today, it is diagnosed in more than 90% of cases, 75% of which are localized. In the disease, it is customary to distinguish the following forms.

Diphtheria in the drawings.

Initial

The child’s temperature rises sharply, but no higher than 37.5-37.7 degrees, and without medical intervention it is not possible to lower it for 3 days.

Intoxication is expressed moderately, pronounced pain in the throat appears. Tonsils slightly swell, they form a membranous coating that resembles initially a jelly mass, and then a cobweb. Attempts to eliminate it can lead to bleeding, and in place of the removed film the next day a new one forms.

Localized

Plaque becomes more loosened, its elimination practically does not harm the mucosa. The submandibular and regional lymph nodes increase slightly, their sensitivity to palpation (palpation) increases. The defeat of the tonsils is more active, and can be both bilateral and asymmetric.

Sometimes (quite rarely) it flows into catarrhal diphtheria, which is characterized by a minimal manifestation of common symptoms: fever up to 37.5 degrees, discomfort when swallowing, signs of general intoxication of the body, etc. The tonsils swell, the oropharynx undergoes hyperemia.

Common

Despite the name, this form of the disease is diagnosed in no more than 11% of cases.

Unlike localized, it is characterized by more pronounced symptoms and the active spread of film plaque, which almost immediately goes beyond the tonsils. Edema of the cervical subcutaneous tissue is not observed.

Subtoxic

Signs of intoxication become pronounced, pain when swallowing intensifies. The kid begins to complain more actively about the general malaise. A clear film coating appears on the tonsils, which rarely goes beyond them. They themselves change color to close to burgundy or even purple.

Regional lymph nodes are compressed, in the area above them puffiness forms, which, however, is moderate.

Toxic

Today, it manifests itself in more than 20% of cases of the total number of diseases, but mainly in adults. It develops both from a localized or common form of diphtheria, and independently.

It is accompanied by a sharp jump in temperature to 39-40 degrees in the very first hours after the onset of the disease. Intense throat pain is accompanied by general symptoms of intoxication, as well as sometimes unpleasant sensations in the abdomen and / or neck.

Often there is vomiting, painful trismus (when restrictions arise when opening the mouth), delirium and hyperemia. In the subcutaneous tissue in the neck, a dough-like swelling is formed that does not cause pain, which over time partially affects the back and face. A specific putrefactive odor is heard from the mouth, and the voice becomes more nasal.

Hypertoxic

It is considered the most severe and is usually diagnosed if a young patient has chronic diseases (for example,).

It is expressed by a rapid rise in temperature, chills, vomiting and other signs of acute intoxication. There may be hemodynamic problems (expressed as low blood pressure, pallor, etc.). Skin hemorrhages and bleeding of the internal organs occur, DIC appears.

All this can at any time cause shock of an infectious-toxic form and lead to death in literally 1-2 days from the first manifestation of symptoms.

Diphtheria and tetanus - School of Doctor Komarovsky - Int

Diphtheria croup

This form of diphtheria today is not as common as diphtheria of the oropharynx, but its spread is gradually gaining momentum. In the disease, 2 variations can be distinguished: localized (the so-called diphtheria of the larynx) and widespread (when the infection also extends to the trachea with bronchi).

In its development, it passes through 3 stages in turn:

1. Dysphonic. At this stage, the voice becomes hoarse, a barking cough begins. Moreover, if in adults this stage lasts about a week, in children the signs make themselves felt already in the first 2-3 days.
2. Stenotic. Here, the sick person loses his voice, his cough becomes soundless, breathing problems appear, and the skin acquires a bluish tint.
3. Asphyxial. Respiratory problems and blueness of the skin intensify. The child begins to cramp, impaired consciousness. If until this moment the correct help was not provided to the baby, a fatal outcome follows.

How to recognize diphtheria croup.

This disease almost never starts on its own. As a rule, it goes hand in hand with other types of diphtheria (diphtheria of the eyes, larynx, oropharynx).

Despite the low degree of intoxication, the child develops severe irritation in the area around the nose, begins, purulent or red blood discharge appears. The mucous membrane of the nose noticeably swells, and fibrinous deposits, sores and erosive formations appear on its surface.

Diphtheria eye

A disease in which the organs of vision receive the most damage.

It proceeds in 3 forms:

1. Catarrhal. There is one-sided inflammation of the conjunctiva and a significant increase in eye discharge. However, neither regional inflammation nor enlargement of the lymph nodes in the child is observed. The temperature remains within 37.5 degrees.
2. Filmy. With this form, symptoms of general intoxication of the body are already making themselves felt. The conjunctiva is gradually covered with a fibrinous film, the eyelids swell, serous-purulent discharge appears on the eyes. At the same time, even if initially only one eye struck the disease, it quickly spreads to the second.
3. Toxic. Symptoms of intoxication from the very first days of infection are manifested quite acutely, there is a pronounced edema of the eyelids. The skin around the eyes is irritated, excessive blood-purulent discharge begins. In the absence of timely treatment, the child may encounter pathologies such as panophthalmia (inflammation of the eyeball) or regional inflammation of the lymph nodes.

Diphtheria of the skin, ear, genitals

All these variants of diphtheria in children are extremely rare, so it is appropriate to combine them into a single group. Nevertheless, these forms of the disease exist, and therefore it is nevertheless necessary to talk about them.

Ear diphtheria mainly develops with diphtheria of the pharynx or nose. The patient has swelling, fibrinous plaque in the affected area, mucosal and skin hyperimia, as well as pronounced soreness of regional lymph nodes.

Genital diphtheria complicates the process of urination and makes it painful. In boys, the foreskin and adjacent tissues are affected, in girls - the labia, vagina, perineum and even the anus.

Diphtheria of the skin, as a rule, is observed in those parts of the skin where diaper rash, small cracks and serious wounds, fungus, and other types of similar injuries are present. It is accompanied by the formation of dirty gray plaque and copious serous-purulent discharge. Symptoms of general intoxication of the body are practically not expressed.

From the foregoing, it is not difficult to conclude that the symptoms of diphtheria in children under one year old, in 5-year-old peanuts, in adolescents and adults are predominantly similar. The key difference is the speed of the defeat processes. Where an adult may still have a week of handicap for treatment, the baby will “burn” in literally 1-2 days.

Therefore, for those who want to protect their child from the consequences caused by the disease (after all, they may turn out to be quite serious), it is worthwhile to show the pediatrician at the first signs of malaise in the child.

Diphtheria and tonsillitis: looking for differences

In order to address in a timely and timely manner for help, it is necessary not only to know the signs of diphtheria, but also to be able to distinguish it from other, apparently similar diseases.

The disease is often confused with, false croup and other diseases. However, the greatest difficulties are naturally caused by angina, which in addition to everything is found everywhere.

Therefore, for convenience, we will present the differences between these diseases in the form of the following table:

• For the first time, exactly one year after the end of the 3rd stage of the primary course (the same DTP vaccine is used).
• The second time - when the baby is 7 years old (ADS-M-toxoid is used).
• The third time - at the age of 14 (vaccinated with ADS-M-toxoid).
• At 4 and subsequent times - 10 years after undergoing the previous procedure (the same ADS-M-toxoid is used).

If you want this terrible disease to not take your child by surprise, you must strictly follow this schedule. If desired (for example, when a child is allergic to active components), the DTP vaccine can be replaced with Infanrix, Infanrix Hexa or Pentaxim vaccines.

Good to know!   If, for some reason, the child did not receive primary vaccination before 4-6 years old, he needs to twice administer the ADS-toxoid with an interval between vaccinations of 45 days. Revaccination will be required after about a year. If the primary vaccination is required for a child 6 years of age or older, then everything will be exactly the same, only the period before revaccination will be reduced to 6-9 months.

Diphtheria is an acute infectious disease. In its course, inflammation develops at the place where the pathogen penetrated and localized. Previously, this disease affected a large number of children. Thanks to mass active immunization, the incidence rate has significantly decreased. Today, single infections are found, group outbreaks rarely occur. The pathogen is diphtheria bacillus. The incubation period is from two days to a week.

Causes

The main sources of the disease are people who tolerate corynebacteria, and those patients who have diphtheria. The cause of the disease may be contact with an infected person, with the general use of certain objects, through the hands. A distinctive feature of diphtheria is that it is possible re-infection in the presence of appropriate conditions.

It is known that vaccines against the disease do not protect the child one hundred percent. In this case, he carries diphtheria in a milder form. Main factors such as contribute to the development of the disease:

• ODS, flu;
• infections that are more common in childhood (measles, rubella, chickenpox);
• diseases of a chronic nature that affect the area of \u200b\u200bthe nose, pharynx.

Symptoms

In a young child, the disease is more complicated. Most often, you can see the development of a disease that affects the area of \u200b\u200bthe pharynx, nose, and larynx. Sometimes a combined type occurs. For children who have been vaccinated, infection of the pharynx, which proceeds in a simple form, is often characteristic.

A distinctive feature of the development of diphtheria is the presence of a low temperature. From the site where inflammation occurs, discharge begins to appear. The most dangerous form of health is damage to the pharynx. Unlike sore throat, with the appearance of diphtheria, there is no sore throat. In this case, symptoms such as:

• characteristic gray fibrinous films formed on the mucous membrane;
• when they increase, breathing is difficult.

The disease is characterized by intoxication, the presence of inflammation of the mucous membranes. A child may appear signs such as:

• weakness and drowsiness,
• general malaise
• headache,
• redness of the tonsils and pharynx,
• difficulty swallowing,
• discomfort in the affected area,
• swollen lymph nodes.

Diagnosis of diphtheria in a child

Diagnostic examination includes analysis of complaints and medical history. This often includes an epidemiological history. Cases of possible infection from other patients are considered. When diagnosing, a general examination is carried out for the presence of a characteristic diphtheria plaque. Films have distinct edges. Their removal occurs with certain difficulties. After the plaque is removed, the surface of the affected area begins to bleed. After a certain amount of time, a new film coating is formed.

In the process of diagnosis, such methods as are also used:

• a bacteriological method that allows you to detect diphtheria bacillus in a smear that is taken from the nose or pharynx;
• the serological method makes it possible to detect antibodies in the blood.

In some cases, the child and his parents need to consult a professional who specializes in childhood infections.

Complications

There are a number of serious complications that can occur after an illness. These include:

• myocardial lesions;
• heart rhythm disturbances;
• kidney damage leading to the formation of swelling;
• damage to the nervous system (muscle paralysis may develop);
• pneumonia;
• infectious-toxic shock, which contributes to the formation of pulmonary and cerebral edema, often results in death.

Local diphtheria in most cases ends in complete recovery. The toxic form can lead either to the onset of consequences or to the death of the patient. The prognosis of the outcome of diphtheria depends on how long the serum was injected, how effective it was. A distinctive feature of the disease is that the child who has suffered it remains stable immunity.

Treatment

Diphtheria can occur easily or in a complicated form. The treatment course depends on the type of disease. It is strictly forbidden for parents to independently treat a child. All manipulations should be carried out by a specialist in order to avoid complications.

With even a slight suspicion of a disease, the treatment course is carried out in the inpatient department of a medical institution. The main effective method is diphtheria serum, which should be administered in a timely manner. The doctor prescribes a course of drugs - antibiotics. It is developed taking into account the age of the child, the characteristics of the disease.

What can you do

Parents should isolate the child even in case of suspected diphtheria, evacuate him to the hospital for further examination and treatment. If the child has contacted someone, then it is necessary to inform the attending physician about this. It is strictly forbidden for parents to choose medications and folk remedies on their own. At the slightest suspicion of a disease, they should call a doctor. Only a specialist can make the most correct diagnosis after the examination. It is necessary for the child to create the most comfortable conditions conducive to a quick recovery.

What does the doctor do

Initially, the doctor after a diagnostic examination begins treatment with the use of serum against diphtheria. It is effective if applied in the early stages of the disease (the first few hours). Simultaneously with the introduction of the drug into the patient’s body, the doctor prescribes:

• special antibacterial agents
• detoxification therapy.

Prevention

The most effective and effective way to protect your child from infection is immunization with appropriate medications. Such funds can quite reliably prevent the occurrence of the disease. Parents must constantly maintain the child’s immunity, monitor their nutrition, lifestyle. You should also regularly carry out wet cleaning in the house using disinfectants. All toys, furniture and other furnishings must be carefully crafted. The children's room needs to be constantly aired, maintain a favorable microclimate in it.

Diphtheria (not to be confused with dysentery!) Is one of the classic childhood airborne infections. Unlike adults, the disease in children, as a rule, proceeds in a mild form. But why in this case, the diphtheria vaccine is included in the calendar of mandatory vaccinations?

What complications of this pathology are life-threatening, and how not to confuse diphtheria with the symptoms of ordinary sore throat in children?

The essence of pathology

Pathogenic diphtheria bacilli, getting on the mucous membranes of the pharynx, larynx, trachea and bronchi, begin to multiply and secrete a toxin. It damages the cells and penetrates the bloodstream.

In the place of the entrance gate, a fibrin film forms, as a protective reaction of the body. It is the fibrin film in diphtheria that is the main symptom in children for making a diagnosis, and you can study it on any photo of this pathology.

Toxins also cause general intoxication and are selectively fixed by individual tissues (cardiac muscle, nerve ganglia, kidneys, adrenal glands and internal lining of capillaries). As a result, circulatory failure develops.

The fibrin film covering the respiratory epithelium (larynx, trachea, bronchi) easily comes off. This is due to the weak attachment of cells with the basement membrane. The torn film enters the respiratory tract and causes asphyxiation (asphyxiation).

The film covering the stratified squamous epithelium (pharynx, tonsils), comes off with difficulty, which is complicated by deep bleeding ulcers.

Pathogen

There are two types of diphtheria bacilli: pseudodiphtheria and toxic strains. The latter are the causative agents of diphtheria in children, although morphologically they are indistinguishable. They are resistant to the environment, but are sensitive to high temperatures and disinfectants.

The main route of transmission from the patient or carrier is airborne. But there are cases of contact infection: with a kiss, indirectly through household items (dishes, toys). It is extremely rare that infected milk can cause the disease.

Clinical picture

The clinic of diphtheria in children depends on the localization of the process. Most often, diphtheria angina develops (damage to the pharynx and pharynx). It can be combined with diphtheria of the larynx. The latter can be an independent form of pathology.

Less commonly, a diphtheria lesion of the nasal mucosa joins them. Rare forms include diphtheria of the eyes, ears, external genitalia, umbilical wounds, damaged skin.

Diphtheria pharynx in children

In the most favorable case, fibrin films do not appear at all. There is redness of the tonsils, sore throat when swallowing, a slight increase in body temperature, unexpressed intoxication. Such symptoms can easily be confused with regular sore throat. And only bacteriological examination will confirm diphtheria.

With the formation of films there is no longer any doubt about the diagnosis. They can cover the tonsils with islets, envelop the entire tonsil and pass to the surrounding mucous membranes. In the most severe cases, fibrinous inflammation extends to the pharynx.

The fibrin film contains a mass of pathogens, so the larger the surface it covers, the more toxins are released and the more pronounced symptoms of the disease. With the growth of the film, the sore throat intensifies, tonsils increase, block the entrance to the larynx, and breathing is difficult. It becomes noisy, frequent and unproductive.

With toxic diphtheria, edema additionally develops, and the skin of the neck turns blue.

• Toxic diphtheria grade 1   manifested by edema of the upper half of the neck.
• At 2 degrees, it extends to the entire neck, and at 3 degrees   comes below the clavicle on the anterior chest wall.

Diphtheria croup

It is isolated and in combination with damage to the pharynx or nose. Isolated often develops in children under 3 years old. With diphtheria in children, the film can cover only the mucous membrane in the larynx or spread further - to the trachea and even the bronchi. Regardless of the type of croup, the disease is characterized by a staged course.

1. Catarrhal stage   (initial) lasts about a day and is manifested by unexpressed intoxication and cough, gradually losing sonority.
2. Stenotic due to narrowing of the airways, which leads to respiratory dyspnea. In the act of breathing, auxiliary muscles begin to take part, the chest is retracted during exhalation. As oxygen starvation increases, cyanosis intensifies, breathing quickens, the child becomes restless, rushing about in the bed.
3. In the asphyxial stage   the child is indifferent, breathing is frequent and shallow, the skin is pale with a cyanotic hue, the pulse is threadlike. In case of untimely restoration of airway patency death may occur.

Diphtheria of the nose

The catarrhal and ulcerative form is manifested by redness of the nasal mucosa and the appearance of bleeding ulcers. Serous discharge from the nose becomes at first sucrose, and then blood-purulent. Intoxication and hyperthermia are low. Fissures of the skin around the nasal passages are characteristic.

Localized and common film forms are characterized by increased intoxication, high temperature, swelling of the nose and cheeks.

Diphtheria eye

As a rule, one eye is affected. Purulent blepharitis develops with the formation of films on the conjunctiva of the eyelids. When the process spreads to the eyeball, ulcerative keratitis or total inflammation of the entire eye develops.

External genital diphtheria

It occurs mainly in girls simultaneously with the defeat of a different localization. It proceeds in severe intoxication, is characterized by the formation of films on the mucous membrane and swelling of the surrounding skin.

Diphtheria skin

It develops in places of damage to the skin. As well as for other forms, swelling and the appearance of the film are characteristic. Intoxication is expressed.

Complications of diphtheria in children

The degree of complications depends on the form and severity of the disease, more often the common membranous and toxic forms are complicated.

From the cardiovascular system

1. Cardiovascular failure, developing on the 2-4th day of the disease and manifested by hypotension, weak frequent pulse, pallor of the skin, general weakness and lethargy.
2. Joining toxic myocarditis occurring at 1-3 weeks.   Tachycardia is gradually replaced by bradycardia, hypotension is aggravated, and heart rhythm disturbance appears. Myocarditis is prone to decompensation, is severe and prolonged. Drug rehabilitation is slow - for 1-2 months.

From the nervous system

1. Early neurotoxicosis characterized by headache, dizziness, agitation or lethargy, dizziness or loss of consciousness, repeated vomiting, which does not bring relief, abdominal pain, cramps.
2. Later complications include mononeuritis.   (develops at 1-2 weeks) and polyneuritis (appear at 4-6 weeks). With mononeuritis, paralysis of the soft palate most often develops: it hangs and does not move during phonation. As a result, the voice becomes nasal, the child is often choked, liquid food flows through the nostrils. Less commonly observed paralysis of accommodation with a violation of the reading process. The defeat of the facial nerve is manifested by the distortion of the face. Diaphragmatic neuritis leads to respiratory failure, a feeling of lack of air, the participation of auxiliary muscles in the process of inhalation-exhalation.

Polyneuritis often develops after mononeuritis and is characterized by paralysis of the limbs, occasionally extending to the muscles of the neck and trunk.

On the part of the kidneys

Nephrotic syndrome develops, characterized by changes in the urine: proteinuria, cylindruria, hematuria and leukocyturia. But clinical renal failure does not develop.

Local complications

1. Purulent inflammation: tonsillitis, rhinitis, blepharitis, conjunctivitis, dermatitis.
2. Perifocal edema of the skin.
3. Regional.
4. Detachment of fibrin films with the formation of deep ulcers with bleeding or leading to obstruction of the lower respiratory tract and asphyxiation.

Superinfection

1. Paratonsillitis.

Diagnostics and differential diagnostics

Diagnostic search is based on an anamnesis, examination of a sick child, a general and specific examination.

• When collecting an anamnesis, it is established whether there was contact with a patient with diphtheria, how the disease started and how it manifested itself before visiting a doctor.
• On examination, determine the degree and type of inflammation. With fibrinous inflammation, the location, color, and nature of the film are studied.
• Non-specific examinations include temperature measurements, blood and urine tests, auscultation of the heart and respiratory organs.
• A specific examination is presented by conducting bacterioscopy of smears from the affected areas, taking material for bacteriology, staging reactions to detect antibodies and determining their titer in the blood.

Differential diagnosis, first of all, is carried out with nonspecific tonsillitis. The primary sign of diphtheria in children is the formation of a dense film that is difficult to separate from the mucous membrane of the pharynx.

Temperature indicators, the size of enlarged tonsils, bad breath are only secondary symptoms, as they depend on the individual resistance of the child's body.

Other diseases that need to be excluded: ARVI, adenoviral conjunctivitis.

Therapy

It is carried out only in a hospital. Specific treatment of diphtheria in children begins at the first suspicion of pathology and consists in the introduction of antitoxic antidiphtheria serum. The dosage is established depending on the age of the child, as well as on the form and severity of the disease, the prehospital duration of the disease.

• The standard dose for children under 3 years is 1/3 of the dose for an adult.
• At the age of 4 to 7 years, 1/2 adult dose is administered.
• Category 8-12 years requires the introduction of 2/3 doses of an adult.
• After 12 years, a full adult dose is administered.

In case of severe intoxication, the dosage is increased.

Before the introduction of serum, an allergological test is carried out. If time does not allow, serum is administered fractionally according to the method of Infrequently. Simultaneously with serum, diphtheria toxoid is administered in small doses to stimulate immunity.

Nonspecific treatment includes symptomatic drugs:   detoxification, desensitizing, antibiotics to prevent superinfection.

• With stenosis of the respiratory tract, aspiration and thermal procedures are carried out, oxygen is supplied, antispasmodics are administered. In case of asphyxiation, a tracheostomy is performed.
• With myocarditis, bed rest, fractional nutrition are prescribed, cardioprotectors are administered.
• Diphtheria paralysis requires strictly bed rest, drugs that improve nerve conduction, including vitamins of group B. During the rehabilitation period, the rehabilitation center needs massage, active and passive gymnastics.

Parental assistance

• Help your child withstand prolonged bed rest.
• Create him complete peace.
• Provide humidification (for example, by hanging wet towels).
• Give the child liquid food, non-acidic juices of freshly pressed, rosehip infusion. If food comes through the nose, feed through a wide straw.
• Help him gargle several times a day with tincture of sage.
• Carefully remove all mucous membranes with paper towels.

Preventative measures

Prevention of diphtheria in children consists of active immunization. Diphtheria vaccine (in combination with pertussis and tetanus) is included in the vaccination calendar. The first vaccination is carried out at 3 months, repeating the introduction of the drug every half month twice more. One year after the last vaccination, revaccination is carried out. Subsequently - at 7, 14 years old - toxoid is used for immunization.

Immunity after vaccination is persistent for 5 years.   But there are cases of diphtheria in vaccinated children. And if the vaccine did not save from the disease, then it still provided an erased or mild course of pathology. It is worth noting that an unvaccinated child who has had diphtheria cannot boast of such immunity. After the infection, re-infection is not excluded.

Many modern mothers refuse to vaccinate their children, fearing for their lives. But the vaccine situation is very bloated. Yes, children can have a reaction to a diphtheria vaccine, both local (redness, thickening, hyperthermia), and general (lethargy, fever). But it usually lasts no more than 3 days, and indicates a high resistance of the child's body.

Prevention in the outbreak

• It should be remembered that a patient with diphtheria is contagious from the first clinical manifestations of the disease to complete recovery. But they write it out only after two specific tests with a negative result with an interval of 2 days. For admission to an institution, an additional two-time examination is required with negative results.
• Contactees are examined by a doctor and observed within 10 days of the proposed incubation period.
• Carriers are hospitalized and undergo a course of rehabilitation.

Does vaccination really need - video

In the video you will find out why they are vaccinating against diphtheria. They will tell you what ended the rejection of active immunization during the period of perestroika. An experienced specialist tells about the composition of vaccines, domestic and imported, which will help you in the future choice of the drug.

Diphtheria in children often proceeds in a mild form. But do not forget about the possible serious complications entailing a fatal outcome. Therefore, do not refuse vaccination against diphtheria to your children. It will provide strong anti-diphtheria immunity. In extreme cases, the disease will proceed in a mild form without consequences.

Are you familiar with such a pathology as diphtheria? What do you know about vaccinations? Tell us about it in the comments.