Diphtheria - infectious disease caused by bacteria diphtheria, transmitted by airborne droplets, characterized by inflammation of the mucous membranes preferably roto and nasopharynx, and phenomena of intoxication and visceral authorities.
Factor virulence of pathogens - a toxin secreted by them.
The source of infection - the patient or carrier diphtheria bacilli. Ways of transmission - airborne, contact, less food. Ill people of almost all ages who do not have immunity to the pathogen and its toxin.
The causative agent of diphtheria stable in the environment. The diphtheritic film, it is stored for 3-5 months in the dust - up to 2 months on food - up to 12-18 days, droplets of saliva left on the surface of a glass on the door handles, children's toys, diphtheria bacteria can be maintained 15 days. Corynebacterium survival on environmental subjects among the autumn-spring period can be up to 5.5 months, and all this time saved pathogenic properties of the originator.
The incubation period - 2-7 days (possibly up to 12 days).
manifestations of diphtheria
Diphtheria oropharynx begins acutely with chills or chilling, fervescence, often no higher than 38 ° C, although it may be a higher temperature in the second day of the disease. At the same time there are other signs of intoxication: headache, severe weakness, fainting can be.
From the first hours of the disease appears to moderate pain in the throat when swallowed, which increases during the day. Submandibular lymph nodes are slightly painful, sometimes moderately increased.
Febrile period lasts no more than 3 days. With the temperature normalization virtually disappear all the symptoms of intoxication, reduced or eliminated pain in the throat when swallowing.
The mucosa of the oropharynx moderately reddened with a localized form of diphtheria. Typically, hyperemic region has a narrow rim bordering film.
The mucosa is swollen tonsils, the relief is smoothed. The film is preferably on a convex surface of the tonsils, thick, grayish-white or off-gray color smooth shiny surface, clearly limited edges, the same thickness all over, it is difficult to be removed spatula.
When ostrovchatom embodiment, the film has the form of islands seated with irregular outlines; with filmy - it covers a significant part of the tonsils, and in tonsillar envelops the whole amygdala. The film on the tonsils without treatment persists 6-7 days.
In diphtheria of the respiratory tract: a rough, barking cough; hoarseness; dyspnea.
In diphtheria of the nose: the difficulty of nasal breathing, sanioserous discharge from nasal passages.
Treatment
Emergency hospitalization for suspected diphtheria.
Diphtheria serum is injected as soon as possible without waiting for laboratory confirmation of diagnosis / m or / in a dosage form appropriate clinical disease.
Before the introduction of the full dose spend cutaneous or conjunctival test for hypersensitivity.
- Intradermal test: diphtheria antitoxin in 1: 100 dilution is administered intradermally, the reaction is considered positive for the formation of infiltration within 20 minutes after injection.
- Conjunctival sample: diphtheria serum at a 1:10 dilution was instilled into the lumen of the conjunctiva of one eye, the other eye was instilled with 0.1 ml 0.9% sodium chloride solution.
The reaction is considered positive when a local reaction (itching, redness).
In all cases (in Vol. H. and carrier) Antibiotics, such as erythromycin 40-50 mg / kg / day. (Maximum 2 g / d.) For 14 days or of benzylpenicillin 100,000-150,000 IU / kg / day. 4 administration / m.
Prevention of diphtheria
Diphtheria carried diphtheria toxoid, which is part of the combined drugs - DTP, Td, Td.
Vaccinate children during the first 4 years of preparation is carried out three times DPT 4-6 years for use of ADS with a double introduction, patients older than 6 years are usually vaccinated with Td.
Revaccination is carried out in 9-12 months after the complete vaccination course. Repeated administration of Td is performed at 6, 11, 16 and then every 10 years.
In the case of disease in children's collective children who were in contact with the patient examined bacteriologically and uncouple for 7 days.
Recovering the extract is carried out after a double negative result bacteriological examination.
