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Children began to be vaccinated against diphtheria, but before that the mortality rate from this infectious disease was quite high. Now children are more protected, but none of those vaccinated are safe from infection. You will learn about the symptoms, treatment and prevention of diphtheria in children by reading this article.

What it is?

Diphtheria is a bacterial infectious disease caused by Loeffler's bacillus. These bacteria of the genus Corynebacteria themselves do not pose any particular danger. A poisonous exotoxin produced by microbes during their life activity and reproduction is dangerous for humans. It blocks protein synthesis, practically depriving the body's cells of the ability to perform their naturally intended functions.

The microbe is transmitted by airborne droplets - from person to person. The more severe the symptoms of diphtheria in a patient, the more bacteria he spreads around himself. Sometimes infection occurs through food and water. In countries with hot climates, Loeffler's bacillus can also spread through household contact.

A child can become infected not only from a sick person, but also from a healthy person who is a carrier of the diphtheria bacillus. Most often, the causative agent of the disease affects the organs that are the first to meet on its way: the oropharynx, larynx, and less often - the nose, genitals, skin.

Today, the prevalence of the disease is not too high, since all children are required to be vaccinated with DTP and DPT. The letter "D" in these abbreviations stands for the diphtheria component of the vaccine. Due to this, the number of infections over the past 50 years has been significantly reduced, but the disease cannot be completely eradicated.

The reasons are that there are parents who refuse mandatory vaccination of their child, and their sick children spread the diphtheria bacillus to others. Even a vaccinated child can become infected, but his disease will be milder and it is unlikely that it will reach the point of severe intoxication.

Signs

The incubation period, during which the rod only “examines” in the body without causing any changes, ranges from 2 to 10 days. In children with stronger immunity, the incubation period lasts longer; children with weakened immune defenses can show the first signs of an infectious disease as early as 2-3 days.

These signs may remind parents of a sore throat. The baby's temperature rises (up to 38.0-39.0 degrees), headache, and fever appear. The skin looks pale, sometimes somewhat bluish. From the first day of illness, the child’s behavior changes greatly - he becomes lethargic, apathetic, and drowsy. Painful sensations appear in the throat, and it becomes difficult for the child to swallow.

When examining the throat, enlarged palatine tonsils are clearly visible, the mucous membranes of the oropharynx look swollen and reddened. They are increased in size. The palatine tonsils (and sometimes the tissues bordering them) are covered with a coating that resembles a thin film. It most often has a gray or gray-white color. The film is very difficult to remove - if you try to remove it with a spatula, bleeding marks remain.

A symptom that may indicate diphtheria is swelling of the neck. Her parents will notice without difficulty. Against the background of soft tissue swelling, you can also palpate enlarged lymph nodes.

The most severe form of diphtheria is toxic. With it, all the above symptoms are more pronounced - the temperature rises to 40.0 degrees, the child may complain of severe pain not only in the throat, but also in the abdomen. The deposits on the tonsils and arches are very dense, serous, and continuous. The intoxication is severe.

Swelling of the neck is pronounced, the lymph nodes are greatly enlarged and painful. It is difficult for the baby to breathe through his nose due to hyperemia of the tonsils, and sometimes ichor comes out of the nose.

Hypertoxic diphtheria has the most severe manifestations. With it, the child is often unconscious or delirious, and has convulsions. All symptoms (fever, fever, swelling of the larynx and tonsils) develop rapidly. If proper medical care is not provided in time, coma occurs within two to three days. Death is possible due to developing failure of the cardiovascular system.

However, not all forms of diphtheria are so dangerous. Some (for example, nasal diphtheria) occur with almost no symptoms and do not threaten the child’s life.

Danger

A rather dangerous complication of diphtheria is the development of diphtheria croup. In this case, stenosis of the respiratory organs occurs. Due to swelling, the larynx narrows, the trachea and bronchi swell. At best, this leads to a change in the voice, hoarseness, and difficulty breathing. At worst, it leads to suffocation.

The most dangerous complication of diphtheria is the development of myocarditis (inflammation of the heart muscle). Irregular heart rhythm and impaired pulmonary respiration can lead to the development of respiratory as well as cardiovascular failure after 2-3 days. This condition is also deadly for the child.

Due to the action of a strong toxin, kidney failure can develop, as well as neurological disorders such as neuritis and regional paralysis. Paralysis is most often temporary and disappears without a trace after some time after recovery. In the vast majority of cases, paralysis of the cranial nerves, vocal cords, soft palate, neck muscles and upper limbs is recorded.

Some of the paralytic changes occur after the acute stage (on the 5th day), and some appear after diphtheria - 2-3 weeks after visible recovery.

The most common complication of diphtheria is acute pneumonia (pneumonia). As a rule, it occurs after the acute period of diphtheria has been left behind (after 5-6 days from the onset of the disease).

The main danger lies in late diagnosis. Even experienced doctors cannot always recognize diphtheria in the first day or two. Namely, this time is important in order to administer anti-diphtheria serum to the child, which is an antitoxin, a substance that suppresses the toxic effects of exotoxin. Most often, in case of death, it is precisely the fact of untimely diagnosis that becomes clear, and as a result, the failure to provide proper assistance.

To prevent such situations, all doctors have clear instructions in case of detection of dubious symptoms, which may even indirectly indicate that the child has diphtheria.

Varieties

Much in the choice of treatment tactics and in the prognosis for recovery depends on what type of diphtheria and to what extent the baby is affected. If the disease is localized, then it is more easily tolerated than the diffuse (widespread) form. The smaller the source of infection, the easier it is to deal with it.

The most common form that occurs in children (about 90% of all cases of diphtheria) is oropharyngeal diphtheria. It happens:

• localized(with minor “islands” of plaque);
• spilled(with the spread of inflammation and plaque beyond the pharynx and oropharynx);
• subtoxic(with signs of intoxication);
• toxic(with a rapid course, swelling of the neck and severe intoxication);
• hypertoxic(with extremely severe manifestations, with loss of consciousness, critically large and extensive plaque and swelling of the entire respiratory system);
• hemorrhagic(with all the signs of hypertoxic diphtheria and general systemic infection with diphtheria bacillus in the bloodstream).

With the development of diphtheria croup, the child’s condition worsens, and at the same time, the croup itself is divided into:

• diphtheria of the larynx - localized form;
• diphtheria of the larynx and trachea - diffuse form;
• descending diphtheria - the infection quickly moves from top to bottom - from the larynx to the bronchi, affecting the trachea along the way.

Nasal diphtheria is considered the mildest type of the disease, since it is always localized. With it, nasal breathing is disrupted, mucus mixed with pus and sometimes blood comes out of the nose. In some cases, nasal diphtheria is concomitant and accompanies pharynx diphtheria.

Diphtheria of the organs of vision manifests itself as ordinary bacterial conjunctivitis, which, by the way, is quite often mistaken for damage to the mucous membrane of the eyes by Loeffler's bacillus. Usually the disease is unilateral and is not accompanied by fever or intoxication. However, with toxic diphtheria of the eyes, a more violent course is possible, in which the inflammatory process spreads to both eyes and the temperature rises slightly.

Skin diphtheria can develop only where the skin is damaged - there are wounds, abrasions, scratches and ulcers. It is in these places that the diphtheria bacillus will begin to reproduce. The affected area swells, becomes inflamed, and a thick gray diphtheria plaque develops on it quite quickly.

It can persist for quite a long time, and the general condition of the child will be quite satisfactory.

Genital diphtheria in childhood is rare. In boys, foci of inflammation with typical serous plaques appear on the penis in the area of ​​the head; in girls, inflammation develops in the vagina and is manifested by bloody and serous purulent discharge.

Diagnostics

Existing laboratory tests help to quickly and promptly recognize diphtheria in a child. A swab from the child's throat must be taken for diphtheria bacillus. Moreover, it is recommended to do this in all cases when a dense grayish coating is noticeable on the tonsils. If the doctor does not neglect the instructions, he will be able to diagnose the disease in time and administer the antitoxin to the baby.

The smear is not very pleasant, but quite painless. The doctor runs a clean spatula over the filmy plaque and places the scraping into a sterile container. Then the sample is sent to a laboratory, where specialists can determine which microbe caused the disease.

After establishing the presence of corynebacteria, and this usually happens 20-24 hours after laboratory technicians receive the material, additional tests are taken to determine how toxic the microbe is. At the same time, specific treatment with anti-diphtheria serum is started.

Additional tests include a blood test for antibodies and a general blood test. It should be noted that every child who has been vaccinated with DTP has antibodies to the diphtheria bacillus. A diagnosis cannot be made based on this test alone.

With diphtheria, the number of antibodies rapidly increases, and during the recovery stage it decreases. Therefore, it is important to monitor the dynamics.

A general blood test for diphtheria in the acute stage shows a significant increase in the number of leukocytes, high ESR levels (the erythrocyte sedimentation rate during acute inflammation increases significantly).

Treatment

Diphtheria should be treated exclusively in a hospital - according to clinical recommendations. In a hospital setting, the child will be under round-the-clock supervision of doctors who will be able to respond in a timely manner to complications if they arise. Children are hospitalized not only with a confirmed diagnosis, but also with suspected diphtheria, since delay in dealing with this disease can have very disastrous consequences.

In other words, if a called doctor finds a thick gray coating in the child’s throat and a number of other symptoms, then he is obliged to immediately send the child to an infectious diseases hospital, where he will be prescribed all the necessary examinations (smear, blood tests).

Although Loeffler's bacillus is a bacterium, it is practically not destroyed by antibiotics. Not a single modern antibacterial drug has the desired effect on the causative agent of diphtheria, and therefore antimicrobial agents are not prescribed.

Treatment is based on the administration of a special antitoxin - PDS (anti-diphtheria serum). It stops the effect of the toxin on the body, and the child’s own immunity gradually copes with the stick as such.

Humanity owes the appearance of this serum to horses, since the drug is obtained by hypersensitizing these graceful animals with diphtheria bacillus. Antibodies from horse blood, which are contained in the serum, help the human immune system to mobilize as much as possible and begin the fight against the causative agent of the disease.

If a severe form of diphtheria is suspected, doctors in the hospital will not wait for test results and will immediately administer the serum to the baby. PDS is done both intramuscularly and intravenously - the choice of administration method is determined by the severity of the child’s condition.

PDS horse serum can cause severe allergies in a child, like any foreign protein. It is for this reason that the drug is prohibited for free circulation and is used only in hospitals, where a child who develops a rapid reaction to PDS can be provided with timely assistance.

During the entire treatment, you will need to gargle with special antiseptics that have a pronounced antibacterial effect. Most often, Octenisept spray or solution is recommended.

After the acute stage, when the main danger has passed, but the likelihood of complications remains, the child is prescribed a special diet, which is based on gentle and soft food. Such food does not irritate the affected throat. These are porridges, soups, purees, jelly.

Everything spicy is excluded, as well as salty, sweet, sour, spices, hot drinks, soda, chocolate and citrus fruits.

Prevention

A person can get diphtheria several times in his life. After the first illness, acquired immunity usually lasts for 8-10 years. But then the risks of getting infected again are high, although repeated infections are much milder and easier.

Specific prevention is vaccination. The DTP and ADS vaccines contain anti-diphtheria toxoid. In accordance with the national vaccination calendar, they are given 4 times: 2-3 months after birth, the next two vaccinations are carried out with an interval of 1-2 months (from the previous vaccination), and the fourth vaccine is administered a year after the third vaccination. The child is revaccinated at 6 years and 14 years old, and then vaccinated every 10 years.

Early detection of the disease prevents its widespread spread, which is why if you suspect a sore throat, peritonsillar abscess or infectious mononucleosis (diseases similar in symptoms to diphtheria), it is important to immediately conduct laboratory tests.

In a group where a child with diphtheria is identified, a seven-day quarantine is declared, and all children are required to take throat swabs for diphtheria bacillus. If in such a group there is a child who, for some reason, has not been vaccinated with DPT or ADS, he must be given anti-diphtheria serum.

Much depends on parents in preventing this disease. If they have taught the child hygiene, constantly strengthen his immunity, make sure that the baby grows healthy, and do not refuse preventive vaccinations, then we can assume that they are maximally protecting the child from a dangerous disease, the course of which is unpredictable. Otherwise, the consequences can be very sad.

See the following video for all about the rules of vaccination against diphtheria.

Diphtheria now seems to be a thing of the past; there are often articles stating that this disease is a myth invented to intimidate parents. Unfortunately, it is not. In the 90s of the last century, a diphtheria epidemic was recorded, which claimed the lives of 6,000 people.

After this epidemic, there are isolated cases of this disease, which also lead to death. Unfortunately, epidemic alertness for this disease is currently reduced, which may threaten new outbreaks of morbidity.

How can you become infected with diphtheria?

Diphtheria is a disease caused by Carinebacterium diphtheria (or Lefler's bacillus). The causative agent of diphtheria in children is stable in the external environment. You can become infected either by communicating with a sick person or through food or an object on which bacteria are preserved.

Both an adult and a child can get sick. During the last epidemic, children aged 3 to 14 years were most susceptible.

Diphtheria in children can occur at any age; it rarely develops in a child under one year of age.

The incubation period ranges from 2 to 10 days. On the 7th day of the incubation period, quarantine is imposed on all those in contact with the infected person.

Symptoms of diphtheria in children:

1. The appearance of ivory-colored films (usually on the palatine tonsils). The films are difficult to remove from the mucous membrane, but if you make an effort and still remove this coating, blood appears. If left untreated, the films rapidly increase in size, and at the same time the patient’s condition worsens.
2. The picture of intoxication of the body is expressed, reminiscent of a state of general poisoning.
3. Inflammation and redness, pain in the area of ​​the entrance gate (usually the oropharyngeal mucosa, nasal mucosa).
4. Increased body temperature. But, if we talk about body temperature, it all depends on the form and severity of the disease, it can range from 37˚C to 41˚C.
5. Severe weakness, lethargy, pallor. The child refuses to play and prefers peace and quiet.

What kind of diphtheria can it be?

There are many classifications of this disease necessary to make a diagnosis.

Depending on the severity of diphtheria, it can be:

• subtoxic;
• toxic I, II, III degrees;
• hypertoxic.

Depending on the location of the lesion, diphtheria occurs:

• pharynx;
• larynx;
• respiratory tract;
• genitals .

The symptoms of diphtheria are determined by the form of the disease.

Symptoms of diphtheria pharynx

When the diphtheria bacillus lands on the mucous membrane, it begins to produce diphtheria toxin. This, in turn, penetrates into the cells and leads to the development of necrosis of mucosal tissue. This is how a dense fibrinous film appears, fused with the surrounding tissues.

Diphtheria of the pharynx in children can be island and membranous.

The island form is more common in vaccinated children.

Signs of the island form of diphtheria:

• begins acutely, can occur at a temperature of 37˚C;
• a sore throat appears;
• tonsils are swollen, plaque appears. Islands of plaque do not develop as rapidly as in other forms.

The membranous form is more pronounced and will often have a severe course.

Signs of filmy form of diphtheria:

• in this case, the disease is more rapid, it begins acutely with a rise in temperature to 39˚C;
• there is severe pain in the throat when swallowing;
• palatine tonsils enlarge due to edema;
• A plaque appears on the tonsils, and the further it spreads, the more severe the patient’s condition will be.

Diphtheria of the larynx

This form of diphtheria rarely affects only the larynx; more often it affects the mucous membranes of the oropharynx, nose, and larynx. It occurs in the form of true croup (croup is a narrowing of the lumen of the larynx due to edema). Diphtheria croup often spreads throughout the entire respiratory tract.

Diphtheria of the larynx is characterized by a cyclical process. There are stages of croupous cough, stenotic and asphyxial stages.

They develop like this:

• the first 2 - 3 days the body temperature rises, pain appears, the voice becomes hoarse, signs of intoxication appear;
• Over the next 3-6 days, noisy breathing develops, shortness of breath when inhaling (the child has difficulty inhaling), and lack of voice. True croup develops;
• On the 6th - 9th day of the disease, the asphyxial stage begins, the condition becomes extremely severe, breathing is shallow, there is no consciousness.

Features of diphtheria infection in young children

Young children rarely get sick. If they get sick, the mucous membranes of the oropharynx, nose, larynx, as well as the skin and umbilical wound are most often affected. Complications develop earlier in children. The course of the disease is very severe.

Immunity after diphtheria is antitoxic and lasts for a year. Everyone has a chance to become infected again. In this case, the disease occurs in a milder form than the first time.

Diphtheria can be confused with other diseases, such as streptococcal tonsillitis, infectious mononucleosis, acute leukemia. To clarify the diagnosis, laboratory research methods are used.

Treatment of diphtheria in children

Even in our age of advanced technologies and antibiotics, the disease is considered quite severe. Therefore, treatment of all patients with diphtheria is carried out under the constant supervision of doctors from the infectious diseases department and, if necessary, from the intensive care unit. Do not underestimate the severity of this disease.

If the child lives in a place where there are no problems with delivery to the hospital, antitoxic diphtheria serum (APDS) is administered in the hospital. In cases where medical evacuation is delayed or takes a long time, APDS is administered by emergency physicians.

Typically, doses are calculated based on the severity of the disease. The most effective is the administration of serum in the first 18-24 hours from the onset of the disease. The serum will be least effective 4 days after the onset of diphtheria. Therefore, the sooner the serum begins to act, the greater the chances of a successful outcome.

Plasmapheresis or hemosorption is also used to treat diphtheria.

Along with all the methods listed above, antibiotic therapy is carried out.

The choice of all drugs and treatment methods is based on the form and severity of the disease.

Since children with diphtheria often end up in the intensive care unit, nursing care is an integral part of treatment.

1. It is important to ensure compliance with bed rest; it is often required for a long time, from 4 to 8 weeks.
2. The child’s diet must be gentle; all foods must be boiled and pureed.
3. The nurse monitors the patient with diphtheria, his condition, temperature, and also monitors compliance with the ventilation and quartz regimes in the ward.
4. Monitors the personal hygiene of a person who is unable to maintain it independently.
5. Prepares children for therapeutic procedures.
6. Assists the doctor in performing manipulations and carries out the doctor's orders.

After suffering from the disease, the patient remains in the dispensary for some time.

Complications and consequences of diphtheria:

1. The most common complication is myocarditis. It can develop at different stages of the disease, from the first days to the third week. It is believed that the earlier this complication occurs, the less favorable the prognosis of the underlying disease.
2. Polyneuropathies characterized by paresis and paralysis are common. This complication can occur in patients with mild forms of diphtheria and in the absence of adequate care.
3. Infectious-toxic shock is an equally serious condition that can also cause death. Accompanies hypertoxic and toxic forms of diphtheria.
4. From the urinary system, this is toxic damage to the kidneys.

Prevention

1. Quarantine is imposed for 7 days from the last case of the disease. During this time, all contacts are tested for diphtheria bacillus.
2. Vaccination of adults and children. Vaccination is carried out from 3 months with various vaccinations. For example, with the DTP vaccine according to the scheme: at 3 months, at 4.5 months, at 6 months, and then at 18 months. Revaccination is carried out at 7 and 14 years of age. There are also analogues of the DTP vaccine - these are Pentaxim, Infanrix, Bubo-Kok. It is better to decide which vaccine to take with your local doctor. From 6 years of age, ADS-M is used for planned age-related revaccinations or in epidemic foci of diphtheria.
3. If the child has not been vaccinated and has had contact with a patient with diphtheria, emergency vaccination against diphtheria is given, which is carried out with the ADS-M or AD-M vaccine.

To summarize the article, I wish you never encounter this terrible disease, if possible, vaccinate yourself and your children, because the health of the child is in your hands.

Diphtheria is an acute infection, which is characterized by the development of inflammation at the site of penetration and localization of the pathogen. Previously, the incidence among children was high. Mass active immunization (vaccination) has led to a decrease in morbidity. But even now there are sporadic (single) cases of diphtheria, and group outbreaks are possible.

Characteristic of this infectious disease is the formation of a fibrinous dense film at the site of localization of the process and severe intoxication. This quite serious disease can even result in death. How diphtheria occurs in children, what are the main symptoms of this disease and what treatment is prescribed, we will talk in this article.

Causes of the disease

The causative agent of the disease is diphtheria bacillus (Corynebacterium). It is quite stable: it tolerates low temperatures (down to -20°C) and drying; remains for a long time on surrounding objects. But when boiled, the stick dies in one minute, and disinfectants (hydrogen peroxide, chloramine and others) have a detrimental effect on the pathogen within 10 minutes.

The source of infection is a patient with diphtheria or a carrier of the diphtheria bacillus. The latent (incubation) period is usually three days, but can be shortened to two days or extended to ten. The child is contagious from the last day of incubation until final recovery. The bacteria carrier does not have any clinical manifestations of the disease, but spreads the infection.

The airborne route of infection is the main route of infection for diphtheria. Less commonly, infection occurs through contact and household contact (through toys or common objects).

A child can get sick at any age. But infants rarely get sick, since they receive antibodies from their mother’s milk, which provide them with passive immunity. Susceptibility to diphtheria in children is low - up to 15%. Mostly unvaccinated children are affected. There is a winter seasonality of the disease.

The entrance gate for corynebacteria is the mucous membranes of the nasopharynx and larynx. Much less often, the pathogen penetrates through the mucous membranes of the eyes or genital organs, the umbilical wound, and skin with impaired integrity.

At the site of penetration, corynebacteria multiplies and releases exotoxin during life. It has a local effect (causes cell death in tissues at the site of penetration) and a general effect (entering the blood and spreading through the vascular bed). A dense grayish fibrinous film is formed from the affected cells at the site of localization of the inflammatory process.

The general effect of the toxin can result in severe complications: damage to the nervous system and heart muscle. On the part of the heart, myocarditis develops, the heart rhythm is disturbed, and even cardiac arrest may occur. Damage to the nervous system by the toxin leads to impairment of vision, swallowing, and speech. The toxin can cause severe swelling in the neck.

Symptoms of diphtheria in children

Considering the localization of the process, diphtheria is distinguished:

• oropharynx;
• larynx;
• eye;
• nose;
• umbilical wound;
• wounds;
• genitals.

Oropharyngeal diphtheria

In children oropharyngeal diphtheria occurs in 95% of cases. It can occur in one of the following clinical forms:

• localized;
• widespread;
• toxic.

The course and nature of the manifestations of the disease depend on the presence of immunization and the age of the child.

In vaccinated children, in rare cases of the disease, diphtheria has a localized, easily occurring form, with a favorable outcome (or is expressed in the form of bacterial carriage).

In those who are not vaccinated, the disease is severe, with a high risk of complications and unfavorable outcomes.

The clinical form depends on the age of the children. Newborn babies may develop a process in the umbilical wound; nasal diphtheria develops in infants; after a year, the larynx is more often affected, and after 2 years, as a rule, the process is localized in the pharynx.

Localized form has 3 varieties: catarrhal, island and membranous. The disease begins acutely. The child has a sore throat, the temperature rises to 38°C or 39°C, and the lymph nodes in the neck are enlarged. The inflammatory process is limited to the tonsils.

At catarrhal form there is redness of the tonsils, there are no other changes in the pharynx (plaques, swelling).

At island shape the onset is acute, there is a sore throat, a rise in temperature to 39°C; health, as a rule, suffers slightly. On slightly reddened tonsils, plaque appears in the form of a shiny film of grayish-white or yellowish color with a clear border.

Plaques on the tonsils are located in the form of single or multiple islands. They rise above the level of the tonsil, are difficult to remove when examined with a spatula, and the mucous membrane bleeds after removal. The lymph nodes in the neck are enlarged but painless.

At filmy form plaque covers the tonsil almost completely. At first, the plaque may look like a cobweb-like mesh, later it becomes a dense grayish film with a pearlescent sheen. When the film is forcibly removed, the surface bleeds.

Common form diseases are registered less frequently. It has a moderate course. The onset is acute, the small patient complains of a sore throat, body temperature is within 39°C. A fibrinous film appears outside the tonsils: on the uvula, palatine arches, and the posterior wall of the pharynx. There is no swelling of the neck. Lymph nodes are enlarged and somewhat painful.

Symptoms of intoxication are typical: the child is inactive, lethargic, has no appetite, and has a headache.

Toxic diphtheria – this is a severe form of the disease. It develops in unvaccinated children. The beginning is acute. The child has a fever, the temperature rises to high values ​​(up to 40°C). Symptoms of intoxication are significantly pronounced, the patient refuses food. Periods of excitement and inhibition alternate. Severe pallor of the skin, possible vomiting. Due to spasm of the masticatory muscles, it is difficult to open the mouth.

Swelling of the oropharynx, sometimes asymmetrical, is one of the earliest signs of toxic diphtheria. It appears before the formation of the diphtheria film.

The plaque is also translucent at first, but soon it becomes dense, with clear boundaries, and extends beyond the tonsil. When examining the child, a sickly-sweet specific odor from the mouth is felt.

On the 2-3rd day of illness, painless swelling of the subcutaneous tissue of the neck is detected; it may extend lower into the collarbone area. The lower the spread of edema, the more severe the condition of the little patient.

The child's condition is serious. The baby's skin is pale, his lips are dry, his tongue is thickly coated. The neck is thickened. Breathing is noisy. A bloody discharge from the nose may appear. The greatest danger is convulsions.

Diphtheria of the larynx

Young children may develop diphtheria of the larynx, a dangerous complication of which is true croup. Moreover, damage to the larynx can develop in isolation, or it can also occur with diphtheria of another localization, when the films grow and gradually descend into the larynx, block the glottis and make breathing difficult.

There are 3 stages in the development of diphtheria croup:

• stage of croupous cough;
• stenotic;
• asphyxial.

IN stages of croupous cough against the background of mild intoxication, the temperature rises within 38°C, hoarseness and a dry cough appear. In the future, the rough cough disturbs in the form of attacks and becomes barking.

After 2 or 3 days it gradually develops stenosis stage : its main symptom is wheezing. The inhalation becomes long with a noticeable retraction of the intercostal muscles, supraclavicular and subclavian fossae.

The stage of stenosis can last up to three days. At the same time, breathing becomes increasingly difficult, the voice is lost, and signs of respiratory failure develop. The child becomes restless, sleep is disturbed, and the bluishness of the skin increases.

If qualified assistance is not provided, stage of asphyxia. The child becomes lethargic, breathing becomes less noisy; cyanosis extends to cold extremities; blood pressure decreases; pulse is frequent, weak filling; pupils are wide.

Subsequently, the temperature drops below normal levels, breathing becomes arrhythmic. Uncontrolled urination and bowel movements may occur. They appear and the child loses consciousness. In the absence of help and surgical intervention, death occurs from asphyxia.

Nasal diphtheria

Nasal diphtheria is registered more often at an early age. Manifestations of the process are as follows: the temperature is normal or slightly elevated, breathing through the nose is difficult due to swelling of the mucous membrane, and discharge in the form of ichor appears from one nasal passage. The baby's general condition suffers little.

Other types of diphtheria

If hygiene rules are not followed, it can develop diphtheria of rare localizations: The ear, eye, umbilical wound, genitals, and skin are affected.

The general condition does not suffer. A gray film forms at the site of the lesion. When the eyes are affected, a unilateral process is characteristic; the film from the conjunctiva can also transfer to the eyeball; the eyelid is swollen.

The skin is affected by diaper rash, wounds, abrasions, and scratches. Swelling of the skin and the formation of a fibrinous grayish film that is difficult to remove appears.

Complications of diphtheria

The course of diphtheria can be complicated by damage to the kidneys, heart, and nervous system.

Diphtheria is a disease that can lead to very serious complications. In the absence of timely treatment, the diphtheria bacillus toxin penetrates into various organs through the bloodstream and can cause toxic shock, myocardium, and peripheral nervous system. With diphtheria croup it often develops.

Nephrotic syndrome occurs with kidney damage. Protein increases in the urine, cylinders and a small amount of formed elements appear. But kidney function is not impaired. Upon recovery, urine analysis returns to normal.

Damage to the nervous system with the development of paralysis, it may appear in the early stages (at 2 weeks of illness) and later. The cranial nerves are affected. Paralysis of the soft palate and oculomotor nerves is more common.

Manifestations of these lesions may be:

• choking on food;
• pouring out liquid food from the nasal passages;
• nasal voice;
• deviation of the tongue to the healthy side;
• swelling of the eyelid on one side.

Diagnostics

Diphtheria is diagnosed based on clinical manifestations and laboratory data. Among the clinical symptoms, an important sign for diagnosis is taken into account: the presence of a characteristic dense fibrinous film that is difficult to remove.

Laboratory methods used:

• a blood test to check for the presence of diphtheria antitoxin in the child’s blood;
• bacterioscopic: detection of corynebacteria under a microscope in a smear from the affected area;
• a bacteriological method that allows you to isolate diphtheria bacilli from a smear taken from the affected area.

A fact confirming the diagnosis is also the reverse development of all manifestations of diphtheria just one day after the intravenous infusion of anti-diphtheria serum.

Treatment of diphtheria

At the slightest suspicion of diphtheria, the child is treated only in a hospital setting, and if signs of complications appear, in the intensive care unit.

Treatment of diphtheria in children must be comprehensive. The main and most important method of treatment is the use anti-diphtheria antitoxic serum. It is administered even if diphtheria is suspected, without waiting for the results of bacteriological culture: this is the only way to avoid serious complications and even save the child’s life. This is due to the fact that the serum neutralizes the effect of the diphtheria bacillus toxin on the child’s body.

Since antitoxic anti-diphtheria serum is prepared on the basis of horse serum, the individual sensitivity of the child’s body to it is checked before its administration. If hypersensitivity is detected, the serum is administered according to a special method in a diluted form.

The serum is administered intravenously. In mild cases it is administered once, and in severe cases it is administered over several days. Doctors are faced with the task of administering the serum as early as possible. The dose of antitoxin is prescribed depending on the severity of the disease, the form of diphtheria and the duration of the disease.

Comprehensive treatment also includes antibiotics, which prevent further spread of the process and for the prevention of pneumonia. Antibiotics have no effect on the toxin of the diphtheria bacillus, so they are used not instead of anti-diphtheria serum, but in combination with it.

Among the antibiotics used, depending on the prevailing sensitivity of the pathogen, the following drugs are used: Penicillin, Erythromycin, Ampicillin, Gentamicin, Rifampicin, Tetracycline, Ceftriaxone, Ciprofloxacin, Cyprinol and others.

When the larynx is damaged, they are used as anti-inflammatory drugs. ( Dexamethasone, Prednisolone, Fortecortin, Ortadexon, Novomethasone, etc.). With croup, it is necessary to ensure a flow of fresh air; sedatives and desensitizing agents are also used. If there is a risk of suffocation, it is used in the stage of stenosis. surgery– tracheotomy.

As symptomatic therapy Antipyretics (Analgin, Panadol, Paracetamol, etc.), vitamin preparations, and detoxification therapy can be used.

When myocarditis develops, oxygen therapy is used and medications are prescribed to normalize the heart rhythm. For pneumonia, medications that dilate the bronchi are used. With the development of respiratory disorders, the child is transferred to artificial (hardware) respiration.

Caring for a sick child makes a significant contribution to complex treatment. The little patient needs strict bed rest. It is the parents’ task to calm the baby down, give him something to drink, feed, and change clothes on time. If swallowing is impaired, feeding using a nasogastric tube is used.

Non-traditional methods of treating diphtheria can only be used as a means to alleviate sore throat and make the child feel better. For this purpose, you can lubricate your throat with freshly squeezed cranberry juice, gargle with lingonberry, lemon or cranberry juice every half hour. You can lubricate the affected areas with tincture of Rhodiola rosea root or tincture of eucalyptus leaves 3 times a day.

Forecast

Localized forms usually end in recovery.

The toxic form of the disease can be fatal. The prognosis depends entirely on the timing of serum administration.

Transferred diphtheria leaves lasting immunity.

Prevention

Vaccination against diphtheria begins at three months of age.

To prevent diphtheria, the following activities are carried out:

• immunization (vaccination) of the entire population;
• isolation of patients;
• identification, isolation and treatment of diphtheria bacillus carriers;
• monitoring contact children.

A reliable and important preventive measure to protect against diphtheria is vaccination. Vaccinations are carried out with diphtheria (weakened) toxin, which is part of the diphtheria-tetanus-pertussis vaccine (DPT) or diphtheria-tetanus toxoid (DT).

Children are vaccinated from the age of three months: the drug is injected into the muscle three times with an interval of one and a half months. Revaccination is carried out at 1.5-2 years and at 7 and 14 years.

As prescribed by the pediatrician (if the child has contraindications to DPT and ADS), vaccination is carried out with more gentle preparations (they have a reduced antigen content): ADS-M-toxoid or AD-M-toxoid is administered 2 times according to an individual schedule.

On the day of vaccination, the child may experience a rise in temperature, malaise, slight redness and hardness at the injection site.

Patients with diphtheria are isolated for 7 days. Isolation is terminated upon receipt of a negative bacteriological test (smear from the mucous membranes of the nose and throat). Disinfection is carried out at the source of infection. Contact persons are monitored and examined for 7 days (a swab is taken from the nose and throat for bacteriological examination).

Summary for parents

Diphtheria is a dangerous airborne infection. It can lead to serious complications and even death of the child. If you have the slightest suspicion of this disease, you should immediately consult a doctor. The success of treatment absolutely depends on its timely implementation. You should not refuse the proposed hospitalization of a sick baby.

Diphtheria can be prevented if your child is vaccinated on time. You should not refuse vaccination! After all, it is simply impossible to prevent your beloved child from coming into contact with the diphtheria bacillus bacteria - in transport, in a store, in any group.

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Diphtheria is an infectious disease characterized by an inflammatory process at the site of introduction of the pathogen with the formation of fibrinous films, general intoxication phenomena as a result of the entry of exotoxin into the blood, causing severe complications in the form of infectious toxic shock, myocarditis, polynephritis and nephrosis.

Etiology. The causative agent of the disease is Corynebacterium diphtheria (Leffler's bacterium). There are toxigenic and non-toxigenic strains of the microorganism. The disease is caused by toxigenic strains that produce exotoxins. The degree of toxigenicity of different strains may vary. Corynebacterium is stable in the environment, can survive for a long time on objects used by the patient, but at the same time quickly dies under the influence of disinfectants.

Epidemiology. The source of infection is a patient or a carrier of toxigenic corynebacterium. Bacterial carriage is hundreds of times greater than the number of patients and poses a serious epidemiological danger.

Depending on the duration of excretion of the pathogen, a distinction is made between transient carriage - up to 7 days, short-term carriage - up to 15 days, average duration - up to 30 days, and prolonged or recurrent carriage - more than 1 month (sometimes several years).

The main mechanism of infection transmission is airborne droplets. Infection is possible through household items and third parties, as well as through food, through contaminated products. Susceptibility to diphtheria depends on the level of antitoxic immunity. The infectiousness index is low and amounts to 10-15%. Infants are relatively immune to the disease, which is due to the presence of passive immunity received from the mother. After an illness, strong immunity remains.

Pathogenesis. The entrance gates of infection are the mucous membrane of the oropharynx, nasal cavity, larynx, and, less commonly, the mucous membrane of the eyes, genitals, wound and burn surfaces of the skin, and umbilical wound. At the entrance gate, the pathogen multiplies and releases an exotoxin.

The development of the disease is associated with the action of both an exotoxin and other waste products of the pathogen, including necrotoxin, which causes cell necrosis at the site of the pathogen.

The pathological process is accompanied by disruption of local circulation and increased permeability of the vascular walls. Exudate rich in fibrinogen leaks from the vessels into the surrounding tissues. Under the influence of thrombokinase, released during necrosis of epithelial cells, the protein coagulates, forming a fibrinous plaque on the surface of the mucous membrane (a characteristic sign of diphtheria).

Getting into the lymphatic and bloodstream, diphtheria toxin causes intoxication of the body, damage to the heart muscle, nervous system, and kidneys. As a result of paresis of the lymphatic vessels, swelling is formed in the tonsils, neck, and chest.

When the pathological process is localized in the larynx, diphtheria croup develops. Narrowing of the lumen of the larynx occurs as a result of reflex muscle spasm, swelling of the mucous membrane, and the formation of fibrinous films.

Clinical picture. The incubation period lasts from 2 to 10 days. In vaccinated and unvaccinated children, the clinical manifestations of the disease are different. Unvaccinated patients are characterized by a severe course of diphtheria, a high proportion of toxic and combined forms, and the development of severe complications. In vaccinated children, the disease is mild and the clinical diagnosis of diphtheria presents significant difficulties.

Depending on the location of the pathological process, the following clinical forms of the disease are distinguished: diphtheria of the pharynx, larynx, nose, eyes, genitals, skin, and in newborns - umbilical wound.

Diphtheria of the pharynx. It is the most common clinical form of the disease in unvaccinated children. There are localized (mild), widespread (moderate) and toxic (severe) forms of pharyngeal diphtheria.

At localized form(Fig. 67 on color on) the plaque does not extend beyond the tonsils. At first they look like a thick cobweb-like mesh or a gelatinous translucent film; they are easily removed, but then appear again. By the end of the first - beginning of the second day, the plaque is dense, smooth, grayish-white in color with a pearlescent sheen, difficult to remove, and when removed, the underlying tissue bleeds slightly. After a few hours, the tonsils are again covered with a film, on the surface of which ridges and folds often form. According to the severity of the overlap, the localized form is divided into island and membranous. In the island form, the plaque is located in the form of single or multiple islands of irregular shape, ranging in size from a pinhead to 3-4 mm. The tonsils are moderately hyperemic and swollen. The filmy form is accompanied by plaque covering part of the tonsils or their entire surface.

The temperature in the first days of the disease is high, but can be low-grade or normal. Symptoms of intoxication are moderate and include headache, malaise, decreased appetite, and pale skin. Slight tachycardia may be observed, blood pressure is within normal limits. From the first hours of the disease, slight or moderate pain in the throat appears when swallowing. Regional lymph nodes enlarge moderately and become sensitive to palpation.

Catarrhal diphtheria of the pharynx is extremely rare in unvaccinated children. The disease occurs against a background of low-grade or normal temperature. Tonsils are swollen. There is slight hyperemia with a cyanotic tint to the mucous membrane of the pharynx and tonsils. There is no plaque.

At common form(Fig. 68 on color incl.) The plaque spreads beyond the tonsils to the palatine arches, uvula and pharyngeal walls. Intoxication, swelling and hyperemia of the tonsils, and the reaction from the tonsillar lymph nodes are more pronounced than in the localized form.

For toxic diphtheria pharynx (Fig. 69 on color incl.) are characterized by severe intoxication, swelling of the oropharynx and subcutaneous tissue of the neck. From the first hours of the disease, body temperature rises sharply, reaching 39-41 °C in the first days. Intoxication symptoms rapidly increase: general weakness, headache, chills, pale skin, cyanosis of the lips, dullness of heart sounds, anorexia. The child experiences repeated vomiting, abdominal pain, tachycardia, expansion of the heart's boundaries, decreased blood pressure, adynamia, and delirium. The severity of intoxication corresponds to the severity of the local inflammatory process and the prevalence of swelling of the subcutaneous tissue of the neck.

According to the severity of edema, there is a subtoxic form of diphtheria (swelling is located above the regional lymph nodes), toxic I degree (swelling goes down to the middle of the neck), II degree (up to the collarbone), III degree (below the collarbone, to the H-III rib and below). A massive plaque forms on the swollen, purplish-cyanotic tonsils, which quickly spreads to the soft and hard palate.

Swelling of the mucous membrane of the oropharynx is pronounced. Regional lymph nodes are significantly enlarged, reaching the size of a chicken egg in grade III.

Diphtheria of the larynx, or diphtheria (true) croup More often it occurs in combination with diphtheria of the pharynx. General intoxication with croup is moderate. The severity of the disease is determined by the degree of laryngeal stenosis. Depending on the prevalence of the process, croup is divided into localized (diphtheria of the larynx) and widespread (diphtheria of the larynx, trachea and bronchi).

Diphtheria croup is characterized by a gradual, over several days, development of the main symptoms of the disease. Catarrhal stage begins gradually against the background of low temperature (up to 37.5-38 ° C). From the first hours of illness, a cough appears, then a slight hoarseness of voice, which progressively increases without decreasing under the influence of distracting procedures. The cough is initially wet, then rough, “barking.” The catarrhal stage lasts from 1 to 2-3 days.

IN stenotic stage Aphonia develops, the cough becomes silent, and stenotic breathing progressively increases. Intoxication and hypoxia increase. The duration of this stage is from several hours to 2-3 days.

When going to stage of asphyxia anxiety, increased sweating, cyanosis, tachycardia, dullness of heart sounds, loss of pulse at the height of inspiration appear. The child's pronounced anxiety gives way to drowsiness and weakness. The pulse becomes threadlike, breathing is rare with long intervals, blood pressure drops, consciousness darkens, and convulsions appear. Cardiac arrest occurs, preceded by bradycardia.

Diphtheria of the nose. It occurs mainly in young children in areas of diphtheria infection. More often observed in combination with other forms of the disease. With diphtheria of the nose, difficulty in nasal breathing, light bloody or serous-purulent discharge appears. The nasal mucosa is swollen and hyperemic. Ulcers, erosions, and fibrin films are found on the nasal septum. The skin around the nasal passages is irritated, with infiltration, weeping, and crusts. Body temperature is normal or subfebrile.

Diphtheria of the eyes, skin, genitals, umbilical wound. These forms of the disease are rare, usually secondary and develop in combination with oropharyngeal diphtheria

At diphtheria of the eye the plaque is localized on the conjunctiva of the eyelids, sometimes spreading to the eyeball. The eyelids are swollen, and a serous-bloody secretion is released from the conjunctival sac.

Skin diphtheria develops only when it is damaged with the formation of a dense film in the area of ​​wounds, scratches, and diaper rash. In girls, diphtheria films can be localized on the mucous membrane of the external genitalia.

Umbilical diphtheria occurs in newborns. Bloody crusts and slight swelling of the surrounding tissues appear on the umbilical wound. The disease occurs with elevated body temperature and symptoms of general intoxication. Complications such as erysipelas, gangrene, peritonitis, and venous thrombosis are possible.

Features of the course of diphtheria at vaccinated children. The disease occurs against the background of reduced antitoxic immunity. The main features of diphtheria in vaccinated people include: almost exclusive localization of the process on the palatine tonsils, no tendency for it to spread, frequent damage to the tonsils without the formation of films, the presence of erased forms of the disease, and a tendency to spontaneous recovery. Manifestations of general intoxication are short-lived. Filmy or island-like plaque has some peculiarities in vaccinated children: it can be removed without much difficulty, removal is often not accompanied by bleeding, and the tendency to form febeche protrusions is weakly expressed. Fibrinous deposits are most often combined with moderate hyperemia and swelling of the tonsils. Swelling of the palatine arches may be noted. Normalization of temperature without special treatment occurs no later than 3-4 days of illness, the tonsils are cleared of plaque within 4-7 days, and their disappearance is possible more quickly.

Complications of diphtheria are caused by the specific action of diphtheria toxin. They are observed mainly in toxic forms of pharyngeal diphtheria. The most severe complications are: infectious-toxic shock, myocarditis, toxic nephrosis, polyradial couloneuritis with the development of peripheral paresis and paralysis.

Laboratory diagnostics. Of the laboratory diagnostic methods, bacteriological examination is of greatest importance. To identify Loeffler's bacteria, a swab is taken from the throat and nose. Patients diagnosed with tonsillitis, nasopharyngitis in the presence of plaque, infectious mononuptosis, stenotic laryngotracheitis, peritonsillar abscess, as well as children and adults from the source of infection are subject to examination in outpatient settings.

The preliminary result of the study is obtained on the 2nd day of the disease, the final result is obtained 48-72 hours after studying the biochemical and toxigenic properties of the pathogen.

Specific antibodies in blood serum can be detected using the agglutination test (AG), RPGA, ELISA, etc.

Treatment. At the slightest suspicion of diphtheria of any localization, patients are immediately sent to an infectious diseases hospital for examination and treatment, since the child’s life depends on timely administration antitoxic antidiphtheria serum.

The antitoxic effect of the serum is most effective when administered in the first hours of the disease, while the toxin is circulating in the blood; only in this case is it possible to prevent the fixation of massive doses of the toxin by the tissues. The serum is administered using the Bezredko method.

Serum doses depend on the form, severity, day of illness and age of the child. For children 1 and 2 years of age, the dose is reduced by 1.5-2 times.

For localized forms of diphtheria of the pharynx, nose and larynx, the serum is usually administered once in a dose of 10,000-30,000 AE; if the effect is insufficient, the administration is repeated after 24 hours.

For widespread and subtoxic diphtheria of the oropharynx, as well as widespread croup, the serum is administered in a dose of 30,000-40,000 AE once a day. Treatment is continued for 2 days.

For toxic diphtheria of the pharynx, degrees I and II, the average dose of serum per course of treatment is 200,000-250,000 AE. On the first day, the patient must be administered 3/4 of the course dose, the serum is administered 2 times with an interval of 12 hours.

In case of toxic diphtheria of the oropharynx of the III degree and hypertoxic form, as well as in the combined form, the course dose can be increased to 450,000 AE. On the first day, the patient is administered half of the course dose in three doses with an interval of 8 hours. A third of the daily dose can be administered intravenously.

After administration of the serum, the patient is monitored for one hour.

Along with the serum, in order to suppress the vital activity of the causative agent of the disease, antibiotics (macrolides or cephalosporins) are used in an age-specific dosage orally, intramuscularly or intravenously (depending on the severity of the condition) for 5-7 days.

For toxic diphtheria or severe combined forms, detoxification and pathogenetic therapy is carried out, aimed at preventing the development of complications. According to indications, syndromic therapy is prescribed.

Patients with diphtheria croup, if conservative treatment is ineffective, undergo tracheal intubation or tracheotomy.

Treatment of bacteria carriers. First of all, restorative treatment is prescribed and chronic foci of infection in the nasopharynx are sanitized. Good nutrition and walks in the fresh air are important.

For long-term bacterial carriage, use erythromycin or other macrolides orally for 7 days. More than 2 courses of antibiotic therapy should not be carried out.

Care. Patients are closely monitored. The nurse should closely monitor compliance with bed rest. Its duration ranges from 7-10 days for a localized form of diphtheria to 45 days for a toxic one. Patients with toxic diphtheria are prohibited from turning over in bed and sitting up on their own. Children should be fed and watered while lying down. In case of severe pain or inability to swallow independently, feeding is carried out through a tube. Food in the acute period of toxic diphtheria should be liquid or semi-liquid. After normalization of body temperature and disappearance of plaque, the patient is transferred to a normal diet. Children with symptoms of paresis of the soft palate (the appearance of a nasal voice, choking) are fed very carefully, slowly, every 2 hours in small portions to avoid aspiration of food.

A patient with croup must be provided with a calm environment, protected as much as possible from mental trauma and anxiety, and created all the conditions for long and deep sleep. It is recommended that the child stay in the box with the transom open; in the cold season, frequent playback should be carried out. When caring for a patient with diphtheria, much attention is paid to the hygiene of the nasopharynx and oral cavity.

Prevention. Active immunization plays a major role in the prevention of diphtheria. To prevent the spread of infection, early identification of patients and carriers of toxigenic corynebacteria is necessary. Identified patients and carriers of toxigenic strains are subject to mandatory hospitalization. Patients are discharged after clinical recovery and a double (every 2 days) bacteriological examination, which is carried out no earlier than 3 days after the end of treatment. Carriers are admitted to the children's team after a course of antibiotic therapy and control bacteriological examination.

Events in the hearth. Before hospitalization of the source of infection, ongoing disinfection is carried out, after isolation - final disinfection. Children who have been in contact with sick people are separated for 7 days. The outbreak is subject to medical surveillance, including a daily double examination with mandatory thermometry and a single bacteriological examination. Those in contact with the patient are subject to examination by an ENT doctor. Children who are due for their next vaccination or revaccination are immediately immunized. Previously vaccinated children are monitored for their anti-diphtheria immunity status (DPIA). Persons with low levels of diphtheria antitoxin in the blood (less than 0.03 IU/ml) are subject to immunization.

Lecture. Whooping cough

Whooping cough is an infectious disease characterized by attacks of spasmodic coughing during the height of the disease.

Etiology. The causative agent of whooping cough is the Bordet-Gengou bacterium, which produces an exotoxin. The microorganism is highly sensitive to environmental factors.

Epidemiology. The source of infection is a patient or a bacteria carrier. The patient is dangerous within 25-30 days from the onset of the disease. Its contagiousness is especially great in the catarrhal period and throughout the entire period of spasmodic cough. Persons with atypical forms of the disease and carriers pose a particular epidemiological danger. The duration of carriage is about 2 weeks.

The mechanism of transmission of infection is airborne. Susceptibility to whooping cough is high, the contagious index reaches 70-80%. Children under 3 years of age are most susceptible to the disease. Newborns and children in the first months of life do not receive passive immunity from their mother if she has specific antibodies to the Bordet-Zhang bacillus. After an illness, strong immunity remains.

Pathogenesis. The entry point for infection is the mucous membrane of the upper respiratory tract, where the pathogen multiplies. The toxin secreted by the rod causes irritation of the respiratory tract receptors, which causes paroxysmal coughing and leads to the emergence of a stagnant focus of excitation in the central nervous system. In the dominant focus, irritations are summed up, while nonspecific stimuli (painful, tactile, sound) can cause an attack of spasmodic cough. Excitation often radiates to the emetic and vascular centers with a response in the form of vomiting and generalized vascular spasm, as well as to the center of skeletal muscles with the occurrence of clonic and tonic convulsions.

Clinical picture. The incubation period ranges from 3 to 15 days. During the course of the disease, three periods are distinguished: catarrhal, spasmodic and the period of resolution. Catarrhal period lasts 1-2 weeks and is manifested by malaise, a slight increase in body temperature, dry cough, and slight mucous-serous discharge from the nose. The general condition of the children is not impaired. In subsequent episodes, the cough gradually intensifies, becomes intrusive and becomes paroxysmal in nature.

Transition of the disease to spasmodic period characterized by the appearance of spasmodic coughing attacks. It warms up suddenly or after short warning signs (aura) in the form of causeless anxiety, a burning sensation or a tickling sensation behind the sternum. The attack begins with a deep breath, followed by a series of coughing impulses, quickly following each other as you exhale. Then a deep breath occurs, accompanied by a whistling, drawn-out sound due to the passage of air through a spastically narrowed glottis (reprise). During an attack, the child’s face turns red and takes on a bluish tint. The neck veins swell, the eyes become watery and “bloodshot.” The head is pulled forward, the tongue protrudes out of the mouth to the limit. In this case, the frenulum of the tongue is injured by the lower incisors, and an ulcer appears on it. In severe cases, the attack is accompanied by numerous recurrences. During a convulsive cough, involuntary urination and defecation may occur. At the end of the attack, a small amount of viscous sputum is released, and sometimes vomiting occurs (Fig. 70). In young children, convulsive cough often ends in apnea. The number of attacks per day, depending on the severity of the disease, ranges from 8-10 to 40-50 times or more.

As a result of circulatory disorders and congestion, the patient's face becomes puffy and the eyelids become swollen. Petechiae appear on the face, neck, and upper body. Hemorrhages into the conjunctiva of the eyeballs are possible.

The spasmodic period lasts 2-4 weeks, then the disease progresses to resolution period. The attacks become less frequent and disappear, the cough loses its typical character, and recovery gradually begins. The total duration of the disease ranges from 1.5 to 2-3 months. In addition to the typical forms of whooping cough, atypical forms.

At erased forms disease, there are no coughing attacks; the cough itself lasts several weeks or months.

Subclinical (asymptomatic) form detected in foci of the disease during bacteriological and immunological examination of contacts. Changes in peripheral blood are rare

Whooping cough in infants is difficult. The catarrhal period is shortened, the spasmodic period is extended. During an attack of spasmodic cough, repeated breath holdings or stopping are possible. Apnea occurs not only at the height of the attack, but also outside it.

Whooping cough in vaccinated children, As a rule, it has a mild course. There are no complications. An erased form of the disease often develops. Hematological changes typical for whooping cough are rarely observed.

Complications that occur with whooping cough are associated with the underlying disease or are the result of reinfection or superinfection. The first group of complications includes pneumothorax, emphysema of the subcutaneous fatty tissue and mediastinum, atelectasis, umbilical hernia, rectal prolapse, and encephalopathy.

The most common complications arising from the accumulation of secondary infection are pneumonia and severe bronchitis. These complications can lead to death in children in the first months of life.

Laboratory diagnostics. Isolation of the pathogen is of decisive importance for laboratory diagnosis. Material from the patient is taken using the “cough patch” method. The best seeding occurs when examined in the first 2 weeks from the onset of the disease. As a rapid diagnosis, an immunofluorescent method is used, with which the pathogen can be detected directly in smears of mucus from the nasopharynx in almost all patients at the onset of the disease. For serological diagnosis, RA, RSK, RPGA are used. These reactions are only relevant for retrospective diagnosis. In addition, they are often negative in children in the first two years of life. In a general blood test, whooping cough is characterized by leukocytosis, pronounced lymphocytosis against the background of normal or slow ESR. The most pronounced changes in the blood appear during the spasmodic period.

Treatment. Patients with whooping cough are treated at home. Hospitalization is carried out in young children, in case of severe disease, in case of complications or for epidemiological indications.

Etiotropic therapy of the disease includes the prescription of broad-spectrum antibiotics to which the pathogen is sensitive (ampicillin, gentamicin, chloramphenicol succinate). Macrolides can be used: Rulid, Sumamed, Klacid, Erythromycin. TO potassium And benzylpenicillin sodium salt And phenoxymethylpenicillin The causative agent of whooping cough is insensitive. Antibiotics are used in age-related doses. The course of treatment is 8-10 days. They are prescribed in the catarrhal period and in the first days of spasmodic cough. In later stages of the disease, their use is inappropriate. Early use of antibiotics helps to significantly alleviate coughing attacks, reduce their number, and shorten the duration of the disease.

Pathogenetic and symptomatic therapy is important in the treatment of whooping cough. The use of sedatives is indicated ( tinctures of valerian, motherwort). Antipsychotics are used to reduce the frequency and severity of spasmodic cough attacks ( seduxen, diprazine, aminazine), which relieve bronchospasm, reduce the excitability of the respiratory center, calm the patient, and promote deepening of sleep.

An obligatory component of therapy are drugs that reduce the viscosity of sputum ( pertussin, mucaltin, ambroxol and etc.). Inhalation of ambroxol with proteolytic enzymes has a good effect (trypsin, chymotrypsin), alkaline inhalations.

The use of bronchodilators is indicated ( euphylong). It is advisable to include aminophylline in aerosol therapy.

Antitussive drugs have a positive effect (libexin, bromhexine, tusuprex, paxeladine, sine-code). They are not prescribed to children 1 year of age.

Antihistamines are widely used to suppress the allergic component ( suprastin, tavegil etc.) in normal doses. In severe cases, glucocorticoids are used for 7-10 days.

According to indications, drugs are prescribed that improve cerebral circulation ( Cavinton, trental).

In case of apnea, emergency care is provided: mucus is sucked out from the upper respiratory tract, artificial respiration, and oxygen therapy are performed. Drugs that stimulate the respiratory center are not used, since respiratory arrest is associated with overexcitation of the respiratory center.

Care. The room in which the patient is located must be frequently ventilated and cleaned only with a wet method. Long walks in the fresh air are shown. External irritants that cause an attack of smasmatic cough should be excluded. During an attack, it is better to hold the child in your arms or sit him in bed. At the end of the attack, mucus from the mouth and nose is removed with a gauze swab. The patient must be fed in small portions after a coughing attack. If children vomit frequently, it is recommended to supplement their diet. Of no less importance in care is interestingly organized leisure time. The child needs to be occupied with playing, modeling, reading books, and watching children's television programs at home.

Prevention. Active immunization plays a major role in disease prevention. To prevent the spread of infection, the patient is isolated for 25-30 days from the moment of illness.

Events in the hearth. IN the fireplace is wet cleaned and ventilated. Children under 7 years of age who have not previously had whooping cough and are unvaccinated are subject to separation for 14 days from the moment the patient is isolated. If Oosh.noy is treated at home, children under 7 years of age who are in contact with him and have not had whooping cough are subject to separation for L days from the onset of cough in the sick person. For children of the first year of life who are not immunized against whooping cough, in contact with a sick person, administration antipertussis immunoglobulin in a dose of 6 ml (3 ml every other day). Children over 7 years old are not subject to separation. They are under medical supervision for 25 days from the onset of cough in a sick child.

Diphtheria is an acute infection caused by Corynebacterium diphtheriae, the symptoms of which are caused by the production of a toxin - an extracellular protein product of a toxigenic strain of the pathogen.

Etiology. The causative agent of diphtheria, Corynebacterium diphtheriae, or Loeffler's bacillus, is an unevenly staining gram-positive, non-spore-bearing, non-motile pleomorphic bacterium. Flask-shaped swellings at its ends, which are not a true morphological characteristic, reflect the results of cultivation on an inadequate nutrient medium (Leffler). Diphtheria bacilli grow best on special nutrient media containing inhibitors that can inhibit and slow down the growth of other microorganisms.

Toxigenic and non-toxigenic microorganisms are found among smooth and rough strains; exotoxin production is determined in any of the three types of corynebacterium colonies. Treatment of diphtheria strains with bacteriophages carrying toxigenic genes helps to increase the number of pathogens producing the toxin. However, phage reproduction is not a necessary condition for toxin production, which is determined by genetic factors and cultivation conditions. The toxin is apparently produced by those cells in which spontaneous induction of prophages into phages occurs.

Diseases are caused by toxigenic and non-toxigenic strains of diphtheria bacillus, but only the first, toxigenic, are responsible for the development of complications such as myocarditis and neuritis.

Epidemiology. Diphtheria is a disease common throughout the world, characterized by seasonality: the peak incidence occurs in the autumn and winter months. Infection occurs through contact with a patient or bacteria carrier. Bacteria are transmitted by airborne droplets; the role of the household route of infection is small.

Pathogenesis and pathomorphology. Initially, the infection is localized on the mucous membranes of the upper respiratory tract, less often on the conjunctival membrane, wound surfaces of the skin or in the genital area. After 2–4 days of the incubation period, the pathogen strains with the bacteriophage begin to produce a toxin, which is first adsorbed on the cell wall, then overcomes it and interferes with the processes of protein synthesis of the cell, promoting the enzymatic cleavage of nicotinamide adenine dinucleotide with the subsequent formation of inactive adenosine diphosphoribose transferase. In this case, the synthesis of cellular proteins stops due to disruption of the transfer of amino acids from RNA to elongating polypeptides.

Tissue necrosis is most pronounced along the periphery of the breeding zones of diphtheria pathogens. In these areas, an inflammatory reaction develops, together with the processes of necrosis, promoting the formation of characteristic plaques, which are initially easily removed. As toxin production increases, the affected area becomes wider and deeper, fibrinous deposits appear on its surface, quickly transforming into dense, firmly fixed films from gray to black, depending on the blood content in them. They also contain fibrin and surface epithelial cells. Separation of the film causes bleeding, since the epithelial layer is firmly embedded in its composition. During the healing process, the films peel off on their own.

Swelling of the surrounding soft tissues can reach alarming proportions. Films and edematous soft tissues can hang over the airways, compromising their patency and causing suffocation, which may be accompanied by expansion of the larynx and tracheobronchial tree.

The toxin produced at the site of diphtheria bacilli reproduction enters the bloodstream and spreads throughout the body. When the tonsils, pharynx and pharynx are already covered with diphtheria films, toxemia begins.

The toxin has a destructive effect primarily on the heart, nervous system and kidneys. After fixation of the toxin in the cells, a latent period passes before the development of clinical symptoms. Myocarditis usually develops within 10-14 days, and diseases of the nervous system - no earlier than 3-7 weeks after the onset of the disease.

Diphtheria is most characterized by toxic necrosis and hyaline degeneration of organs and tissues.

Clinical manifestations. The symptoms of diphtheria are determined by the localization of the infection, the immunological status of the macroorganism and the severity of toxemia. The incubation period is 1–6 days. Classification based on initial location of infection:

1) nasal diphtheria occurs mainly in young children. Initially, it is characterized by mild rhinorrhea in the absence of general disorders. Gradually, the discharge from the nose becomes serous-bloody in color, and then mucopurulent. Excoriations appear on the upper lip and nasal passages, and an unpleasant odor may appear. White films are visible on the nasal septum. Slow absorption of the toxin and weak severity of general disorders cause late diagnosis;

2) diphtheria of the tonsils and pharynx - a more severe form of the disease. The onset of the disease is characterized by an imperceptible, gradual increase in body temperature, anorexia, malaise and pharyngitis. After 1–2 days, films appear in the pharynx, the prevalence of which depends on the immune status of the patient. With partial immunity, films may not form. At the beginning of the disease, the film is thin, gray in color, spreading from the tonsils to the soft and hard palate, resembling a thick cobweb. This symptom distinguishes diphtheria from other forms of membranous tonsillitis. Subsequently, the films thicken and spread to the walls of the pharynx or larynx and trachea.

Cervical lymphadenitis in some cases is accompanied by swelling of the soft tissues of the neck, in others it can be very pronounced, resembling a bull's neck. The swollen tissues are soft and painless, warm to the touch. These signs are observed in children over 6 years of age.

The course of pharyngeal diphtheria depends on the extent of the films and the amount of toxin produced. In severe cases, breathing problems and circulatory collapse may develop. The pulse rate increases disproportionately to body temperature, which increases slightly or remains within normal limits. Paralysis of the soft palate is often observed. Stupor, coma and death may occur within 7-10 days. In less severe cases, the child recovers gradually, often developing myocarditis or neuritis. In mild cases of the disease, recovery occurs within 7-10 days, soon after the films peel off;

3) diphtheria of the larynx develops when films spread from the tonsils and nasopharynx. Isolated diphtheria of the larynx is rare and often occurs with mild symptoms of intoxication. Clinical symptoms resemble those of ordinary infectious croup: noisy difficulty breathing, increasing stridor, wheezing and dry cough. Suprasternal, subclavian and intercostal retractions during inspiration indicate severe laryngeal obstruction, which, if left untreated, can be fatal. Sudden and often fatal obstruction of the larynx can occur in mild diphtheria when partially detached films block the airways.

Severe cases of diphtheria are accompanied by the spread of films to the entire tracheobronchial tree. Signs of toxemia are mild in children with isolated laryngeal diphtheria. In more severe forms of combined lesions of the larynx and nasopharynx, severe toxemia and airway obstruction are observed;

4) skin diphtheria is characterized by ulcers with clear edges and a bottom covered with diphtheria film. This form of the disease is more common in countries with hot climates and poses a significant epidemic danger;

5) diphtheria of the conjunctival membrane is usually limited to a local process, with redness of the eyelids, swelling and formation of films;

6) diphtheria of the ears is characterized by external otitis media with long-term persistent purulent discharge that produces an unpleasant odor.

Cases of vulvovaginal diphtheria have also been described. In addition, diphtheria infection can be localized in several places at the same time.

Diagnosis. Diphtheria is diagnosed:

1) based on clinical data;

2) upon confirmation of pathogen isolation;

3) using the fluorescent antibody method.

Microscopic examination of diphtheria films is considered irrational.

Differential diagnosis. Mild forms of nasal diphtheria must be differentiated from foreign bodies in the nose, sinusitis, adenoiditis and congenital syphilis; diphtheria of the tonsils and pharynx - with streptococcal pharyngitis, usually accompanied by more severe pain when swallowing, high body temperature and very easily detachable films covering only the tonsils. In some patients, diphtheria of the throat and streptococcal pharyngitis coexist; diphtheria of the tonsils and pharynx - with infectious mononucleosis, non-bacterial membranous tonsillitis, primary herpetic tonsillitis, some blood diseases (agranulocytosis and leukemia), post-tonsillectomy changes, toxoplasmosis, tularemia, salmonellosis and cytomegalovirus infection, Vincent's angina; diphtheria of the larynx - with croup of a different etiology, acute epiglottitis, laryngotracheobronchitis, aspiration of foreign bodies, peripharyngeal and retropharyngeal abscesses, laryngeal papillomas, hemangiomas and lymphangiomas.

Complications. Sudden death due to occlusion of the lumen of the larynx or trachea by exfoliated diphtheria film; narrowing of the airways due to significant swelling of the neck tissue; myocarditis after severe and even mild forms of diphtheria, but more often with widespread lesions and delayed diagnosis; neurological complications (soft palate palsy, oculomotor nerve palsy, phrenic nerve neuritis and diaphragm palsy, limb paralysis); damage to vasomotor centers; gastritis, hepatitis and nephritis.

Treatment. The basis of treatment is neutralization of free diphtheria toxin and destruction of the pathogen using antibiotics. The only specific treatment is diphtheria antitoxin, obtained from the serum of hyperimmunized horses.

Antitoxin should be administered intravenously as early as possible and in quantities sufficient to neutralize all toxin circulating in the body. It is administered once in order to avoid sensitization by horse serum upon repeated administration, having previously tested for sensitivity to foreign proteins. Antitoxin doses are selected empirically: for mild forms of nasal or pharyngeal diphtheria, 40,000 units are prescribed, and for more severe forms, 80,000 units. A dose of 120,000 units is prescribed for the most severe forms of diphtheria of the pharynx and larynx. The same dose of antitoxin is administered in case of multiple localization of infection, massive edema and disease duration of more than 48 hours.

Antibiotics (erythromycin and penicillin, amoxicillin, rifampicin, clindamycin) are prescribed to stop further production of the toxin by the diphtheria bacilli, and are discontinued after receiving three negative culture results for diphtheria bacilli.

Maintenance therapy. In order to prevent the development of myocarditis in diphtheria, strict bed rest is prescribed for 2–3 weeks; electrocardiography – 2–3 times a week for 4–6 weeks for timely diagnosis of incipient myocarditis. Strict bed rest is absolutely necessary when myocarditis develops. In the presence of symptoms of heart failure, except for cases of diphtheria arrhythmia, patients with myocarditis are prescribed digitalis preparations, in severe cases - prednisolone for 2 weeks at a daily dose of 1-1.5 mg/kg.

It is necessary to maintain body hydration at an optimal level, suction out nasopharyngeal secretions, closely monitor the swallowing reflex and voice changes, and perform a tracheostomy to ensure airway patency.

Food should be liquid and high in calories. In case of paralysis of the soft palate or pharyngeal muscles, the child should be fed through a gastric tube to prevent aspiration.

Vaccination is necessary for persons who have had diphtheria, since half of them do not develop strong immunity and relapses of the disease are possible.

Prevention diphtheria includes:

1) immunization with the use of diphtheria toxoid - diphtheria toxin, devoid of toxic properties, adsorbed on aluminum hydroxide (AD-anatoxin). Recently, AD toxoid has been included as a component in the complex vaccines DPT, ADS, ADS-M, etc. Primary vaccination is carried out starting from 3 months of age with the DTP vaccine three times with an interval of 45 days. The first revaccination is 12–18 months after the third vaccination, the second – after 6–7 years with ADS-toxin, the third – at 16 years and then after 10 years with ADS-toxin;

2) isolation of patients, suppression of the spread of infection and monitoring of contacts. Patients are considered infectious as long as they have pathogens at the site of infection. Isolation is stopped after three negative culture results are obtained.

Prognosis and outcomes depend on the severity of primary intoxication and the timing of treatment. A favorable outcome is more likely with localized forms of diphtheria of the oropharynx and nose. In toxic forms, the frequency and severity of complications depend on the severity of the form and the timing of treatment with anti-diphtheria serum. Death can occur in cases of severe myocarditis or paralysis of the respiratory muscles.

Children with the hypertoxic form of oropharyngeal diphtheria die in the first 2–3 days of illness due to severe intoxication.

Diphtheria infection leaves immunity, which persists in 50% of patients for at least 1 year. Repeated cases of the disease are rare, but persons who have had this disease should also be vaccinated against diphtheria.