Diphtheria

DiphtheriaDIPHTHERIA - an acute infectious disease of airborne transmission mechanism; characterized lobar or diparities inflammation of the mucous membrane at the gate of the infection in the call, nose, larynx, trachea, rarely in other organs and General intoxication. Etiology, pathogenesis. Pathogen - toxigenic diphtheria Bacillus, gram-positive, stable in the environment. Pathogenic effects associated with the exotoxin. Nontoxigenic Corynebacterium non-pathogenic. Diphtheria Bacillus vegetates on the mucous membranes of the throat and other organs, where they develop lobar or dipteridaceae inflammation with the formation of films. Produced by the pathogen exotoxin absorbed into the blood and causes a General intoxication with myocardial damage, peripheral, and autonomic nervous system, kidneys, adrenal glands. The symptoms for. The incubation period is from 2 to 10 days. Depending on the localization of the process there are diphtheria of the throat, nose, throat, eyes and other Diphtheria of the throat. There are localized, widespread and toxic diphtheria throat. In a localized form are formed fibrinous filmy deposits on the tonsils. Zev moderately hyperemia, pain when swallowing expressed moderately or poorly, regional lymph nodes are enlarged slightly. General intoxication is not expressed, the reaction temperature is moderate. A variation of this form is ostrovica diphtheria of the throat, at which deposits on tonsils look like small plaques, often located in the lacunae. When common form of diphtheria throat fibrinous deposits are transferred to the mucous membrane of the Palatine arches and uvula; intoxication expressed, the body temperature is high, more significant and the response of regional lymph nodes. Toxic diphtheria is characterized by enlarged tonsils, significant swelling of the mucous membrane of the throat and the formation of thick off-white attacks, coming from the tonsils, soft, even the hard palate. Regional lymph nodes are greatly enlarged, the surrounding subcutaneous tissue edema. Swelling of the cervical subcutaneous tissue reflects the degree of intoxication. When toxic diphtheria I degree of swelling extends to the middle of the neck, at the second level to the collarbone, III-degree-below the clavicle. The General condition of the patient is severe, high temperature (39-40 gr. C), weakness, anorexia, and occasionally vomiting and abdominal pain. There are distinct disorders of the cardiovascular system. A variation of this form is subconsiously diphtheria of the throat, in which the symptoms are weaker than in toxic diphtheria 1 degree. Diphtheria of the larynx (diphtheria, or true, cereals) in recent times is rare, is characterized croupous inflammation of the mucous membrane of the larynx and trachea. The disease is rapidly progressing. In the first catarrhal (distanceso) stage, lasting 1-2 days, a fever of the body, usually moderate, progressive hoarseness, cough, at first, "barking", then losing its sonority. In the second (stenotic) the stage of growing the symptoms of stenosis of the upper respiratory tract: noisy breathing, tension in the breath of auxiliary respiratory muscles, inspiratory retraction compliant seats of the chest. The third (anfictionica) stage manifests a pronounced disorder of gas exchange - cyanosis, loss of pulse at the height of inspiration. sweating, anxiety. If timely H0 render medical aid, patient dies from asphyxia. Diphtheria of the nose, conjunctiva of the eyes, external genitalia in recent times almost not observed. Typical complications occurring mainly in toxic diphtheria II and III degree, especially p^and late treatment. In the early period of the disease can increase the symptoms, vascular and cardiac weakness. Myocarditis normally observed on the 2nd week of illness and is characterized by impaired contractility of the myocardium and the conduction system. Reverse the development of myocarditis occurs relatively slowly. Myocarditis is one of the causes of death diphtheria. Mono - and polyradiculoneuritis appear sluggish peripheral paresis and paralysis of the soft palate, outside the main muscles, muscles of the limbs, neck, trunk. Danger to life are paresis and paralysis of the laryngeal, respiratory intercostal muscles, diaphragm and defeat innervation devices hearts. There may be complications due to secondary bacterial infection (pneumonia, otitis, and other). Confirmation of the diagnosis is the allocation of toxi-genic diphtheria Bacillus. To differentiate needs from angina, infectious mononucleosis, "false croup", filmy adenoviral conjunctivitis (diphtheria eyes). Treatment. The primary method of therapy is perhaps the best early/m introduction of diphtheria serum in appropriate doses (table. 12). In milder forms of diphtheria serum is injected once, when severe intoxication (particularly in toxic forms) for a number of days. Avoid anaphylactic reactions performed intradermal test with diluted (1:100) serum, in the absence of within 20 min of reaction injected 0.1 ml of whole serum and in 30 minutes - the entire therapeutic dose. In toxic forms with entire detoxification is also non-specific pathogenetic therapy: intravenous drip infusion of protein drugs (plasma, albumin), and neocompensan, gemodeza in combination with 10% glucose solution; enter prednisolon, cocarboxylase, vitamins. In bed when the toxic form of diphtheria, depending on its severity must be observed 3-8 weeks. In diphtheritic croup-needed rest, fresh air.


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