Diphtheria - An acute infectious disease of the nature, which poses a risk to human life. When diphtheria inflammation of the upper respiratory tract, and may start an inflammatory process of the skin at the site, where there is Abrasions . inflammation and cuts . However, diphtheria is not a danger to human lesions of local character, and general intoxication of the organism and the subsequent toxic damage to the nervous and cardiovascular systems. This illness is known to people since ancient times. Diphtheria at different times ascribed to the following naming: "Syrian disease", "deadly plague throat", "cereal", "malignant sore throat." As an independent nosology of the disease called "diphtheria" was allocated in the nineteenth century. Later it got its present name.
Diphtheria
The causative agent of the disease is a rod-shaped gram-positive bacterium Corynebacterium diphtheriae It can remain in the environment for a long time, while in the dust on the surface of objects . The source and the reservoir of infection is a person who is ill with diphtheria, or being a carrier of toxigenic strains . The most common sources of infection are people sick with diphtheria oropharynx . The infection is spread by airborne droplets, yet in some cases it can also be transmitted through dirty hands or household items, linens, dishes, etc. . d . The emergence of diphtheria of the skin, genitals, eyes is due to the transfer of the pathogen through contaminated hands . Sometimes also recorded outbreak of diphtheria that arise as a result of reproduction of the pathogen in food . The infection enters the human body mainly through the mucous membranes of the oropharynx, in rarer cases - through the mucosa of the nose and throat . Very rarely getting infection occurs through the conjunctiva, genitals, ears, skin, .
Features diphtheria
Diphtheria - a disease that is directly dependent on the level of vaccinated population. To date, the incidence of fixed periodic ups that occur in low level of vaccine prevention. Currently, the disease is often a shift from childhood: diphtheria sick adults, especially those who by profession have to meet a lot of people. With the deterioration of the epidemiological situation in humans the disease is more severe, and this increases the number of deaths. However, in people who have previously been vaccinated against diphtheria, the disease is mild and not accompanied by complications.
Symptoms of diphtheria
Duration incubation period in diphtheria it is from two to ten days. There are several variants of diphtheria in accordance with its clinical classification. Options for flow of such forms are slightly different. In most cases (about 90-95%) in both children and adults, arises diphtheria oropharynx . When developing this form of diphtheria, acute symptoms. The patient's body temperature increases, ranging from low grade to very high. It persists for two to three days. Showing signs of a moderate intoxication organism. Man complains of headaches, a feeling of general malaise. He has pale skin, decreased appetite, periodically there tachycardia . When the body temperature of the patient begins to subside, the local manifestations of diphtheria, which are marked in the area of the entrance gate of infection may become more intense. The patient noted the oropharynx congestive hyperthermia diffuse type, moderate swelling of the tonsils, the soft palate and arches. Tonsils appear plaque, which is in the form of a film or separate islands. In the first hours of the disease fibrinous plaque like a jelly, later, he is like a cobweb film. But on the second day of illness plaque becomes much denser, it has a gray color and a pearlescent gleam. If you try to remove the plaque with a spatula, the mucous begins to bleed. At the same time the next day at the place where the film has been removed, a new plaque. Furthermore, when symptoms of diphtheria are expressed magnification and hypersensitive lymph nodes . Can asymmetrical response or one-way on the tonsils and the increase in regional lymph nodes. Very seldom is currently logged catarrhal localized form of diphtheria oropharynx . In this form of diphtheria observed minimal symptoms. The person shown only minor discomfort while swallowing, hypothermia small oropharyngeal mucosa. In this case, the diagnosis may be difficult. With the right approach to the treatment of the disease is completely cured. Comparatively rarely diagnosed common form of diphtheria oropharynx . If we compare it with a localized form, the difference is not only distributing plaque on tonsils, but beyond them. In this form of the disease in humans is also observed more pronounced intoxication and all related to her symptoms. At sub-toxic form of diphtheria Symptoms of intoxication also occur. The patient complains of pain when swallowing, pain is sometimes present in the neck. In tonsils, painted in purple-cyanotic color, there is plaque, which may slightly affect the tongue and palatal arch. Also, there is moderate swelling, pain and swollen lymph nodes. In addition, the feature of this form of diphtheria is the presence of local edema subcutaneous tissue of the regional lymph nodes. Most common among adults toxic form of diphtheria oropharynx . It is characterized by a very rapid progression, a sharp rise in body temperature. In this form of diphtheria may cause not only pain in the throat and in the abdomen, in the neck. In addition, some patients have vomiting, agitation, delirium, delirium. The man pale skin, there is a pronounced swelling of the mucosa of the oropharynx, diffuse redness. Plaque apply to all the oropharynx, in the process of developing the disease fibrin film grubeyut. They persist for two weeks or more. If the patient has a place toxic diphtheria III degree , The swelling can occur on the face, on the neck from behind, on the back. There is a marked general toxicity syndrome. If a toxic diphtheria oropharynx joins the defeat of the larynx and nose, the disease is particularly difficult to treat. The most serious form of diphtheria is hypertoxic form Which predominantly occurs in people suffering alcoholism . diabetes . chronic hepatitis and others. In this case, quickly increases the body temperature, abrupt symptoms of intoxication, tachycardia, lowering blood pressure, weak pulse. There may be bleeding in the skin and organs, fibrinous raids and soaked with blood. The patient rapidly develops toxic shock, which can cause death within one or two days after the onset of illness. 
At diphtheria croup possible manifestation of the localized form of the disease that affects the throat, and widespread when simultaneously there is a defeat of the larynx trachea, bronchi. Manifestation of croup occurs in three successive stages - disfonicheskoy . stenotic and asfiksicheskoy . To disfonicheskoy stage characteristic rough cough, development hoarseness . On stenotic stage voice of the patient afonichny And the cough becomes silent. Gradually increasing the intensity of breathing difficulties manifested cyanosis Tachycardia. AT asfiksicheskoy stage of the patient breathing pure, first surface, then - rhythmic. Drop in blood pressure, pulse thready, cyanosis increases. In humans, there are convulsions, disturbance of consciousness and eventually death comes from asphyxia . Furthermore, diphtheria meets the nose, eyes and genitals, ear. Such states are recorded infrequently in patients.
Complications of diphtheria
As a complication of diphtheria allocate a number of severe conditions: toxic shock . mono and polyneuritis . myocarditis . Toxic nephrosis . suprarenalopathy . These complications sometimes develop in localized diphtheria oropharynx, but often they are the consequence of more severe forms of the disease. The most common complications occur when toxic diphtheria. The most common complication becomes severe toxic diphtheria myocarditis .
Diagnosis of diphtheria
When the diagnosis of a specialist in first drew attention to the presence of symptoms characteristic of diphtheria. If there is a version of the membranous disease, diphtheria is much easier to diagnose due to the presence of fibrinous character attacks. At the same time the most difficult to diagnose ostrovchaty embodiment diphtheria oropharynx like symptoms in this condition are similar to features sore throat coccal etiology . In the process of diagnosing toxic diphtheria oropharynx is important to differentiate the disease from necrotic angina . peritonsillar abscess . candidiasis . For diagnosis conducted laboratory tests of blood and bacteriological tests. For this pathogen is isolated from the source of the inflammatory process, and then determine its type and toxigenicity.
Treatment of diphtheria
If the patient is diagnosed with "diphtheria", it necessarily must be immediately hospitalized. Depending on how severe form of the disease occurs is determined by the duration of inpatient treatment of the patient. The main point in the treatment process is the introduction of a diphtheria patient antitoxic diphtheria serum . Its effect is to neutralize a toxin, which circulates in the blood. Therefore the action of this serum is most effective if you enter it as soon as possible. If there is suspicion that the patient develops a toxic form of the disease or diphtheria croup, then this serum should be introduced immediately. A positive skin test (the so-called Sample Schick ) Patient is a contraindication to the use of a serum with a localized form of diphtheria. In other cases, the serum is administered simultaneously assigning antihistamines and glucocorticoids . Enter the drug intravenously and intramuscularly. Sometimes, in the case of severe and prolonged drug intoxication may re-enter. 
To carry out detoxification treatment for diphtheria used crystalloid and colloid solutions intravenously. Sometimes, especially in severe cases, these drugs are added by the introduction glucocorticoids . The complex also includes the treatment of vitamins, antisense drugs. When toxic diphtheria II and III degrees, severe forms of the disease and the combined diphtheria spend hypertoxic plasmapheresis . Moreover, in some forms of the disease (subtoxic, toxic), apply treatment antibiotics . As auxiliary treatment in diphtheria of the larynx is important to regularly ventilate the room where the patient is, give him a warm drink, do steam inhalation for which it is advisable to use baking soda, chamomile, hydrocortisone Eucalyptus. If there is a manifestation of hypoxia in patients with diphtheria, to eliminate this phenomenon using humidified oxygen through a nasal catheter, as well as carry out the removal of films electric pumps. If the patient is a series of events indicating his serious condition, possible to use a surgical intervention (of intubation . tracheostomy ). It tachypnea more 40 min . tachycardia . hypercapnia . cyanosis . anoxemia . carbon dioxide acidosis . If the patient appears toxic shock, its further treatment is performed in the ICU.
Prevention of diphtheria
The main preventive measure is the diphtheria immunization coverage. It is also important to carry out regular epidemiological analysis to predict an epidemic of the disease process in a particular area. To date, the main method of controlling diphtheria remains vaccination . Vaccinations against diphtheria held vaccine DTP children, starting from the third month of life. Vaccinations against diphtheria children will receive three times, and the interval between vaccination is 30-40 days. After 9-12 months after vaccination, revaccination. Vaccinations against diphtheria now produce as among adults. The first immunization is carried those included in the so-called high-risk groups. It physicians, students, staff, schools and children's institutions, and others. When vaccination of adults is used vaccine Td Vaccinations do every ten years as long as the person is under 56 years old. Vaccinations against diphtheria do and the people who once suffered the disease. To carry out vaccination against diphtheria is virtually no contraindications. At the same time, people who have not received vaccination in due time and in contact with the patient, it is necessary to immunize a matter of urgency. The effectiveness of the prevention of diphtheria depends directly on the vaccination coverage of the population, as well as how much quality vaccines at the same time has been used.
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