Diphtheria in children is a sharp infectious disease characterized by inflammation of the mucous membranes of the upper respiratory tract and nasopharynx, as well as, in some cases, of the skin in the places of damage. This disease can lead to a fatal case. The main manifestation is the appearance of fibrinous films of grayish color on the surface of the tonsils and mucous membranes of the oropharynx.
For diphtheria in children, as well as for many infectious diseases of the upper respiratory tract, mainly winter seasonality is characteristic.
The main pathway of the pathogen is airborne. In rare cases, the infection is transmitted by contact by household. The incubation period ranges from 2 to 7 days (an average of 3 days). Individuals who are not immunized against infection can fall ill at any age.
Pathogen and causes of diphtheria in children
The main causes of diphtheria in children are the absence of age-related vaccination. The causative agent of the disease is Corynebacterium diphtheria. When producing a diphtheria toxin, it causes the disease. The entrance gate of the infection is most often the mucous membrane of the mouth, nose, and larynx. Corine bacteria spread to tissue cells and begin to produce exotoxin - a substance that causes the death of cells in the body. Exotoxin provides both local and general action for dissemination by the vascular channel. When diphtheria sticks hit the pharyngeal tonsils from the affected cells, a specific fluid is released, with a thickening of which a dense fibrinous film of grayish color is formed.
The most serious complications of exotoxin include: myocarditis (inflammation of the heart muscle) and damage to the nervous system. In the event of a myocardium, there is a violation of the heart, there are various severe violations of the rhythm up to the complete stops of cardiac activity. With damage to the nervous system, visual disturbances may occur due to the type of diplopia (doubling), swallowing act, speech, until complete loss of voice. A diphtheria toxin can penetrate the tissues of the neck, causing a very severe severe swelling ("bovine neck").
Signs and symptoms of diphtheria in children
Symptoms of diphtheria in children are very diverse and depend on the localization of the infectious process.
Symptoms of nasal diphtheria
In case of this form there is a defeat of the nasal passages. Of them stands out the bloody detachable. At a detailed examination, areas of the thin crust appear on the nose wings. Such a form of disease rarely leads to complications. However, for dental health organizations, nasal diphtheria is problematic because it spreads more rapidly than other forms of the disease. The first signs of diphtheria appear quickly.
Symptoms of oropharyngeal diphtheria
Diphtheria of the oropharynx is the most common form of the disease. Characterized by the appearance of dense fibrinous films on the tonsils, which are very difficult to remove with a spatula. When trying to remove - they begin to bleed.
Symptoms of diphtheria, such as the appearance of the inflammatory process of the oropharynx, an increase in body temperature to 38.3-38.9 ° C, tachycardia, general weakness, are also common for the disease of this form.
Signs of diphtheria of the larynx
Laryngeal diphtheria is one of the most dangerous forms of diphtheria in the occurrence of complications. Patients have the following signs of diphtheria: high body temperature (39.4-40 ° C), general weakness, severe cough, chills and loss of voice, respiratory distress. The appearance of a "bovine neck" indicates the high content of exotoxin in the bleeding. In rare cases, acute respiratory failure and, as a consequence, death occur.
Diphtheria skin in children
Occurs about 33% of all cases of the disease. It is mainly characteristic of people who do not observe the rules of personal hygiene. Virtually any area of the skin can be infected with a diphtheria sticks. In the infection site, inflammation of the derma occurs with the formation of a grayish plaque, ulcers, wounds do not heal.
Need to remember! At the first suspicions of the appearance of diphtheria should immediately apply to the treatment institution.
Diagnosis of diphtheria in children
Diagnose a disease is necessary in an emergency. Usually, the doctor presents a diagnosis based on clinical manifestations, without waiting for confirmation of laboratory data. Diagnosis of diphtheria in children is based on various data.
First, he examines the patient's ears, nose and mouth to exclude other diseases that cause inflammation of the oropharynx, high body temperature - streptococcal infection, infectious mononucleosis, etc. The most important feature that characterizes diphtheria is the appearance of dense fibrinous films.
Diagnosis of diphtheria can be confirmed by bacterioscopy of the smear from the infected area. Gram color is used. Under a microscope, diphtheria sticks look like numerous beaded, closely spaced colonies.
Treatment of diphtheria
Diphtheria - a particularly dangerous disease, the treatment of which is carried out in the hospital. In the event of severe complications (respiratory failure, etc.), treatment is carried out in the intensive care unit. The treatment of diphtheria includes an integrated approach: both with medication and careful care of the patient.
The main method of treating diphtheria is the introduction of anti-diphtheria serum (PDS), without waiting for confirmation of the disease through laboratory tests. PDS is made on the basis of horse serum. Its introduction almost completely eliminates the harmful effects on the human body of exotoxin. Before administration, the physician should make a sample of individual sensitivity to serum. About 10% of all patients have a high sensitivity to the PDS. For them it is necessary to conduct anti-toxin dilution. Since 2004 antitoxic anti-diphtheria serum is the only drug against diphtheria exotoxin.
Dosage: from 20,000 to 100,000 IU, depending on the severity, form and timing of the disease. Antitoxin is administered intravenously.
Antibiotics are used to prevent further prevention of infection, as well as the prevention of severe complications (pneumonia). They are used not as a substitution therapy PDS, but in a complex with her. For the treatment of diphtheria used: penicillin, ampicillin, erythromycin. Of these, erythromycin is more effective in treating the disease, because it has a better ability to penetrate the tissue.
Caring for a patient with diphtheria
Patients suffering from diphtheria require severe bed rest, careful care and intensive care - infusion, oxygen therapy, cardiovascular and respiratory monitoring, and treatment of the pathology of the nervous system. Patients with diphtheria in the larynx may require an emergency surgical operation for acute stenosis.
After recovery, patients should rest at home for about 2-3 weeks. In addition they undergo immunization against diphtheria.
Treatment of complications of diphtheria and prognosis
In case of myocarditis in patients with diphtheria, oxygen therapy is prescribed - with the help of which it is possible to avoid rhythm disturbances. Sometimes, with more severe rhythm disturbances, an artificial rhythm driver must be installed. Patients with impaired swallowing may receive food through the nasogastric tube. Patients with pneumonia, acute respiratory distress, are transferred to artificial ventilation of the lungs.
The prognosis depends on the form, severity, the presence of complications, the timing of the administration of antitoxin. The more these indicators, the higher the likelihood of a fatal case.
The risk group with a fatal case includes: children under the age of 15, patients with concomitant pneumonia or myocarditis. Diphtheria of the nose and skin is rarely fatal.
Diphtheria prevention includes 4 main aspects: immunization of the population, isolation of infected patients, notification of a disease outbreak in the health care administration.
Immunization of the population is currently the most effective way to prevent the occurrence of diphtheria. Immunization is performed by administering the vaccine against diphtheria, pertussis, tetanus (AKDP) in 3 steps:
- First vaccination in 3 months;
- Second vaccination in 4.5 months;
- Third vaccination in 6 months.
Further revaccination of the population is carried out:
- The first - in 18 months;
- Friend - at 7 years old;
- The third - at 14 years.
Afterwards, all adults undergo revaccination against diphtheria every 10 years since the last revaccination.
Patients with diphtheria need to be isolated within 1-7 days. The isolation of the patient stops after the final disinfection and a one-time negative result of the bacterial study of oral mucus.
Given that diphtheria has a very short incubation period, detection and surveillance of persons who have been in contact with the patient is being performed. In order to prevent it, it is assigned a seven-day course of antibiotic therapy.
These measures are necessary for monitoring the potential foci of infection, as well as contributing to the formation of more reliable information about the nature of the focus of the onset of diphtheria.