Diphtheria is an acute infectious disease, which is characterized by specific inflammation of the skin, mucous membranes of the pharynx, larynx, eyes, as well as concomitant toxic damage to various organs. Among patients with diphtheria, children aged 4 to 6 years predominate..
Diphtheria, causes, symptoms, first emergency medical care for diphtheria, measures at the source of infection.
Diphtheria can affect the skin in the external genital area of girls, damaged skin, umbilical wounds in newborns. After the pathogen has been introduced into the mucous membrane, the poison that is secreted by it spreads with lymph flow throughout the body, which causes the effects of general intoxication. At the site of introduction, the pathogen causes inflammation with the formation of a fairly characteristic film-like coating and gray-white color, which is tightly soldered to the underlying tissues.
body – stay normal. This is the increased danger of this form of the disease, since patients late seek medical help or do not go at all, becoming a source of increased danger to others.
Pharyngeal diphtheria is initially manifested by a feeling of malaise and an increase in the total body temperature to febrile values (38–39 degrees). Soon throat pains and submandibular lymph nodes increase. When examining the pharynx, redness of the mucous membrane is noted, and on the tonsils and soft palate, a white or grayish plaque that is difficult to remove with a spatula is found. The larger the area covered with plaque, the more pronounced are the symptoms of general intoxication of the body and the heavier the general course of the disease.
Often, a toxic form of diphtheria can develop, which is characterized by an acute onset, an increase in body temperature up to 39-40 degrees, less often – pain in the abdomen. With this form of the disease, severe pain when swallowing and repeated vomiting often develop. The patient complains of general weakness and lethargy, the skin of the face is pale; heart rate is characteristic.
An early clinical manifestation of the toxic form of diphtheria is a pharynx, which is characterized by the closure of the tissues of the tonsils and soft palate up to the complete absence of a gap between them. Film diphtheria plaque covers almost the entire palate and nasopharynx, the patient’s breathing becomes wheezing, and his mouth is constantly half open.
In the area of the submandibular lymph nodes, edema develops, which extends to almost the entire area of the neck, less often – to the chest. Edema of the I degree extends to the middle of the neck, edema of the II degree – to the clavicles, III degree – even lower. A bit later, abundant nasal discharge appears..
Laryngeal diphtheria, or true croup.
Diphtheria of the larynx, or true croup, is an inflammation of the larynx and narrowing of its lumen, which are characterized by hoarseness of the patient’s voice, the appearance of a barking cough and difficulty breathing until suffocation occurs. False croup most often develops in children aged 1 year to 5 years. It can appear against the background of acute respiratory infections, flu, etc., while true croup occurs exclusively with diphtheria.
The development of croup is based on pathological muscle contraction, inflammation and swelling of the laryngeal mucosa. Since the mucous membrane of the larynx is inflamed, the air irritates it at the time of inspiration, which leads to muscle contraction, narrowing of the lumen of the larynx and, as a result, difficulty breathing. A hoarse voice and a barking cough are the result of inflammation of the vocal cords.
With true croup, the symptoms quickly increase, hoarseness becomes maximum (up to loss of voice), and respiratory distress often develops at the end of the first and the beginning of the second week from the onset of the disease. With him, the skin of the child turns blue, he rushes about in bed, he has rapidly increasing weakness and insufficiency of cardiac activity. Failure to provide timely assistance can result in death..
Back in the 19th – early 20th centuries false and true cereals in many countries were among the main causes of child mortality. Currently, the number of fatalities has sharply decreased. The exception is in areas where medical care (in particular, pediatrics and resuscitation) is poorly organized.
First Aid for Diphtheria.
The patient needs bed rest, fractional nutrition with liquid or semi-liquid food with lots of vitamins. A 1% solution of boric acid is used to treat the oral cavity. The most important and most successful method of treating any form of diphtheria is the introduction of anti-diphtheria serum, which neutralizes the toxin secreted by diphtheria bacillus..
It should be noted that the earlier the antidiphtheria serum is introduced, the more successful the treatment. It is important to remember that it is not administered at the prehospital stage. To prevent the development of allergic reactions (anaphylactic shock), an intracutaneous test with diluted serum (1: 100) should be preliminarily administered before the introduction of anti-diphtheria serum.
It is also important to remember that diphtheria croup and toxic diphtheria require additional treatment. If there are indications, antibacterial agents, drugs that stimulate the activity of the cardiovascular system are administered. If a patient is suspected of having diphtheria, he is subject to immediate hospitalization. Further treatment is carried out in the infectious ward of the hospital in conditions of strict isolation of the patient.
If there are signs of acute respiratory failure, it is necessary to insert a breathing tube into the trachea or make a tracheostomy. If a toxic form of diphtheria is diagnosed, then detoxification therapy is also carried out, which consists in intravenous drip infusion of blood plasma or albumin, as well as hemodesis in combination with a 10% glucose solution.
In addition, it may be necessary to administer to the patient preparations from the group of glucocorticosteroids and cocarboxylase. 2–5 mg / kg of body weight of prednisolone and 10–20 mg / kg of body weight of hydrocortisone are administered intravenously. In the absence of the expected therapeutic effect, similar doses are re-administered after 20-30 minutes. With diphtheria croup, it is advisable to use sedatives, which nevertheless do not cause deep sleep.
Activities in the center of diphtheria.
Diphtheria prevention is mainly carried out in two directions. Timely hospitalization of the patient with subsequent disinfection of the room where he constantly lives (including personal items), and vaccination, which, in the absence of contraindications, is given to children from 3 months of age three times with an interval of 1–1.5 months, and subsequently at 6 and 11 years old.
A child who has had a diphtheria infection is not allowed to attend child care facilities during the entire expected incubation period of the disease, i.e., to be in a team. The main conditions for eliminating bacteriocarriers are regular walks in the fresh air. Airing the room and increasing the amount of vitamins in the diet.
Based on the book “Quick help in emergency situations”.