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Diphtheria

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Diphtheria
Diagnosis

Diphtheria — the acute infectious disease which is characterized by toxic defeat of cardiovascular and nervous systems, local inflammatory process with the advent of typical fibrinous films.

Etiology. The activator — a diphtheritic stick, belongs to a sort of korinebakteriya, is characterized by serological heterogeneity, subdivided into three kulturalno-biochemical types, into two versions — toxicogenic and not toxicogenic. Sticks can is long to remain in the dried-up pathological material at a temperature below 0 °C. In disinfecting solutions perish quickly.

Epidemiology. Incidence in Russia under the influence of mass preventive vaccination of children low, in a number of areas for many years of a disease of diphtheria are not registered. Against the high level of immunity at children shift of diseases on more senior age groups is observed. Diphtheria meets in the form of sporadic cases at not vaccinated or short vaccinated. The disease belongs to group of droplet infections.

Pathogeny. The main effective agent is the diphtheritic exotoxin striking fabrics on site of implantation of bacteria on a mucous membrane or in a wound. Toxin causes death of the cells of a mucous membrane allocating a thrombokinase. Getting into depth of fabrics, it strikes vessels, increases their permeability with a blood serum exit in surrounding fabrics. Toxin strikes a vegetative nervous system, including the device regulating cardiac performance. It can lead to early death of the patient as a result of a simpatikoparez and a cardiac standstill, especially at an exercise stress. On 2 — the 4th week of a disease development of paralyzes of extremities and a soft palate is possible (twang). In a muscle of heart there are profound degenerative changes (fatty regeneration) to possible sudden death on 3 — the 4th week of an illness at a stressful situation, a sharp rising from a bed. Kidneys, a liver, adrenal glands can be surprised. At diphtheria of a throat accumulation of films on phonatory bands, hypostasis of mucous membranes and a submucosa is noted that at a spasm of muscles is followed by full asphyxia.

The clinic of diphtheria differs in variety of forms depending on defeat localization — a pharynx, a throat, a nose, a mucous membrane of eyes, skin, wounds, the limitations of process (localized and extended), existence of intoxication (toxic and nontoxic forms).

In modern conditions in 85 — 95% of cases pharynx diphtheria meets. On modern classification distinguish localized (ostrovchaty, filmy), widespread, toxic diphtheria of a pharynx of I, II and III degrees, hypertoxical, hemorrhagic and gangrenous forms. Existence and an atypical catarral form admits.

The disease develops from rise in temperature, moderate reddening of a mucous membrane of a pharynx, emergence of the typical grayish-whitish, smooth, not removed the pallet fibrinous plaques in the form of islands or entirely covering almonds. The pharyngalgia when swallowing is expressed poorly. The toxic form of diphtheria of a pharynx is followed by hypostasis of the peritonsillar and cervical fat expressed by intoxication, damage of internals — hearts, kidneys, adrenal glands, a liver. The pharynx is narrowed because of sharp hypostasis of a peritonsillar fat, almonds are almost closed with each other, are covered with a typical plaque. Mucous membrane of a pharynx and handles cyanochroic, hyperemic. Cardiac sounds are muffled, arrhythmias often come to light, arterial pressure falls, the liver is increased. In blood the neutrophylic leukocytosis, an aneosinophilia is noted. SOE is raised, in urine a proteinuria, pathological elements.

Diphtheria of a throat (laryngitis) is followed by the barking cough, an osiply voice. On this background the croup — the stenosing laryngitis (laryngotracheobronchitis) with considerable narrowing of a gleam of a throat can develop.

Clinical symptoms of a diphtheritic croup develop gradually. In the absence of specific therapy process progresses. Allocate three degrees of manifestation of a croup:
I \disfonichesky — — catarral degree lasts 2 — 4 days, is followed by difficulty of breath on a breath, there are retractions of intercostal spaces, epigastric area, the whistling respiratory noise and tension of auxiliary respiratory muscles. Transition of process to II — stenotic — the stage lasting of 2 — 4 h till 2 — 3 days is followed by constant difficulty of a breath and noisy breath. III \the asphyxial stage of a croup is followed by sharp concern of the patient. There are cyanosis of lips, then extremities, persons, paradoxical pulse, spasms. At increase of oxygen insufficiency of the patient can die.



 
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