Diphtheria
Description of the disease
This is an infectious inflammation of the throat and respiratory tract mucosa, manifesting with general intoxication of the body, and damage to the heart and nervous system.
Causative agent
Diphtheria is caused by the bacterium Corynebacterium diphtheriae. The diphtheria-causing bacteria produce a strong external toxin. The bacteria are resistant to drying, can survive for a long time on objects and in dust, but are sensitive to high temperatures, disinfectants, and antibiotics.
Spread
The source of infection can be a sick person, a recovering person, or a carrier of bacteria. Also, individuals vaccinated against diphtheria, having antitoxin but not antibacterial immunity, are important. People with mild, atypical forms of diphtheria are particularly significant. The disease is transmitted through airborne droplets, sometimes with contaminated milk, objects, and other household items. In recent years, adults have been the most affected. After recovering from diphtheria, protective immunity does not always develop.
Symptoms
The signs of infection appear 2-10 days after exposure. The main forms of the disease are distinguished based on their location: throat (pharyngeal), throat and nasal diphtheria, less commonly occurring in the eyes, skin, and genital organs. The most common form is pharyngeal diphtheria, which can be tonsillar, spread pharyngeal, and toxic pharyngeal. Tonsillar diphtheria begins acutely. It is characterized by mild fever (up to 38°C), general malaise, sore throat when swallowing, and loss of appetite. White, grayish-white fibrinous (protein of blood) deposits form on the tonsils, which can later spread and merge into a continuous thick deposit. The mucosa around the deposit is reddened and slightly swollen. The deposit cannot be wiped off with a swab, and when removed, the tonsillar mucosa bleeds. The lymph nodes in the neck are enlarged and somewhat painful. A sweetish, slimy smell from the mouth is characteristic. In the case of the spread of nasal diphtheria, the fibrinous deposit spreads beyond the tonsils onto the tongue and the mucosa of the soft palate arches. With a sudden worsening of spread diphtheria, toxic pharyngeal diphtheria begins, characterized by a stormy onset and severe intoxication. The main complications of diphtheria are toxic kidney damage, inflammation of the heart muscle, and toxic inflammation of many peripheral nerves. Diphtheria is a severe disease that, if not diagnosed and treated promptly, can end in death.
Diagnosis
The most important symptom of diphtheria is a grayish-white fibrinous deposit that cannot be removed with a swab and is elevated above the mucosa. The diagnosis is confirmed by performing bacteriological (the test material is seeded into a bacterial growth medium and pathogens are sought) and sometimes serological (protective factors of immunity – antibodies – are determined in the blood) examinations.
Treatment
Immediate isolation of the patient is necessary when diphtheria is suspected. Severe cases of the disease should be treated in an isolated intensive care unit. A special liquid diet and easily swallowed food are prescribed. For pharyngeal diphtheria, the throat must be rinsed with furacilin solution 4-6 times. After the first culture result, and in severe cases, even before it, checking the patient’s sensitivity to horse serum, antidiphtheria serum is injected into the muscles or veins once, no later than the 7-8th day of the illness. Antibacterial treatment is prescribed: penicillin G or erythromycin, rifampicin. Antibiotics are taken for 10-14 days. Glucose, electrolyte solutions are administered intravenously to reduce intoxication. In severe cases, prednisolone is prescribed. Throat diphtheria is treated with steam inhalations with hydrocortisone, adrenaline, eucalyptus, soda, chamomile.
Prevention
The main prevention of diphtheria is vaccination. Children are started to be vaccinated from 2 months of age. The DTP (diphtheria, tetanus, pertussis) vaccine is used for vaccination. The second and third doses of the vaccine are given to the infant at 4 and 6 months. Children are revaccinated at 18 months (DTP), 6-7 years (DT), and 15-16 years (Td). Later, revaccination every 10 years is necessary.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology