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Diphtheria in children
Last reviewed: 17.10.2021
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Diphtheria in children is an acute infectious disease caused by toxigenic strains of corynebacteria, characterized by an inflammatory process with the formation of a fibrinous film at the site of the pathogen, general intoxication due to exotoxin entering the blood, causing severe complications such as infectious-toxic shock, myocarditis, polyneuritis, and nephrosis .
ICD-10 code
- A36.0 Diphtheria of pharynx.
- A36.2 Diphtheria of the nasopharynx.
- A36.2 Diphtheria of the larynx.
- A36.3 Skin diphtheria.
- A36.8 Other diphtheria.
- A36.9 Diphtheria, unspecified.
Epidemiology
The source of infection with diphtheria can only be a person - a sick or a bacterial carrier of a toxigenic corynebacterium diphtheria.
Depending on the duration of excretory excision, transient carrier is distinguished - up to 7 days; short-term - up to 15 days; average duration - up to 30 days and prolonged or relapsing carriage - more than 1 month (sometimes several years).
The causative agent is transmitted by airborne droplets: with direct contact, less often through infected household items (dishes, linens, toys, books), it is possible to transfer through third parties. The index of contagiosity is relatively small - about 10-15%.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]
Causes of diphtheria in a child
The causative organism - of Corynebacterium diphtheriae - thin, slightly curved stick with a club-bulges at the ends, fixed; spores, capsules and flagella do not form, Gram-positive. By the ability to form a toxin of the corynebacterium, diphtheria is divided into toxigenic and non-toxic.
In addition to toxin, corynebacteria diphtheria in the process of vital activity produce neuraminidase, hyaluronidase, hemolysin, necrotizing and diffuse factors that can cause necrosis and dilution of the main substance of connective tissue.
Diphtheria toxin - a potent bacterial exotoxin - determines both general and local clinical manifestations of the disease. Toxigenicity is genetically determined. Non-toxic corynebacteria diphtheria disease does not cause.
Symptoms of diphtheria in a child
Most often in diphtheria, the oropharynx is affected, more rarely - the airways, nose, larynx, trachea. Rarely observed diphtheria lesions of the eye, ear, genitals, skin. With simultaneous lesion of two organs and more diagnosed combined diphtheria form.
Diphtheria of the oropharynx. Depending on the prevalence and severity of the local process and general intoxication, there is a localized (light), widespread (moderate) and toxic (severe) form of the oropharyngeal diphtheria.
The localized form of diphtheria of the oropharynx is more common in vaccinated children. The raids are located on the palatine tonsils and do not extend beyond their limits. The general condition is moderately disturbed, sore throat when swallowed insignificant. Tonsils form plaques, the first 1-2 days are tender, thin, and later they look like a film with a smooth, shiny surface and clearly outlined edges whitish-yellowish or whitish-gray in color. Depending on the size of the plaque, an island shape is distinguished , in which the raids are arranged in the form of islets between the lacunae, and the film form of localized diphtheria, when the rafts completely or almost completely cover the tonsils, but do not go beyond them. The raids are dense, soldered to the underlying tissue, while attempting to remove their mucous membrane is bleeding. On the site of remote raids, new ones are formed. Tonsillar lymph nodes are not enlarged, painless, mobile.
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Diagnosis of diphtheria in a child
Diagnosis of diphtheria is established on a dense whitish-gray fibrinous film on the mucous membrane of the oropharynx, nose, larynx, and the like. With fibrinous inflammation, the pain and hyperemia of the mucous membrane are poorly expressed. The lymph nodes are enlarged according to the local process, dense to the touch, moderately painful. Sharp soreness in swallowing, bright hyperemia, prolonged fever are not characteristic of diphtheria and testify against this diagnosis. Expression of edema of the cervical tissue and oropharynx corresponds to the magnitude of plaque and the degree of general intoxication.
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Treatment of diphtheria in a child
The success of diphtheria treatment depends mainly on the timely administration of antitoxic antidiphtheria serum. Early administration and sufficient serum doses provide a favorable outcome even in severe toxic forms. Serum antidiphtherist equine purified concentrated liquid is used. To prevent anaphylactic shock, the first injection of serum is done by the method of Bezredki (0.1 ml of diluted 100-fold antidiphtheria serum is injected strictly intradermally into the flexor surface of the forearm, a negative sample is injected subcutaneously with 0.1 ml of undiluted serum and in the absence of symptoms of anaphylactic shock after 30 min enter intramuscularly the rest of the dose).
Prevention of diphtheria in children
The main importance in the prevention of diphtheria is active immunization. To this end, diphtheria toxoid is used, which is a diphtheria toxin lacking toxic properties, adsorbed on aluminum hydroxide (AD-toxoid). In practical work, AD-toxoid is not used in isolated form, it is part of the so-called complex vaccines.
Outcome and prognosis of diphtheria
The prognosis and outcomes for diphtheria depend mainly on the severity of the primary intoxication and the timing from the start of treatment. With localized forms of diphtheria of the oropharynx and nose, the outcome is favorable. In toxic forms, complications develop more often and are more severe the heavier the form and the later treatment with antidiphtheria serum. Death comes from severe myocarditis or paralysis of the respiratory musculature. Children with a hypertoxic form of diphtheria of the oropharynx die in the first 2-3 days of the disease in cases of severe intoxication. The prognosis for diphtheria croup depends solely on the timeliness and correctness of the treatment. The cause of death in adverse cases is the pneumonia that has joined.
Preventive vaccinations protect children from severe forms of diphtheria and adverse outcomes.