Diphtheria in children

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 introduction of the pathogen, phenomena of general intoxication as a result of the entry of exotoxin into the blood, causing severe complications such as infectious toxic shock, myocarditis, polyneuritis and nephrosis.

ICD-10 code

• A36.0 Diphtheria of the pharynx.
• A36.2 Diphtheria of the nasopharynx.
• A36.2 Diphtheria of the larynx.
• A36.3 Diphtheria of the skin.
• A36.8 Other diphtheria.
• A36.9 Diphtheria, unspecified.

Epidemiology

The source of infection with diphtheria can only be a person - a patient or a carrier of the toxigenic Corynebacterium diphtheria.

Depending on the duration of excretion of the pathogen, a distinction is made between transient carriage - up to 7 days; short-term - up to 15 days; medium-term - up to 30 days and prolonged or recurrent carriage - more than 1 month (sometimes several years).

The pathogen is transmitted by airborne droplets: through direct contact, less often through infected household items (dishes, linen, toys, books), and transmission through third parties is also possible. The contagiousness index is relatively low - about 10-15%.

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Causes of diphtheria in a child

The causative agent of the disease is Corynebacterium diphtheriae - a thin, slightly curved rod with club-shaped thickenings at the ends, motionless; it does not form spores, capsules or flagella, it is gram-positive. According to the ability to form a toxin, diphtheria corynebacteria are divided into toxigenic and non-toxigenic.

In addition to the toxin, diphtheria corynebacteria produce neuraminidase, hyaluronidase, hemolysin, necrotizing and diffuse factors during their life processes, which can cause necrosis and liquefaction of the main substance of connective tissue.

Diphtheria toxin is a potent bacterial exotoxin that determines both general and local clinical manifestations of the disease. Toxigenicity is genetically determined. Non-toxigenic corynebacteria of diphtheria do not cause the disease.

Causes and pathogenesis of diphtheria

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Symptoms of diphtheria in a child

The oropharynx is most often affected by diphtheria, less often - the respiratory tract, nose, larynx, trachea. Diphtheria lesions of the eye, ear, genitals, skin are rarely observed. When two or more organs are affected simultaneously, a combined form of diphtheria is diagnosed.

Diphtheria of the oropharynx. Depending on the prevalence and severity of the local process and general intoxication, localized (mild), widespread (moderate) and toxic (severe) forms of diphtheria of the oropharynx are distinguished.

Localized form of diphtheria of the oropharynx occurs more often in vaccinated children. The plaque is located on the palatine tonsils and does not extend beyond them. The general condition is moderately disturbed, sore throat when swallowing is insignificant. Plaques form on the tonsils, in the first 1-2 days they are tender, thin, and later they look like films with a smooth, shiny surface and clearly defined edges of a whitish-yellowish or whitish-grayish color. Depending on the size of the plaque, an insular form is distinguished, in which the plaque is located in the form of islands between the lacunae, and a membranous form of localized diphtheria, when the plaque completely or almost completely covers the tonsils, but does not extend beyond them. The plaque is dense, fused with the underlying tissue, when trying to remove it, the mucous membrane bleeds. New plaques form in place of the removed plaques. The tonsillar lymph nodes are not enlarged, painless, and mobile.

Symptoms of diphtheria

Diagnosis of diphtheria in a child

The diagnosis of diphtheria is established by a dense whitish-grayish fibrinous film on the mucous membrane of the oropharynx, nose, larynx, etc. With fibrinous inflammation, pain and hyperemia of the mucous membrane are weakly expressed. The lymph nodes are enlarged in accordance with the local process, dense to the touch, moderately painful. Sharp pain when swallowing, bright hyperemia, prolonged fever are not characteristic of diphtheria and indicate against this diagnosis. The severity of edema of the cervical tissue and oropharynx corresponds to the size of the plaque and the degree of general intoxication.

Diagnosis of diphtheria

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Treatment of diphtheria in a child

The success of diphtheria treatment depends mainly on the timely administration of antitoxic diphtheria serum. Early administration and sufficient doses of serum provide a favorable outcome even in severe toxic forms. Purified concentrated liquid equine diphtheria serum is used. To prevent anaphylactic shock, the first administration of the serum is done using the Bezredka method (0.1 ml of 100-fold diluted diphtheria serum is administered strictly intradermally into the flexor surface of the forearm; if the test is negative, 0.1 ml of undiluted serum is administered subcutaneously and, if there are no symptoms of anaphylactic shock, the remaining dose is administered intramuscularly after 30 minutes).

Treatment of diphtheria

Prevention of diphtheria in children

Active immunization is of primary importance in the prevention of diphtheria. For this purpose, diphtheria toxoid is used, which is a diphtheria toxin devoid of toxic properties, adsorbed on aluminum hydroxide (AD-anatoxoid). In practical work, AD-anatoxoid is practically not used in isolated form; it is included in the so-called complex vaccines.

Prevention of diphtheria

Outcome and prognosis of diphtheria

The prognosis and outcomes of diphtheria depend mainly on the severity of the primary intoxication and the time since the start of treatment. In 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 more severe the form and the later the treatment with antidiphtheria serum is started. Death occurs from severe myocarditis or paralysis of the respiratory muscles. Children with hypertoxic diphtheria of the oropharynx die in the first 2-3 days of the disease with signs of severe intoxication. The prognosis for diphtheria croup depends solely on the timeliness and correctness of treatment. The cause of death in unfavorable cases is associated pneumonia.

Preventive vaccinations protect children from severe forms of diphtheria and adverse outcomes.