Diphtheria runny nose

Diphtheritic rhinitis or diphtheria of the nose most often occurs in newborns a few days after birth or after 3-8 months, most often in the cold season. In the initial period, the clinical picture corresponds to acute banal rhinitis: nasal congestion, difficulty in nasal breathing (which interferes with breastfeeding), nasal discharge is mucopurulent in nature, sometimes with a gray or bloody tint, with an unpleasant odor. Soon after the appearance of nasal discharge, the skin around the nostrils macerates. Films and superficial erosions appear on the mucous membrane of the nose. This form of diphtheritic rhinitis is usually not accompanied by severe intoxication, but has a tendency to protracted course. Numerous clinical forms of diphtheritic rhinitis have been described in foreign literature.

Clinical forms:

• “Simple” diphtheria of the nose is limited to damage to the nasal mucosa without any pathognomonic signs of diphtheritic inflammation.
• The pseudomembranous form of nasal diphtheria is characterized by the appearance of pseudomembranous plaques that can cover the entire surface of the mucous membrane of the nasal cavity and spread to the mucous membrane of the nasopharynx. This form is often combined with the fibrinous form caused by Leffler's bacillus, combined with pneumococcus and staphylococcus.
• The erosive form of nasal diphtheria is characterized by the appearance of numerous erosions and ulcers in the nose, located under pseudomembranous films. Sometimes this form develops against the background of primary "dry" rhinitis in the absence of the symptoms described above.
• The latent or "occult" form of nasal diphtheria is characterized by the fact that no morphological changes characteristic of the diphtheria process can be detected in the nasal cavity, but the diphtheria bacillus is detected in the nasal mucus. This form differs from simple bacterial carriage in that the general clinical picture reveals choleriform diseases of the gastrointestinal tract or severe bronchopneumonia syndrome.
• The extensive form of nasal diphtheria is characterized by the spread of infection to neighboring areas both in the immediate vicinity (conjunctivitis, sinusitis, otomastoiditis, tubootitis) and at some distance (laryngitis, meningitis, etc.). A characteristic feature of this form of nasal diphtheria is that the primary source of infection is the nasal mucosa.
• The paralytic (polyneuritic) form of nasal diphtheria, as with diphtheria in other localizations, is characterized by initial or delayed paralysis of some cranial nerves and spinal nerves. Thus, damage to the glossopharyngeal nerve (IX pair) is manifested by loss of taste sensitivity in the homonymous posterior third of the tongue, unilateral paralysis of the soft palate, nasal speech, swallowing disorder, and sometimes Sicard's syndrome (neuralgia of the IX nerve); damage to the vagus nerve (X pair) leads to disruption of numerous motor functions of the pharynx and larynx by the type of paresis and paralysis, secretory functions, and functions of vital organs. Bilateral total damage to the vagus nerve or its nuclei leads to the so-called vagal death due to the cessation of respiratory and vasomotor functions.
• Recurrent and chronic forms of nasal diphtheria are observed mainly in carriers of the bacteria. Their general condition slowly but progressively worsens, reaching a state of complete exhaustion, ending in death, or to some complication with the same outcome.

Complications of nasal diphtheria are basically the same as those of measles rhinitis. Late complications include cicatricial stenosis of the nasal passages and nasal vestibule. Nasal diphtheria may be complicated by bronchopneumonia, diphtheritic laryngitis and croup, as well as damage to internal organs and diphtheritic polyneuritis. Late complications include cicatricial stenosis of the nasal passages and nasal vestibule, atrophic processes in the nasal mucosa. Some authors associate the occurrence of ozena with past nasal diphtheria.

The diagnosis of nasal diphtheria is established on the basis of the symptoms described above and the results of a bacteriological study, in which material from the nose or pharynx (if there is damage to its mucous membrane) is taken with a sterile swab at the border between the affected area and the healthy mucous membrane on an empty stomach or 2 hours after eating. When the diphtheria bacillus is isolated, its toxigenicity is determined.

Differential diagnostics are carried out with common acute rhinitis, as well as with rhinogenic manifestations of congenital syphilis, in which numerous syphilitic manifestations are also observed (pemphigus on the palmar and plantar surfaces of the skin, cutaneous syphilides, splenomegaly, etc.). In this case, generally accepted serological and bacteriological studies are carried out. An effective means of differential diagnostics is early diagnostic serotherapy with antidiphtheria serum.

The prognosis is determined as cautious due to the possibility of the infection spreading to the larynx, the possibility of diphtheritic polyneuritis, and damage to vital organs.

Treatment of nasal diphtheria involves a number of general and local measures. General measures primarily include the use of antidiphtheria serum, detoxifying agents, and treatment to maintain or restore the functions of vital organs.

Local treatment is aimed at restoring the respiratory function of the nose and preventing the development of pyogenic infection. Instillations of fibrinolytic enzymes, administration of vasoconstrictor ointments and drops, and aspiration of the nasal cavity contents are used. After using the toilet, the nasal cavity is disinfected using a 1% solution of silver nitrate, protargol, collargol, rinsing with antibiotic solutions and antidiphtheria serum in isotonic sodium chloride solution.